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Jeff Myers op-ed: Solve the Sovaldi math problem
Morning Consult
According to the CDC, an estimated 3.2 million people in the United States have chronic hepatitis C virus infection, with most not even knowing they are infected. The effect of the disease is devastating and can lead to cirrhosis of the liver, liver cancer or even death. In the United States today, more people die due to HCV than HIV/AIDS. Given its prevalence and its contagious nature, HCV infection is a public health crisis, and it must be addressed.
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$1,000 Sovaldi now hepatitis treatment of choice
The Associated Press via The Washington Post
The price is sky-high, but so is demand. A new $1,000-per-pill drug has become the treatment of choice for Americans with hepatitis C, a liver-wasting disease that affects more than 3 million.
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Illinois Medicaid restricts use of hepatitis drug
Miami Herald
Facing ballooning costs for a $1,000 pill to treat hepatitis C, Illinois' Medicaid program is putting tight restrictions in place, including requiring patients to meet 25 criteria and get prior approval before the government program will pay for the new drug.
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North Carolina budget deal includes teacher raises, but no Medicaid overhaul
News & Observer
House and Senate budget writers reached agreement on a $21.3 billion state spending plan that averts significant cuts to Medicaid but leaves unresolved a major overhaul of the health insurance program for the poor. The budget compromise, legislative leaders said, cuts $135 million from the state's Medicaid program but makes no changes to eligibility and no shift in how the care is provided.
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GOP governors push reforms mirroring state Medicaid directors' ideas;
MHPA weighs in

Inside Health Policy
Republican governors sent Senate leaders Medicaid proposals that track closely with ideas state Medicaid directors are urging CMS to embrace — streamline and move away from waiver requirements, treat states as full partners in the rulemaking process and make pricing transparent.
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6 states, DC extending Medicaid pay raise next year to primary care doctors
Kaiser Health News
Just six states and the District of Columbia will use their own money in 2015 to sustain the federal Medicaid pay raise to primary care doctors, which was a key provision of the Affordable Care Act intended to make sure millions of low-income people enrolling in the expanding insurance program have access to a physician.
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Survey: California makes significant progress in enrolling previously uninsured
Kaiser Health News and San Jose Mercury News
A significant portion of previously uninsured Californians gained medical coverage through the nation's healthcare law — about 6 in 10 during the state's first open enrollment, according to a survey by the Kaiser Family Foundation. All told, about 3.4 million people who didn't have health insurance before signups began last fall are now covered, according to the survey.
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Study: Moving children from CHIP to exchange plans would increase costs
Kaiser Health News
Cost sharing would increase and the number of child-specific services covered would decline if millions of low-income children now enrolled in the Children's Health Insurance Program were forced to receive coverage through the health law's insurance exchanges, according to a study.
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CDC: Many children with Medicaid use ER as doctor's office
HealthDay via
The Philadelphia Inquirer

Children covered by Medicaid visit the emergency room for medical care far more often than uninsured or privately insured youngsters, a U.S. survey finds. And children with Medicaid were more likely than those with private insurance to visit for a reason other than a serious medical problem, according to the 2012 survey conducted by the U.S. Centers for Disease Control and Prevention.

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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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Paul Ryan to unveil antipoverty plan; doesn't include Medicaid
The Washington Post
House Budget Committee Chairman Paul Ryan will shift from his years-long focus on cutting federal spending to an antipoverty proposal that seeks to overhaul the safety net but also leaves in place existing levels of funding. The proposal is part of an effort to reorient the Republican Party away from battles of recent years and toward addressing the economic anxieties of the most disadvantaged Americans.

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mhpa2014 annual conference session on advanced data analytics by Deloitte
MHPA
Health analytic methodologies and tools are instrumental in a Medicaid managed care plan's ability to effectively find and engage their members, make their service experience more effective and improve the overall quality and cost of care delivered. In the new paradigm, health plans must capture meaningful data and leverage new methodologies and tools in order to meet their goals.

In "Achieving Improved Member Engagement and Care Through Advanced Data Analytics: Insights on Leveraging Information and Leading Edge Tools from the Field," Deloitte's Jason Wainstein and Megan Cormier will share insights into how an organization can:
  • Effectively engage members
  • Create an enhanced population health management framework through predictive modeling, targeting the needs of high-risk populations and performance monitoring
  • Identify and monitor a high-value provider network
  • Build and utilize effective executive and clinical management dashboards
Sign up before Sept. 8 to save on registration for mhpa2014. For more annual conference details, please click here.

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'Health Care Behind Bars: A Key to Population Health?' on Aug. 1
Alliance for Health Reform
This briefing will explore innovations and challenges in delivering healthcare to a growing population of inmates. This is an expensive group because of the large number of people with mental illness, addiction disorders and conditions associated with aging and hepatitis C. Indeed, corrections spending is the second fastest-growing state expenditure, behind Medicaid, according to the Pew Charitable Trusts.
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TRENDING ARTICLES
Missed our previous issues? See which articles your colleagues read most.

    Health officials crack down on Florida Medicaid marketing (The Associated Press via Miami Herald)
'Intervention: Will North Carolina clean up its Medicaid program?' (Telemachus)
Arkansas weighs plan to make some Medicaid enrollees fund savings accounts (Kaiser Health News)
Agency running Medi-Cal didn't know how many doctors took its insurance (California Health Report)
NC Senate to take up managed care Medicaid plan; MHPA's Myers makes the case for MCOs (NCPoliticalNews.com)

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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Aetna job opportunities
Aetna
The following are job opportunities from Aetna. Visit here, and enter Req # for full description and details.
    MD/Psychiatrist; Newark, Delaware; Req# 19223BR
    This successful candidate will become the Delaware Physicians Care (DPCI) Medical Director for Behavioral Health and will serve as our expert physician resource in the areas of utilization management, quality management, case management and overall medical management. This critical role sits at the intersection of behavioral and physical health services in helping DPCI to develop holistic programs to improve the quality and outcomes of our constituent members.

    MD/Physical Health; Newark, Delaware Req# 19166BR
    The position entails duties and responsibilities of Medical Director for Delaware Physicians Care (DPCI). The successful candidate will serve as a critical contributor to the DPCI medical management team in the role of clinical expert to the various functional areas including utilization management, case management and quality management. A key component of this position is to use the clinical credentials, experience and judgment in rendering benefit determinations based on medical necessity.

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