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MHPA taps HHS appointee Moore to lead policy team
Jennifer E. Moore, Ph.D., joins Medicaid Health Plans of America as the national trade association's vice president of policy and research. Dr. Moore will oversee the trade group's policy, research and advocacy staff as they work on behalf of the Medicaid managed care industry. A trained nurse, Dr. Moore will also serve as MHPA's resident clinical expert.
Dr. Moore comes to MHPA from the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) where she was health scientist and team lead of the Office of Women's Health & Gender Research. There she represented AHRQ on national women's and maternal child health initiatives, including the national perinatal safety project.
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MHPA educates legislators on managed Medicaid issues
MHPA and its member companies from across the country convene on Capitol Hill at its annual legislative fly-in. MCOs, including Anthem, Centene, Health Partners Plans and Cardinal Innovations, aim to educate lawmakers on issues affecting Medicaid health plans and the disadvantaged Americans they serve.
State Medicaid programs, hurting from drug costs, see little promise in 'Cures' bill; Myers comments
When Gilead Sciences' breakthrough hepatitis C drug, Sovaldi, appeared on the market for $1,000 per pill, more than a few eyebrows rose. The drug was remarkably effective, but remarkably expensive, especially for Medicaid programs, which are required by federal law to offer all medications approved by the Food and Drug Administration.
Medicaid programs are still worried that it's just a matter of time until another pricey specialty drug enters the market. Unless Congress acts to make sure new drugs are affordable, Jeff Myers, CEO of Medicaid Health Plans of America, said Medicaid's drug access requirement might have to be changed. The lobbying groups represents privately managed Medicaid plans. "The dramatic price increases make the drug side of the Medicaid program unsustainable," Myers said in an interview.
Drug price transparency bill shelved in California; push continues
Drugmakers won skirmishes in California and Oregon last month, but the fight against high prices for specialty drugs appears to be spreading to other states, as well as the national theater. A bill in the California Legislature asking pharmaceutical manufacturers to explain their prices was shelved last month in the face of stiff opposition.
May 13 Webinar Wednesday: 'Using Smart Texting Campaigns to Engage Medicaid Beneficiaries and Improve Quality'
This webinar will provide an overview of how Medicaid health plans can modernize member engagement and communication through the use of "smart" text messaging. Please join Vineet Singal, co-founder and CEO of CareMessage, a nonprofit member engagement platform focused on the Medicaid market. Learn how you can improve HEDIS and STAR ratings, streamline Medicaid determination, and improve care management through the use of automated, interactive texting campaigns.
Complex Clinical Reviews. Dependent Audits. And More.
Contact HMS today!
Government study: 5 percent of Medicaid enrollees accounted for half of program's spending
The Washington Times
A small-but-expensive fraction of Medicaid recipients accounted for nearly half of all spending for the program each year from 2009 to 2011, according to a new government report that studied people who do not also receive Medicare.
It costs $10,000 more to treat people with diabetes, insurers say
It now costs $10,000 or more per person annually to treat someone with diabetes than someone who doesn't have the chronic disease, according to a new analysis of large insurance company claims data.
As Karl Rove waves white flag on Obamacare, so do GOP governors
News that former George W. Bush White House advisor Karl Rove urged his fellow Republicans to abandon attempts to repeal the Affordable Care Act and focus on a replacement plan comes as thousands of Americans sign up for the law's expanded Medicaid benefits for the poor thanks to changing hearts of GOP governors.
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GOP-led Medicaid expansion states test limits of CMS flexibility on waivers
Republican-led states that already expanded Medicaid now are coming back to the Obama administration with requests to move their expansion programs in more conservative directions, including higher cost-sharing for beneficiaries, work requirements and coverage time limits. These moves may test the limits of the administration's flexibility and could lead to rollbacks in Medicaid expansion across the country.
