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Leadership change at MHPA Board of Directors
Frank J. Siano will be stepping down as board chair of Medicaid Health Plans of America. Siano is leaving his post as vice president of business development, Medicaid, at Aetna and therefore will pass the reins to Kearline D. Jones, vice president of government relations and compliance at Health Partners Plans, who will transition from vice chair to chair of MHPA's board.
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Hepatitis C patients seriously consider suing states restricting
Sovaldi coverage

Inside Health Policy
Patients infected with hepatitis C are preparing to sue in short order states that restrict Medicaid coverage of Sovaldi, and they're using as a model a lawsuit that cystic fibrosis patients recently filed in Arkansas, where Medicaid uses a prior authorization policy to curb use of the cystic fibrosis drug Kalydeco, according to Donna Cryer of the Global Liver Institute. National Association of Medicaid Directors Executive Director Matt Salo said he isn't surprised that liver patients plan to sue, but he thinks patient groups are using the wrong tactic.
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Michigan prisoners may get $1,000-per-pill hepatitis C care
The Detroit News
A new hepatitis C treatment that costs $1,000 a pill will soon be given to some Michigan prison inmates. The same drug isn't available to most Michiganians — whose insurance companies won't pay for it. It may become broadly available to people on Medicaid.
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Oregon Medicaid targets expensive hepatitis drug
The Associated Press via Miami Herald
An Oregon Medicaid committee significantly scaled back access to an effective — but expensive — new drug used to treat hepatitis C. The decision allows only a narrow set of Medicaid patients to be treated with the $1,000-per-pill drug known as Sovaldi, made by Gilead Sciences, Inc.
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How Illinois allocates $84,000 drug for hepatitis C
The Wall Street Journal (Subscription required)
The $84,000-a-patient cost of the Sovaldi hepatitis C treatment has intensified a national debate among lawmakers, insurers and economists about the value of expensive medicines to society at large. The dilemma sparked by Sovaldi, which is made by Gilead Sciences, is also presenting hard choices to state Medicaid programs. In Illinois, for instance, officials recently instituted a new set of 25 stringent criteria for using Sovaldi.
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The obscure drug with a growing Medicare tab; some Sovaldi parallels
The New York Times
An obscure injectable medication made from pigs' pituitary glands has surged up the list of drugs that cost Medicare the most money, taking a growing bite out of the program's resources. Medicare's tab for the medication, H.P. Acthar Gel, jumped twentyfold from 2008 to 2012, reaching $141.5 million, according to Medicare prescribing data requested by ProPublica. The bill for 2013 is likely to be even higher, exceeding $220 million.
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Aug. 6 Webinar Wednesday: 'Where am I? Finding and Impacting Members to Improve Quality Ratings, Reduce Administrative Costs, and Transform Processes'
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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Feds grant Florida 3-year Medicaid managed-care renewal
The Associated Press via Modern Healthcare
The federal government has granted a three-year renewal of Florida's Medicaid managed-care program. About 3 million Floridians — more than half are children — are enrolled in the program, which has been rolling out statewide over the past few months.
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Cleveland's early Medicaid expansion paying off
Kaiser Health News and WPCN-FM
Long before Ohio expanded Medicaid, MetroHealth, a public hospital based in Cleveland, redirected more than $30 million from Cuyahoga County taxpayers to create its very own Medicaid program for residents. MetroHealth used extensive electronic medical records to carefully select uninsured patients and sent 28,000 of them Medicaid cards before they even applied. Then, the hospital gave highly personalized attention to some patients and kept track of them. The results from the first nine months are in, said Dr. Randy Cebul, a researcher at MetroHealth. "All of the clinical outcomes are really amazing," he said.
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mhpa2014 CME session on patient care coordination: Earn 1.5 AMA PRA Category 1 Credits™
Join Patricia Barrett, MHSA, vice president for product development at NCQA, and Alaina Macia, president and CEO of MTM, as they explain how adopting the medical home approach encourages appropriate patient services and treatment through integrated care and describe the benefits of delegation and oversight in the health delivery system to ensure appropriate coordination of care.

CE credit for Using the PCMH Model to Improve Patient Care Coordination is included in the price of mhpa2014 registration. Sign up to attend this and other mhpa2014 sessions before Sept. 8 to get the early-bird discount. For more annual conference details, please click here.

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Studies: Thank the recession for the health spending slowdown
The Washington Post
Some of the best news for healthcare in a while is also driving one of its biggest debates: What exactly is behind the historic slowdown in healthcare spending these past few years. Just how much credit should be given to structural changes in the healthcare system versus the effects of the Great Recession? The answer has major fiscal implications for the country's future as the economy improves and millions more gain health insurance under the 2010 healthcare law.
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Accenture selected as lead Texas Medicaid vendor
Business Wire via Technology Marketing Corporation
The Texas Health and Human Services Commission has selected Accenture to serve as lead Medicaid vendor following the termination of the current prime contractor on Aug. 1. The contract has a three-year base period, with two one-year extension options.
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MHPA commends North Carolina Senate on Medicaid reform plan
PRNewswire via
MHPA, the leading advocacy organization representing Medicaid managed care organizations, congratulates North Carolina's Senate for approving on second reading a real Medicaid reform plan that will deliver coordinated, high-quality care to the needy in The Tar Heel State while providing much needed budget predictability for state taxpayers.

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GOP governors push reforms mirroring state Medicaid directors' ideas
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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States want more time on ACA funds
States running their own Obamacare exchanges were supposed to wean themselves off federal funding by the end of this year, but some of them want that Obama administration spigot open a bit longer. The states aren't asking for the feds to dole out more money on top of the $4.6 billion already dedicated to exchange planning and construction. But they do want to be able to spend their federal exchange grants into 2015 as they grapple with core components of the insurance portals that are balky, unfinished or in disrepair.

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Upcoming Webinar Wednesdays
Here are some upcoming Webinar Wednesday events to mark on your calendars:
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Missed our previous issues? See which articles your colleagues read most.

    North Carolina Senate votes to overhaul Medicaid (WRAL-TV)
Missourians still face delays seeking Medicaid coverage (St. Louis Post-Dispatch)
Jeff Myers op-ed: Solve the Sovaldi math problem (Morning Consult)
$1,000 Sovaldi now hepatitis treatment of choice (The Associated Press via The Washington Post)
Illinois Medicaid restricts use of hepatitis drug (Miami Herald)

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

Aetna job opportunities
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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