CMS Starts Maternal Health Program, 2022 National Spending Normalizes

December 20, 2023 - CMS announced an initiative to improve maternal health outcomes for Medicaid and CHIP beneficiaries.

The new initiative, called the Transforming Maternal Health model, will last ten years. Organizations can apply to participate starting in spring 2024. Medicaid programs that participate will be able to use the model to improve strategies around supporting new mothers, addressing mothers' mental health, ensuring that services for high-risk pregnancies are evidence-based, and more. 

The Supreme Court agreed to review access to the abortion medication mifepristone. Access to the drug, which was approved by the FDA in 2000, has been limited due to an ongoing legal battle.

A report revealed that only 18% of Medicare enrollees with opioid use disorder receive treatment. The results highlighted the need for better strategies around substance abuse care in Medicare.

Lastly, healthcare spending in the US rose 4.1 percent, reaching $4.5 trillion in 2022. Private payers covered the bulk of this spending and hospitals and physician and clinical services were accountable for large shares of the expenditures.

Kyle Murphy: Hello. Welcome to Healthcare Strategies | Headlines. Today's episode...

• CMS Launches Model to Address Maternal Health
• SCOTUS Reviews Medication Abortions
• Medicare Lagging in Treatment of Opioid Use Disorder
• National Healthcare Spending Returns to Normal

This is Kyle Murphy, vice president of editorial at Xtelligent Healthcare Media, and I am very happy to be joined, as always, by Kelsey Waddill, senior editor and multimedia manager at Xtelligent Healthcare Media. How are you doing, Kelsey?

Kelsey Waddill: Hello. I'm good.

Kyle Murphy: It's our last Headlines episode of the year.

Kelsey Waddill: It is.

Kyle Murphy: I know that we started this relatively recently.

Kelsey Waddill: A little, yeah.

Kyle Murphy: So we haven't exhausted ourselves too much, but ... So now we're upon the Christmas season.

Kelsey Waddill: Yes.

Kyle Murphy: Big question for you.

Kelsey Waddill: Okay.

Kyle Murphy: Which is better or more exciting, Christmas Eve or Christmas Day?

Kelsey Waddill: As we were saying before, I have feelings about this. I think Christmas Day gets hyped a lot and everyone's like, "This is when we open our presents," and I guess that's why the hype is so big, but I think Christmas Eve is really underrated and underappreciated. To me, my family has a lot of traditions around Christmas Eve. We go caroling, we bring cookies to the neighbors and stuff, and we go to church and we sing, and I don't know, it's a lot of singing. So that's the theme.

Kyle Murphy: It's just about the singing. You just like singing.

Kelsey Waddill: It's really a lot of singing.

Kyle Murphy: Totally understood.

Kelsey Waddill: But I think that that's a highlight.

Kyle Murphy: I think I agree. My parents used to host Christmas Eve with my large extended family, and that was so exciting. The one thing, when you get to Christmas Day, after you've opened the gifts, it's kind of like, what now? You know what I mean? It's like it's over, and it's like everything's in the rearview, and you have to deal with that. And I think that's a little too heavy, whereas Christmas Eve, the end of Christmas Eve, and you know, when you wake up tomorrow, it's still going to be exciting. Let's get into it.

Kelsey Waddill: All right. Let's go.

Kyle Murphy: All right. So CMS launched the Transforming Maternal Health Model, a 10-year initiative to improve mental health outcomes and access to care. It provides funding and technical assistance to state Medicaid agencies for enhancing services for Medicaid and CHIP beneficiaries. The model focuses on reducing cesarean sections, decreasing the use of pain medication during birth, and lowering postpartum anxiety and depression. It encourages states to achieve the CMS birthing-friendly designation and use evidence-based practices for high-risk pregnancies. State Medicaid agencies may receive up to $17 million for implementation with applications opening in spring 2024. The model supports a whole-person approach and aligns with the Biden-Harris Administration's goal for advancing maternity care, quality, and equity.

Kelsey, you've seen it, you and I have covered it on this podcast, and also our folks over at Life Sciences and Pharma News Intelligence who've covered reproductive health for quite some time. We know that the United States is unfortunately a leader in issues with pregnancy and labor for industrialized, modernized nations. So to me, it stands to reason that a program like this is definitely needed, and when you start getting into the Medicaid population, you know that there are vulnerable folks out there. So what are your thoughts on this program?

