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Modern Healthcare
The 10 highest-polling Republican presidential candidates didn't say a lot about health policy during their first official debate in Cleveland on Thursday night, but one passionate answer by Ohio Gov. John Kasich was not the typical GOP stance. Kasich defended his decision to expand Medicaid in Ohio with a relatively long explanation of how it has brought resources to those who need it most.
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Slate
Coming into Thursday's Republican primary debate, John Kasich had one major strike against him among conservatives that also made him an interesting candidate. As governor of Ohio, he chose to accept Obamacare's Medicaid expansion, a move that, obviously, was anathema to the many members of his party who are seeking to kill off the health law. Moreover, he wasn't sheepish about his decision.
"Now, when you die and get to the meeting with St. Peter, he's probably not going to ask you much about what you did about keeping government small," Kasich said. "But he is going to ask you what you did for the poor. You better have a good answer."
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MHPA
The agenda for mhpa2015 — "Medicaid Turns 50: Its ongoing evolution via managed care and best practices" — is now online. View all of the sessions we have in store for you as well as get info on registration, lodging, and sponsorships here.
For a taste of the conference, please watch this moving video of last year's event.
For more information, please contact Sarah Swango (sswango@mhpa.org/202-857-5772) or Erin Liberatore (ELiberatore@mhpa.org/202-857-5773).
MTM
Home and community-based services (HCBS) can help waiver populations and other special needs members with costly chronic health conditions avoid expensive long-term care and reduce readmissions — but coordinating these services can be a daunting task for case managers. As a service coordinator, MTM partners with health plan case managers to relieve the burden of coordinating disparate provider networks. MTM created a comprehensive solution that offers high-quality network building, credentialing and monitoring; continuous performance tracking and trending; and consolidated claims adjudication and payment, including 100 percent claims verification.
In this webinar, MTM Vice President of Client Services Aaron Crowell will demonstrate how the organization's HCBS coordination model can help solve health plans’ biggest challenges in connecting members to nonclinical care. Additionally, Vice President of Field Health Services Cindi Scollins with WellCare — one of MTM's HCBS clients — will discuss how this model has benefited members using innovative services like equine therapy in the Florida market.
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Inside Health Policy (Subscription required)
The Government Accountability Office says expanding programs to lock beneficiaries at risk of abusing certain drugs into a pharmacy or prescriber could help address potential waste and abuse in Medicaid, even as lawmakers in both houses of Congress are working on legislation to create such programs in Medicare.
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HealthDay
New research reveals high rates of hepatitis C infection among intravenous drug users and baby boomers seen in urban emergency departments. And three-quarters of those who tested positive for the potentially deadly virus did not know they were infected, the researchers added.
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Complex Clinical Reviews. Dependent Audits. And More.
Contact HMS today!
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Business Wire via Yahoo Finance
A new study, "The burden of hepatitis C virus (HCV) disease in commercial and managed Medicaid populations" by Primrose Healthcare, explores a wide variety of factors that affect both the cost and outcomes attributed to HCV patients.
The study, authored consulting firm Milliman and sponsored by Primrose, identifies the broad range of healthcare services used by HCV-infected people. This points to the need for an approach to treatment that focuses on the overall health of HCV patients, including their comorbid conditions.
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Winston-Salem Journal
The resignation of Dr. Aldona Wos as North Carolina health secretary could be the catalyst for breaking the logjam over state Medicaid reform, analysts said Wednesday. Wos' last day will be Aug. 17. Gov. Pat McCrory said she is being replaced by Richard Brajer, a private-sector healthcare executive.
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The News & Observer
The state Senate on Monday night tentatively approved its latest version of privatizing Medicaid by a 38-10 vote. The final vote is scheduled to take place Tuesday, and then the bill will be returned to the House for consideration. It isn't clear if the House will go along with the changes. The legislation, House Bill 372, calls for a mix of commercial insurers and in-state health care providers and a change from the current fee-for-service system to a per-member monthly cost. That is meant to encourage patients and medical providers to control healthcare costs.
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Georgia Health News
Grady Health System's proposal to cover more uninsured through a "waiver" has run into a major snag at the Georgia Medicaid agency.
The big problem is concern about the cost. The current waiver proposal is "cost-prohibitive to the state," Jeremy Arieh, a spokesman for the Georgia Department of Community Health, said.
