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Only 10 percent of Medicaid enrollees' ED use is unnecessary
Medscape (Free registration required)
Medicaid enrollees use emergency departments more often than privately insured and uninsured people, but that use accounts for just 4 percent of total Medicaid spending, a literature review by the Medicaid and CHIP Payment and Access Commission indicates.
The review also found that only 10 percent of ED visits by nonelderly patients are for nonurgent reasons, which compares with the rate of use by privately insured patients. MACPAC researchers reviewed recent studies on ED use and did not find consistent links between Medicaid status and disproportionate ED use for nonemergency situations.
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MHPA responds to SFC data request
MHPA
MHPA responded to Sens. Ron Wyden and Chuck Grassley of the Senate Finance Committee regarding their request for ideas on how to make better use of healthcare data, while protecting privacy. MHPA explained in its letter that MCOs support availability of useful data to improve our healthcare system, but that this must be balanced with protecting the privacy and integrity of data.
Aug. 20 Webinar Wednesday: 'The Promise of Aggregated Data: Trends,
Pitfalls, and Tips for Commercial Payers' by HMS
HMS
Enhancements in technology and the passage of the Affordable Care Act are requiring Medicaid managed care organizations to better understand fraud, utilization and cost trends. Increasingly, MCOs are looking beyond their own plan and state boundaries for regional/national analytics, including aggregated data.
In this webinar, HMS will discuss the promise of combining data for Medicaid managed care organizations. Jim Carlough, HMS commercial vice president of client development, and Dan Olson, HMS director of predictive analytics, will discuss trends in aggregated data, as well as pitfalls and best practices to ensure success. As a bonus, the webinar will include a preview of HMS' upcoming presentation at mhpa2014 about aggregated data findings related to the new Medicaid population.
mhpa2014 INNOVATION session on churn
MHPA
Medicaid managed care organizations that also offer Qualified Health Plans through exchanges under the new ACA and Medicaid MAGI eligibility rules have completed their first Exchange Open Enrollment. The presentation by Paragon Health Consulting's Richard Trembowicz will focus on the risks and opportunities associated with Medicaid churn, and transition between Medicaid and Exchange QHPs.
For details on other sessions at the signature event for the Medicaid managed care industry, please click here for our latest agenda. Don't forget: Sign up before Sept. 8 to grab the early-bird discount.
3 governors tout benefits of Medicaid expansion
The Associated Press via Lexington Herald-Leader
Arkansas, Kentucky and Maryland's governors, who expanded Medicaid under the federal healthcare overhaul, have said there are economic and moral arguments for embracing a key part of the law, despite strong political opposition in their southern states.
SHOWCASE
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Learn the latest trends, pitfalls, and opportunities of aggregated data.
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Medicaid Expansion favored by Idaho work group
The Associated Press via Times-News
An Idaho work group says the state should expand its Medicaid eligibility, but some committee members voiced concerns that their recommendation will be ignored by both the governor and legislators. The 15-member group voted, 10-3, to submit their recommendation to Idaho Gov. Butch Otter, who tasked the panel to evaluate the best healthcare coverage option for low-income adults.
Wisconsin loses $206 million by not fully expanding BadgerCare
Milwaukee Journal Sentinel via St. Paul Pioneer Press
Wisconsin taxpayers would have saved $206 million over two years — 73 percent more than estimated — if officials had fully expanded its main healthcare program for the poor under the federal Affordable Care Act, a new nonpartisan report shows.
Audit: Illinois overdrew federal Medicaid dollars
Miami Herald
Illinois used faulty methods for withdrawing federal Medicaid money, resulting in "a perpetual 'treadmill effect'" of regular overdraws of dollars that the state later had trouble repaying, federal auditors said in a report.
Medi-Cal struggles to provide services to ever-growing clientele in California
Los Angeles Times
Many needy Californians are struggling to receive care through Medi-Cal, the state's version of Medicaid. Concerns about access to care have taken on a new urgency since Medi-Cal enrollment began to swell in the wake of President Barack Obama's federal healthcare overhaul. The program, the state's second-largest expense after schools, is expected to cover 1 in 3 Californians by next year.
Pharmacies turn drugs into profits, pitting insurers vs. compounders
The New York Times
It may be the biggest thing in diaper rash treatment, a custom-made product to soothe a baby's bottom at the eye-popping price of $1,600. This is no Desitin or Balmex, or any other brand found in stores. This cream is blended to order in a pharmacist's lab. Does it work better than the common treatments? There is little evidence either way. But the sky-high prices commanded by such compounded medicines are drawing the ire of health insurance companies that must pick up the bill. They say the industry is profiteering at their expense.
Healthcare price growth moderates
Altarum Institute
Healthcare prices in June 2014 were 1.7 percent higher than in June 2013, a tenth lower than the May year-over-year reading. The June 2014 12-month moving average rose to 1.3 percent from 1.2 percent in May, the highest average since December 2013.
Federal Drug Discount Program faces challenges as it expands under
health reform
RAND Corporation
A federal program that provides billions in drug discounts to safety net hospitals and other healthcare providers is expanding under healthcare reform, but divergent views on the purpose and future scope of the program create uncertainty for safety net providers and drug manufacturers, according to new analysis from the RAND Corporation.
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More than 7.2 million added Americans covered under Medicaid, CHIP
U.S. Department of Health & Human Services
Over the last year, we've seen the Affordable Care Act deliver on a number of important milestones as we work toward more accessible, affordable, quality healthcare. New options have meant that 10.3 million previously uninsured Americans can now rest a little easier knowing that they are covered.
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HHS figures: Missouri led nation in Medicaid roll reductions
The Associated Press via Springfield News-Leader
Missouri's Medicaid program is leading the nation in the number of people dropped from its rolls. New figures from the U.S. Department of Health and Human Services show that Missouri's Medicaid enrollment dropped by 37,260 people in June, compared with its average enrollment from July through September of last year.
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National Hemophilia Foundation Annual Meeting Pre-Conference Symposium on Hemophilia Pharmacy Management: Sept. 18 in Washington, DC
National Hemophilia Foundation
The National Hemophilia Foundation Annual Meeting Pre-Conference Symposium on Hemophilia Pharmacy Management: "Steps for Success With Managed Care and Specialty Pharmacy" will take place Sept. 18 in Washington, D.C.
Specifically designed for specialty pharmacists, home health pharmacists, health plan pharmacists, managed Medicaid pharmacists, medical directors and other health care professionals with an interest in the management of patients with hemophilia, this free event is also a CME/CPE-certified activity.
For more details including program overview, educational objectives, the full agenda, and free registration, click here.
Did you miss Webinar Wednesday? 'Asked and Answered: Mobile Tech, Member Engagement, and the Keys to Accountable Assessments' available online
MHPA
View and download the Aug. 13 Webinar Wednesday by Health: ELT, "Asked and Answered: Mobile Tech, Member Engagement, and the Keys to Accountable Assessments," here. Other webinars are available to download, as well.
Missed our previous issues? See which articles your colleagues read most.
Upcoming Webinar Wednesdays
MHPA
Here are some upcoming Webinar Wednesday events to mark on your calendars:
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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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