Population Health Management (PHM) Page ContentAboutPopulation Health Management is a discipline within health care that studies and delivers care across a specific group of people. It aims to improve the health and quality of life for a targeted group of patients. This is done through comprehensive care coordination, data analytics, risk stratification (high risk, low risk, rising risk), and interventions targeted at the individual, group, and community levels. Please contact firstname.lastname@example.org with questions and inquiries.PHM models vary based on the degree of risk, degree to which payment is tied to quality, reliance on data analytics, and level of care coordination. Comparison of PHM modelsLevel of RiskType of PHM ModelBrief ExplanationLowProvider-Owned NetworksThese Integrated Care Networks are joint ventures of independent providers coming together to negotiate value-based reimbursement that focuses on efficiency and quality outcomes.ModerateBundled Payments or Episode of Care ModelsA single payment for all care and services provided for a specific patient performed by multiple providers for a single procedure or medical condition over a specified period of time. Focused on certain conditions, bundled payments tend to have a specialty/hospital-centered approach. ModerateAccountable Care Organizations (ACOs)Networks of physicians, hospitals, and other health care providers that voluntarily come together to coordinate care and manage the total costs of care of a population. ACOs share in the financial risks and rewards of performance against benchmarks and on patient outcomes. It includes all conditions and has a primary care-centered approach. There are different Medicare ACO models with varying degrees of risk and Medicaid ACOs.HighDirect ContractingBroadens participation by allowing a varied group of participants, including health plans who form a Direct Contracting Entity (DCE), to contract with CMS under a capitated per beneficiary, per month payment for the cost of care for the beneficiary. Different from previous Center for Medicare and Medicaid Innovation models, participant providers (physicians) are paid by the DCE and not CMS, but providers still submit claims.HighProvider-Owned Special Needs PlansSpecial Needs Plans (SNPs) are Medicare Advantage plans (Part C) that limit enrollment to subgroups of Medicare beneficiaries with specific needs (i.e. institutionalized individuals, dual-eligible individuals, or individuals with certain chronic conditions as specified by CMS). SNPs offer services tailored to the specific population under a National Committee on Quality Assurance-approved model of care and must provide Medicare prescription drug benefits (Part D). Plans are sometimes referred to as “provider-led” or “provider-owned” SNPs. Provider-Led Special Needs Plans: One PHM Growing Solution Special Needs Plans (SNPs) are Medicare Advantage plans focused on specific sub populations. There are three types of SNPs. Institutional Special Needs Plans (I-SNPs)/Institutional Equivalent Special Needs Plans (IE-SNPs): I-SNP-eligible individuals are Medicare beneficiaries that reside or are expected to reside in a nursing facility (NF) for 90 days or more. IE-SNP-eligible individuals are Medicare beneficiaries that reside in their own homes that meet (and continue to meet) a NF level of care as determined by the state assessment. Chronic Condition Special Needs Plans (C-SNPs): Eligible individuals must have one or more of the 15 qualifying chronic conditions as determined by CMS. Dual Eligible Special Needs Plans (D-SNPs): Eligible individuals must have Medicare and Medicaid. Providers are now leading SNPs, particularly I-SNPs, which benefit their long term care (LTC) residents. More information on this model and opportunity is included in the PHM Innovation Lab. In 2019, AHCA/NCAL formed the Population Health Management Council to convene and support long LTC providers who are leading in PHM initiatives through advocacy, education, and quality improvement data. Along with AHCA/NCAL provider members, there are organizations whose sole or primary purpose is to partner with LTC providers to support LTC provider ownership interests in PHM models. AHCA/NCAL has four such Council Partners, and more information about each is available below. Resources CY 2022 Medicare Advantage and Part D Rates SummaryOn January 15, 2021 CMS issued the final rates and methodology for CY 2022 Medicare Advantage and Part D plans, three months ahead of its traditional release in order to give plans additional time to prepare their bids for 2022CMS 2022 Advance Notice Part I SummaryCMS has released Advance Notice of Methodological Changes for Calendar Year 2022 for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies – Part I, CMS-HCC Risk Adjustment ModelCMS 2022 Advance Notice Part II SummaryAnnouncement of Calendar Year 2022 Advance Notice of Medicare Advantage Capitation Rates and Part C and Part D Payment Policies, Part II2022 Proposed Rule and 2021 Advance Notice Part II Executive SummaryCMS has released Contract Year 2021 and 2022 Medicare Advantage and Part D Proposed Rule (CMS-4190-P) and the Advanced Notice of Methodological Changes for CY 2021 for Medicare Advantage Capitation Rates and Part C and D Payment Policies Part II2021 MA Rate Notice SummaryAnnouncement of Calendar Year (CY) 2021 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment PoliciesAHCA/NCAL Comment Letter on 2021 Medicare Advantage Proposed RuleAHCA/NCAL Comments on Medicare and Medicaid Programs; Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly Media Coverage: Medicare Advantage and Population Health Management Skilled Nursing NewsApril 2022: ‘It Changed Everything’: Skilled Nursing Provider Cantex Leverages I-SNP to Drive NOI, Transform CareJanuary 2022: Telehealth Opening Doors For Smaller Operators To Join I-SNP NetworksDecember 2021: Pandemic May Have Been ‘Ultimate Stress Test’ for I-SNP Success in Nursing HomesProvider MagazineAugust 2023: Get Involved with Population Health at Delivering Solutions 23May 2023: The Institutional Equivalent Special Needs PlanMay 2023: Are D-SNPs Enough for Dual Eligibles in Long Term Care?March 2023: Where Do Providers Fit in to the CMS 2030 Accountable Care Goal?March 2023: Providers Embrace Population Health ModelDecember 2022: Population Health Management Underway as All Look Toward 2030November 2022: Be Prepared for the Shift to Population HealthSeptember 2022: Special Needs Plans Improve Care and AccessJuly 2022: Advocating for Value-Based Care and I-SNPsMarch 2022: Statement on Medicare Advantage and Part D Advance Notice Fact SheetJanuary 2021: Provider-led Managed Care Continues to Attract Long Term Care ParticipationMcKnight's LTC NewsMarch 2022: Providers applaud expected revenue increase for MA plans STAFF CONTACT Nisha Hammel - Associate Vice President, PHMnhammel@ahca.org STATE NETWORK CONTACTS Indiana Provider Network SupportIowa Provider Network SupportOhio Provider Network Support The PHM Innovation Lab offers foundational resources designed to introduce AHCA/NCAL assisted living, nursing facility, and intermediate care facility members and their staff to the wide array of PHM models available and how these models can better serve LTC organizations, residents, and families.