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In this week’s Friday Five, MAXIMUS is reading about the effects of Medicaid expansion, Montana’s reinsurance waiver, the link between social needs and hospital readmissions, and why pilot projects are important when introducing artificial intelligence. 

1. The effects of Medicaid expansion under the ACA: Updated findings from a literature review  

Results from the Kaiser Family Foundation’s review of studies focused on the effects of Medicaid expansion were largely positive. Overall, expansion improved healthcare coverage, access, quality of care, and affordability while also having a positive impact on state budgets, employment, and reducing uncompensated care costs. There were mixed findings related to provider capacity with some studies finding positive, negative, and neutral effects on appointment availability and wait times.

2. CMS approves Montana reinsurance waiver, issues new direct enrollment guidance 

Last week, the Centers for Medicare and Medicaid Services (CMS) approved Montana’s Section 1332 waiver. According to Health Affairs, the waiver will allow Montana to operate a reinsurance program from 2020-2024. The program is expected to reduce 2020 insurance premiums by 8%. In addition, CMS released new guidelines to determine whether web brokers are adhering to direct enrollment standards and will begin preforming compliance reviews. 

3. Passive social health surveillance and inpatient readmissions 

Individuals with self-identified social needs have significantly higher odds of inpatient readmissions (68%, 89%, and 101% at 30, 60, and 90 days, respectively). The AJMC study relied on a call-center based social services referral program which linked referral and claims data to compare results for individuals who reported food and housing insecurity against those without self-identified needs. The authors argue a passive health surveillance system could serve a complementary function to healthcare screenings. 

4. The looming crisis in long-term care 

Estimates show that between half and two-thirds of seniors will need long-term care, with a recent study pegging the average cost per individual at $138,000. In this Axios article, the author states this is an issue of major concern, since paying for long-term costs will be difficult for Medicare. Neither Medicare nor private insurance cover many services offered in a nursing home or by a home health aide, additionally nurses and caregivers have high rates of turnover, in part due to low wages and reimbursement rates.

5. Pilots, bias important considerations ahead of deploying AI

As federal agencies begin deploying artificial intelligence (AI) programs, officials are stressing the importance of launching pilot projects to test and streamline operations. NextGov reports that pilot projects are both faster and cheaper to launch than a full rollout, but officials add it is important to include individuals with diverse backgrounds in the planning and implementation process, to both increase creativity and reduce potential biases.