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Expensive hep C drugs and Medicaid; MHPA's Myers
weighs in for industry

Star Tribune
A growing number of hepatitis C patients in Minnesota is caught in a bind between the exorbitant cost of the year-old medications — Harvoni, Sovaldi and Viekira Pak — and the tight restrictions insurers have used to prevent the drugs from busting their budgets. The battle could be the first of many in coming years, as other revolutionary medications offer hope against chronic and deadly diseases, but at high prices manufacturers charge to recoup their research investments.

In Minnesota, the fee-for-service portion of Medicaid won't cover Viekira Pak unless patients with histories of drug and alcohol abuse have been sober for six months or sober for three months while participating in addiction treatment. Doctors must "attest" that patients are stable enough to complete the medication course. Other states have instituted a one-and-done policy, meaning they won't cover it again if patients get reinfected. "You're dealing with a vulnerable population of patients, many of whom have alcohol or drug problems," said Jeff Myers, president and chief executive of MHPA, "and you're dealing with a drug that is literally $30,000 a box."
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Modern Healthcare cover story on managed care regs; MHPA's Myers comments on LTC
Modern Healthcare
It's not yet clear whether the CMS' sweeping proposed rule governing Medicaid managed care will resolve the coverage and access problems facing the growing number of low-income adults and children enrolled in private Medicaid plans. But it's likely that there will be political jockeying over many of its provisions.

With long-term care, health plans have concerns about a provision in the proposed CMS rule that would allow managed-care patients receiving LTC services to switch to fee-for-service if their provider is not in-network. Patient advocates had pushed for this provision as a safeguard. As of 2014, 26 states were using managed long-term care, up from eight in 2004, according to the CMS. But Jeff Myers, CEO of MHPA, said this provision could be a disincentive for LTC providers to negotiate contracts with plans if they know they can continue to see patients under fee-for-service or another plan.

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Medicaid expansion gets Senate approval, set for Florida House showdown
Bay News 9
The Florida Senate overwhelmingly approved a Republican-crafted plan to expand Medicaid Wednesday, setting up a showdown with the Florida House, which is expected to vote to reject the plan Friday. The upper chamber's plan would accept $51 billion in federal funding to cover roughly 800,000 low-income Floridians with incomes too high to qualify for Medicaid yet too low to allow them to afford private health coverage. Stuck in the so-called "coverage gap," many of the would-be Medicaid enrollees are reliant on palliative care in hospital emergency rooms, where taxpayers pick up the tab.
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California sees housing as significant investment in healthcare
Kaiser Health News
Health officials handpicked about 100 other ill homeless Los Angeles-area residents to live in the Star Apartments, a sleek, white building with a medical clinic on the bottom floor. The apartments are part of a multimillion dollar experiment: Using county healthcare dollars to house people who are chronically homeless.
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California Senate approves healthcare for undocumented immigrants
The Sacramento Bee
A proposal to expand healthcare to Californians in the country illegally cleared the Senate on Tuesday, passing on a 28-11 vote and heading to the Assembly. Senate Bill 4 would allow undocumented immigrants to purchase health insurance on the state exchange, pending a federal waiver, and enroll eligible people under the age of 19 in Medi-Cal, the state's insurance program for the poor. A capped number of undocumented adults would also be allowed participate, if additional funding is appropriated in the state budget.
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Kansas lawmakers pushing to include Medicaid expansion in
budget negotiations

Kansas Health Institute
Frustrated by their inability to muster more than a handful of votes for any tax plan, Kansas Republican legislative leaders are asking rank-and-file members the "What will it take to get out of here?" question. They're getting a variety of answers as the session, on its 103rd day, inches closer to record territory as the longest in state history. In 2002, legislators met for 107 days.
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Hospitals expected more of a boost from health law
The Wall Street Journal
The health law's expansion of Medicaid in many states hasn't benefited nonprofit hospitals in those states as expected, according to a new report by Moody's Investors Service. Hospitals in the mostly blue states that expanded Medicaid were largely expected to benefit from fewer unpaid bills and more paying customers, but that hasn't generally translated into better operating margins or cash flow, Moody's found.
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June 10 Webinar Wednesday: 'Integrating High-Risk Member Care with Risk Adjusted Revenue for Medicaid Members and Dual Eligibles'
PopHealthCare
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.
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June 17 Webinar Wednesday: 'The Latest Trends in OHI Discovery and Cost Avoidance for Payers of Last Resort'
Syrtis Solution
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.

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SPONSORED CONTENT


Philadelphia Asthma Summit set for June 26
U.S. Housing and Urban Development
The Philadelphia Asthma Summit will take place from 8 a.m. to 4 p.m. on Friday, Jun 26, at the Children's Hospital of Philadelphia. This is the fifth asthma summit that the U.S. Housing and Urban Development has hosted in collaboration with federal, state and local partners.

While each meeting is unique, the overall intent is to advance the conversation locally (state or region) around securing sustainable financing for in-home services targeting children disproportionately impacted by asthma. This Philadelphia Asthma Summit is designed to meet this intent with a specific focus on promoting the value of home-based interventions for children with poorly controlled asthma and reimbursement mechanisms for these services by healthcare insurers for children in low-income households.

Health plans participating in the meeting will hear perspectives and experiences from other health plans serving Medicaid populations. The meeting agenda includes a "Payers' Perspectives Panel" featuring Family Health Network (Barbara Hay, Retired COO), Keystone First (Dr. Lily Higgins, Medical Director) and Aetna Better Health (Dr. Guerra-Garcia, Chief Medical Officer).

RSVP here.

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Job opportunity: Senior Medicaid Strategist | Raleigh-Durham, NC
North Carolina Department of Health and Human Services
The Senior Medicaid Strategist has responsibility for the execution of the day to day activities in all efforts related to implementing Medicaid Reform for DMA. This position acts a project manager by directing internal and external resources to successfully operationalize reform policy. This individual will report directly to the DHHS Deputy Secretary for DMA.

For more details and to apply: click here.

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Job opportunity: RN, manager, Clinical Health Services,
pre-authorization | Detroit

Aetna
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.

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MHPA's Industry NewsBrief
Colby Horton, Vice President of Publishing, 469.420.2601
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