Kelsey Waddill: Yeah. It's a 10-year initiative and we haven't even started yet, so we'll see what happens. But on the outset, the goal is certainly necessary. It's needed to do something that is not just a short-term solution. We need something that's long-ranging. This is potentially one of the most obvious and overt areas of disparity in the US healthcare system, at least probably top 10. And so I think it's good to see, at the federal level, a big push for, hopefully, real change on it.

Kyle Murphy: Well, we know that giving birth is probably one of the most stressful times in anyone's life. You can imagine that, when you put that within the context of economic and medical challenges and other socioeconomic things, that it really just ratchets up the intensity of those things. So to me, it seems like a logical thing to do. The 10-year program seems to be like, this is something that is meant to be institutionalized, so let's hope that the momentum actually leads to some kind of stickiness and this just becomes the way things are done nowadays.

Kelsey Waddill: Yeah.

SCOTUS has agreed to review medication abortions. The Supreme Court of the US will be assessing access to an abortion medication called mifepristone.

This is the timeline for what brought us to this point. So buckle in. It's a ride.

In January, 2023, the Alliance for Hippocratic Medicine filed a lawsuit challenging the FDA's approval of the drug. In early April 2023, a federal judge in Texas issued a preliminary injunction against the FDA's approval. The same month, a judge of the Supreme Court of the United States lifted restrictions on abortion pills, and then on April 21st, the Supreme Court upheld mifepristone's approval during the ongoing cases. So you think, "case closed." Wrong. In mid-August, the US Court of Appeals for the 5th Circuit reviewed abortion pill access and supported instituting restrictions without reversing the FDA approval. As a result, here we are, nearly a full year after the initial lawsuit, with the Supreme Court agreeing to take on a review of the ruling at the manufacturer's request.

Kyle, this lawsuit has, along with the story of Kate Cox, who sought an exception to the abortion rule, which the Texas Supreme Court then denied--both of these stories are bringing up a lot of interesting questions about who has the right to rule on medical decisions. There are a lot of questions being raised about how judges with no medical background can make decisions about whether or not patients should receive certain types of care. But then again, judges are often issuing decisions about areas of society in which they have no personal background. So what are your thoughts on this conversation?

Kyle Murphy: Let me just say first that I'm in a privileged position as a white man to make decisions about my body at will without anyone telling me whether I can or cannot make that decision. So I speak from a position of incredible protections for the decisions I make. I think it's quite interesting and telling that the reversal of Roe v. Wade was about state's rights and things like that, and now that starts to call into--somehow is calling into question the executive branch of the federal government and whether it has the right to do this. This drug, which has been approved and accepted for decades, if FDA does not have [the] authority to approve these things, then what does the FDA do? And if that's the case, then do you have to dismantle this organization that is responsible for nutritional facts on all of our food, that [is] responsible for approving medical devices and other treatments, and really safeguarding the entire American population? Now, whether states want to choose or not want to choose to support, to be against abortion, I feel like we're supposed to see how that's settled out. People are supposed to be able to vote on that, but it seems to me that, in this particular case, there are a lot of people making decisions that impact other people across state lines that, I think, goes against what the larger political discourse was.

So I think it's actually damaging. One of the hallmarks of the United States is life, liberty, pursuit of happiness type of thing. Where's the liberty component? Because I'm not seeing a whole lot of that anymore. I think it's about just time that people start thinking about other people other than themselves and maybe projecting what they want on the world. It doesn't always work that way.

All right. Let's talk about some other depressing stuff.

So Medicare is lagging in the treatment of opioid use disorder. Only 18 percent of the approximately one million Medicare enrollees with opioid use disorder receive medication for treatment, according to a new report published by the Office of Inspector General. Additionally, a report revealed disparities in access to OUD treatment exist, especially among minority, low-income, and elderly Medicare beneficiaries. Medication-assisted treatment is underused due to access barriers and stigma. In 2022, only about 20 percent of those needing OUD medication received it with even lower rates among specific minority groups. Florida--yes, Florida--had the lowest rate of Medicare enrollees receiving OUD medication at 6 percent. Increased education for healthcare providers about buprenorphine and action by CMS to address disparities are suggested. Part D prescriptions for naloxone increased significantly in 2022, but concerns about cost increased due to over-the-counter availability.