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AL.com
The Alabama House of Representatives approved a plan to cut state funding to the Medicaid Agency by $156 million next year. The House approved the budget amendment, 46-44, with Republicans casting all the votes in favor. Sixteen Republicans joined 28 Democrats in voting no. The vote came on reconsideration. The House had rejected the amendment 46-45 moments before.
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The Spokesman-Review
Washington state officials say they've crafted a plan that could improve healthcare for Washington's poorest people. At a public forum Wednesday in Spokane, officials unveiled a five-year pilot program they said will curb the cost of treatment under Medicaid insurance, streamline primary care services and reduce patient demand in emergency rooms, psychiatric hospitals and nursing facilities.
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Managed Medicaid regulatory changes carry significant information technology implications. What will you need to comply? Where will you find it? Download today to learn more!
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The Associated Press via Sun Herald
Alabama Gov. Robert Bentley said Thursday that he is cutting off state Medicaid payments to Planned Parenthood in the face of undercover videos shot by anti-abortion activists that implied the group was selling fetal tissue to researchers.
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Arkansas News
An unknown number of Arkansans who have been kicked out of the private option and other Medicaid programs for seemingly no reason as the state struggles through an eligibility verification process that officials admit has overwhelmed them. The Arkansas Department of Human Services is seeking to verify the eligibility of about 600,000 Medicaid recipients by Oct. 1, as required by state and federal laws.
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The Associated Press via Miami Herald
Even though Latinos make up nearly half of California's 12.5 million Medi-Cal enrollees, a report by the independent California HealthCare Foundation found that 36 percent of the Spanish-speaking Medi-Cal population has been told that a physician won't take them, compared to 7 percent of the overall Medi-Cal population. Even those who speak both English and Spanish reported similar difficulty accessing doctors.
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Iowa Public Radio via Kaiser Health News
Medicaid serves a large population in Iowa. The state expanded Medicaid under the Affordable Care Act and is now open to not only its traditional population — the poor and disabled — but also to adults who earn as much as about $16,000 a year for a single person, and as much as $32,000 for a family of four.
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MHPA
Time is running out to submit member plan programs that highlight best practices for Medicaid and CHIP beneficiaries. The Center for Best Practices Advisory Committee will review submissions for potential inclusion in the 2015-2016 MHPA Best Practices Compendium that will be published in November 2015. Additionally, the selected best practices will be honored during the MHPA annual conference luncheon.
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LexisNexis Health Care
Member information, demographic or other is at the heart of every health plan's operations. Unfortunately, this information is often siloed, incomplete or completely unavailable. This is particularly true for minor populations and the "underbanked" or those with little to no credit fingerprint against which information can be verified or gathered.
Please join Albert Gimbel, senior director of product management for LexisNexis Health Care, and explore the challenges with member demographic data and, more important, what payers can employ to solve the data challenge and ensure they have the information they need to locate, contact, engage and manage their member populations.
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Express-Scripts
Health plans are increasingly challenged with managing the costs associated with specialty medications while providing the specialized care these patients require to ensure medication adherence. Whether it's expensive hemophilia products or new oncology drugs in the pipeline, it is critical for plans to be able to provide the right patients access to the right medication at the best possible price with the highest level of care. Plans also need to take into consideration the new PCSK9 inhibitors — specialty drugs now being used in more common conditions like high cholesterol — where the total annual cost burden of therapy for U.S. payers and patients is on a path to become the most costly therapy class this country has ever seen.
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MHPA
Market Access World and Evidence Congress held an interview with keynote speaker MHPA CEO Jeff Myers, the keynote speaker of Market Access World USA 2015, which is scheduled for Sept. 30 and Oct. 1 in Philadelphia. Listen to Myers discuss the future of patient access, current challenges the sector is facing and why he will be attending this year's congress.
Join the congress to examine:
- Innovative pricing strategies for high-value drugs
- How to overcome barriers to patient access
- How to adapt to the changing models of the payers globally
- How you can meet payers' expectations
- Securing reimbursement for personalized medicines
Book now using code BR01.
Project Transition
Project Transition enables people with serious mental illness, co-occurring substance use disorder and/or a dual diagnoses of SMI and IDD live meaningful lives in the community on terms they define. This position is responsible for the planning, development, and implementation of marketing and sales strategies. View the complete job description.
To apply, please email your resume to Adorable Harper.
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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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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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Sponsored by ...
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7701 Las Colinas Ridge, Ste. 800, Irving, TX 75063
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