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North Carolina Senate set to take up managed care
Medicaid plan; MHPA's Myers makes the case for MCOs

NCPoliticalNews.com
The North Carolina Senate calendar included a measure revamping Medicaid from the current fee-for-service model to one paying providers a set per-member-per-month fee, moving Medicaid from the Department of Health and Human Services to a new department and allowing hospital-led and physician-led accountable care organizations to bid against insurance-based managed care organizations for regional contracts. The health plans would pick up expenses exceeding budgets.
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'Intervention: Will North Carolina clean up its Medicaid program?'
Telemachus
Forbes magazine has an article highly recommended for those in North Carolina who care about higher teacher pay for public education, the University of North Carolina higher education system, the Community College System of North Carolina, tax cuts, better healthcare outcomes for Medicaid patients or anything of relation.
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Will Gilead's hepatitis C drug bust state budgets?
The Wall Street Journal
Will the cost of new hepatitis C treatments bust state budgets? A new analysis suggests many states may, in fact, be overwhelmed as they attempt to pay for the Solvaldi medication sold by Gilead Sciences, which costs $84,000 for each patient, and several forthcoming treatments that may be priced at a similar level.
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SPONSORED CONTENT


mhpa2014 annual conference session on foster care
MHPA
Health plans must develop enhanced care coordination programs to address the unique needs of members in foster care, which are typically more intensive than their non-foster care peers. In mhpa2014's "Helping MCOs Prepare to Serve Children in Foster Care," Dr. Rhonique Shields-Harris, M.D., chief medical officer and vice president of medical affairs for Health Services for Children with Special Needs, will address these needs and offer solutions on how to provide better quality of care to this population.

Sign up before Sept. 8 to save on registration for mhpa2014. For more annual conference details, please click here.

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Lunch briefing: 'Healthcare Spending and the Affordable Care Act' — Wednesday, July 23, Rayburn House Office Building, Washington, DC
National Center for Policy Analysis
What effect is the Affordable Care Act having on healthcare spending? Is the ACA bending the cost curve downward, or will healthcare spending outpace other spending? What predictions can we make about future healthcare spending?
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SHOWCASE
 
One Set of Data...Results Across All Service Lines

How much can our customized solutions save you? Contact HMS today.
 


Health officials crack down on Florida Medicaid marketing
The Associated Press via Miami Herald
Florida has banned health insurance companies from marketing their plans directly to Medicaid recipients as the state rolls out its massive plan to privatize its health insurance program for low-income individuals and the disabled.
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Arkansas weighs plan to make some Medicaid enrollees fund
savings accounts

Kaiser Health News
If all goes according to plan, many Arkansas Medicaid beneficiaries will be required next year to make monthly contributions to so-called Health Independence Accounts. Those that don't may have to pay more of the cost of their medical services — and, in some cases, may be refused services.
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Fertile ground for Virginia Medicaid pitch
The Washington Post
Virginia Gov. Terry McAuliffe renewed his pitch for expanding healthcare to the poor by touring a field hospital set up at a county fairgrounds, where people had camped out for days for the chance to see a dentist or doctor.
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Wisconsin's low Medicaid payments pinch doctor practices in
low-income areas

Milwaukee Journal Sentinel
Wisconsin historically has had broader eligibility for its Medicaid program than most states. Hospitals and doctors have contended for years that the program has some of the lowest payment rates in the country relative to private insurance. A report released by the federal Government Accountability Office now supports that contention — at least for physicians for certain services.
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California agency running Medi-Cal didn't know how many doctors
took its insurance

California Health Report
The California agency that oversees the state's low-income health plan vastly overstated the number of doctors who accepted patients through the state program last year, even as the number of people enrolled in the program was set to skyrocket under the federal Affordable Care Act.
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Study: Collaboration between docs, insurers lowers cost of cancer care
Minnesota Public Radio
A UnitedHealth Group study found the cost of cancer care dropped when doctors were paid a lump sum per case and were showed how they compared with others treating the same cancers. The Minnetonka, Minnesota-based company says even with an increase in drug costs, total costs went down by a third. The study tracked not only costs but also 60 quality of care measures.
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How do you pay for a drug that costs $84,000?
The Washington Post
There's a new $84,000 treatment for hepatitis C that's giving new hope to patients. But it's also giving a healthcare system strained by limited resources a strong reality check. Since Gilead Sciences unveiled Sovaldi more than six months ago, its $84,000 price tag has ignited a conversation in the health policy world about how to make lifesaving medicines more affordable without hurting drugmakers' incentives to develop the treatments in the first place.

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HHS offers states $100 million to improve Medicaid
The Hill
The Department of Health and Human Services is offering $100 million to state Medicaid programs to reform payment systems and improve patient care. Governors and state Medicaid directors had pressed the Centers for Medicare and Medicaid Services for funds to review and improve the health program.

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Senators question cost of $1,000 hepatitis drug
The Hill
Two high-ranking senators have lent their voices to the chorus demanding to know why Gilead's new hepatitis C drug Sovaldi costs $1,000 a pill. Oregon Sen. Ron Wyden, chairman of the Senate Finance Committee, and Iowa Sen. Chuck Grassley, the Judiciary Committee's ranking member, are asking the specialty drugmaker how they justify the high price of the medication, which can cost more than $84,000 per treatment.

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Award-winning Supplier Diversity Program featured at EMSDC meeting
AmeriHealth Caritas
AmeriHealth Caritas' award-winning Supplier Diversity Program was featured at the Eastern Minority Supplier Development Council's 2014 General Meeting on Friday, July 18, in Wilmington, Delaware.
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Centene sponsors National Council of La Raza Conference
Centene Corporation
Centene Corporation has announced that it is a gold-level sponsor of the National Council of La Raza Conference, the largest national Hispanic civil rights and advocacy organization in the United States.
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TRENDING ARTICLES
Missed our previous issues? See which articles your colleagues read most.

    North Carolina governor: 'Door open' to Medicaid expansion (The Washington Post)
Texas state agency prepares to expand STAR+PLUS program (The Athens Review)
NC Senate, House at odds over future of Medicaid (The Associated Press via Salisbury Post)
State governments may spend $55 billion on hepatitis C medications (PRNewswire via MarketWatch)
Oregon moves closer to limiting access on hepatitis C drugs as Senate investigation begins (The Oregonian)

Don't be left behind. Click here to see what else you missed.


Aug. 6 Webinar Wednesday: 'Where am I? Finding and Impacting Members to Improve Quality Ratings, Reduce Administrative Costs, and Transform Processes'
LexisNexis
The changing landscape of healthcare has only increased our dependency on member and provider data to fuel administrative processes, quality initiatives and coordination of care. With more than half of Medicaid enrollees being assigned to managed care organizations, data provided by states and other entities on these members are critical to supporting your efforts to locate, enroll and manage their health and costs.

In this webinar, you will:
  • Get a better understanding of the seriousness of data quality issues across healthcare
  • Discover new ways to verify, augment and monitor provider and member data
  • Hear real-world case studies where data quality issues were identified and resolved to drive quality and performance ratings, efficiency and savings

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