Kelsey, you and I have been following the opioid epidemic for quite some time. It's hard to ignore. There's movies about it on televisions and then there's series about it. To me, it seems, now that we've reached the point where we understand it's an epidemic and it's about treatment, it's very sad that one of the biggest programs in the country does not seem to be able to get this much needed medication treatment and therapy to the people who need it. I guess, in covering the payer space, what are your thoughts on where we are today and what kind of improvements need to be made?

Kelsey Waddill: Yeah. I was just writing about this recently. I think it's interesting because there have been improvements in the prescribing rate, but it's definitely disheartening to see information like this in Medicare, which, for folks who are older, tend to have more likelihood of having joint pain or other forms of ailment that might require some real pain medication and pain management support, you would think that this would be our area where we have some of the strongest strategies for this because it's so common, but unfortunately, that's not necessarily the case. So I do think that we've been seeing a push for other forms of pain management, like physical therapy coverage, and we have come to a place, I think, where we actually have started to know what can be done to prevent this from escalating, which, again, makes it worse that we aren't seeing progress in this particular area of the industry.

Kyle Murphy: It's quite interesting when you think about it, bringing this back to the abortion pill, but just there are restrictions on how certain things are prescribed and then there are very little restrictions on others. And opioids have been widely adopted and accepted and used over the years, but without much understanding of what the longterm implications of them would be, and now we're reaping the consequences of those clinical decisions, honestly, and it's sad. It's a not so subtle indictment on the industry that we'll make pain go away, but we won't really ask ourselves the question of, "yes, but what happens next?" And this just backfired all in a span of a couple of decades of just seeing fatalities left and right and seeing young, old, folks from all walks of life pass away from these use disorders, but it's very, very tragic. So I hope action will be taken relatively quickly and that folks who need this type of assistance are getting it because it's really a mark of a society, how you treat the vulnerable, I would say, in this, the holiday season of caring.

Kelsey Waddill: Yes.

So national healthcare spending is returning back to normal. There's really no segue between those two, but hey, Medicare spending is potentially changing. So national healthcare spending levels are returning back to pre-COVID timeframe. In 2022, US national healthcare spending grew by 4.1 percent to $4.5 trillion, which is still a massive number.

Kyle Murphy: I can't even quantify that number. We say the word "trillion" like it's a real concept.

Kelsey Waddill: Can't wrap my head around it.

Kyle Murphy: It's ridiculous.

Kelsey Waddill: Yeah, I know...but hey, it could have been bigger.

Kyle Murphy: Good point.

Kelsey Waddill: CMS shared that the healthcare's share of the GDP decreased to 17.3 percent. The growth was influenced by Medicaid and private payer spending, along with reduced federal pandemic spending. A record 92 percent of Americans had health insurance, but 26.6 remain uninsured. Private payers were the biggest contributors to healthcare spending, contributing 29 percent of the spending, and then followed by Medicare, and then after that, Medicaid. So one of the biggest drivers of healthcare spending across the board was hospital care, accounting for 30 percent of national expenditures and spending on physician and clinical services. Both of these sectors experienced slower growth in 2022. Retail prescription drugs saw an 8.4 percent increase in spending due to higher prices and more prescriptions.

Kyle Murphy: No way, drugs?

Kelsey Waddill: Yeah.

Kyle Murphy: No way.

Kelsey Waddill: Yeah. Nontraditional medicine services like home healthcare grew by 9.7 percent, and then spending in nursing care facilities and retirement communities increased by 5.6 percent.

Kyle Murphy: And those numbers are only going to rise.

Kelsey Waddill: Kyle, what do you think about ... I guess we were all hoping that it would come back to pre-pandemic levels in terms of it's not as high as it could've been, but I don't know. What do you think of this?

Kyle Murphy: Regression to the mean. I think healthcare is one of those things where it's always fluctuating around 20 percent of GDP. The fact that the numbers came down in