Florida governor's fight over Medicaid expansion takes new turn
Florida Gov. Rick Scott on Friday outlined new steps he's preparing to take in his standoff with the Obama administration over expanding Medicaid. Scott wrote a letter to hospital executives on Friday asking them to submit proposals for how they can share profits in order to fund a low-income pool that would give hospitals money for care they give to uninsured people.
Medicaid missteps gave reluctant Missouri lawmakers a line of attack
St. Louis Post-Dispatch via Southeast Missourian
Nearly 180,000 Missourians can't afford private health insurance, but they either make too much money or don't have children, making them ineligible to join the state's Medicaid rolls. States have the option to alleviate this problem at a cost mostly borne by the federal government. But Missouri's Republican-led legislature so far has refused to use the federal dollars to expand Medicaid's eligibility to cover those in need.
Georgia budget allows state to seek Medicaid changes
The Associated Press via Idaho Statesman
The top executive at Georgia's largest safety-net hospital said Thursday he is pleased to see signs that state officials could seek federal approval to make changes to its Medicaid program. The state budget awaiting Republican Gov. Nathan Deal's signature includes a provision allowing state health officials to seek a waiver from federal Medicaid authorities. The same strategy, called a Section 1115 waiver, has been used in conservative states where governors resisted full Medicaid expansion under the Affordable Care Act but worked with federal officials to craft alternatives that still covered more people.
Mental health drug change goes to Kansas governor
Kansas Health Institute
A proposal to allow prior authorizations for Kansas Medicaid reimbursements on mental health drugs passed its final legislative hurdle Friday. The measure, which was requested by Gov. Sam Brownback's administration as part of a budget proposal and projected to save $8 million, passed the House, 82-31, as part of a small health conference committee package. It passed the Senate, 31-6, earlier in the week and now heads to the governor's desk.
June 10 Webinar Wednesday: 'Integrating High-Risk Member Care with Risk Adjusted Revenue for Medicaid Members and Dual Eligibles'
Taking a holistic approach to integrated programs in high-risk population management can provide true value to members, the plans and the providers serving them. Please join Eddie Gilmartin, vice president, product and business development for PopHealthCare, who will offer groundbreaking programs in high-risk population management that drive rapid, large and demonstrable improvements in member quality of life and satisfaction, while helping its partnering health organizations realize appropriately enhanced revenues, enhanced quality scores and reduced medical costs.
June 17 Webinar Wednesday: 'The Latest Trends in OHI Discovery and Cost Avoidance for Payers of Last Resort'
Why "pay and chase" when you can cost avoid? It's not easy to discover if a Medicaid enrollee has primary commercial coverage at the point of sale—costing time and money, chasing reimbursements for claims that others should have paid. On average less than 17 percent of the dollars billed to primary insurers are paid back to Medicaid plans that paid claims in error. This webinar will focus on a very unique and powerful data source that has the potential to revolutionize the way Pharmacy & Medical OHI (Other Health Information) is discovered. Cost avoidance is more attainable than ever before. Capture savings by having the latest active insurance coverage information available to you, in real time.
Medicaid Managed Care Congress: May 20-22 in Baltimore
Medicaid Managed Care Congress
At the Medicaid Managed Care Congress, government officials, health plan executives and other key players of the healthcare ecosystem come together to hear new case studies from industry peers and expert insights from state and federal regulatory bodies. This event will discuss the successes and challenges of implementation of major ACA provisions, delivery reform and payment reform and states pursuing better value. Use code XP2026MHPAB for a 15-percent discount.
Job opportunity: RN, manager, Clinical Health Services,
pre-authorization | Detroit
Aetna seeks an experienced RN with managed care, leadership and prior authorization expertise. Reinforces clinical philosophy, programs, policies and procedures. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
Visit here and search for requisition #24937BR to learn more and apply.
Job opportunity: Clinical director, Homecare & Managed Care
First Quality, a leading manufacturer of disposable home healthcare products, is seeking a clinical director for our Homecare & Managed Care Business. This candidate will provide leadership and have a focus on clinical education, utilization management protocols and programs and operational program development within homecare and managed care markets.
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