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Study: Higher prices by hospitals, other providers, drove 2011 spending increases
Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Spending on medical care for Americans with job-based insurance rose 4.6 percent last year, mainly driven by higher prices charged by hospitals and other medical providers, a report says. The growth came despite a sluggish economy which some economists thought would translate into more modest spending growth. Still, last year's per enrollee increase ranks below the 5.8 percent increase in 2009, according to the Health Care Cost Institute, a nonpartisan research group funded by insurers. It isn't clear from the data whether last year's uptick represents a return toward the higher averages of the past — or whether it was an anomaly within a general slowdown, said David Newman, executive director of the institute. More



MHPA's 2012 Annual Meeting only 1 month away
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If you haven't signed up yet for the MHPA 2012 Annual Meeting, "A Pivotal Time for Medicaid Health Plans," register online now from your PC or PDA. Also note that no more rooms are available at the Hyatt Regency Washington on Capitol Hill. See the list of nearby hotels for available rooms.

Romney adviser's firm: Most states will expand Medicaid — if Obama is re-elected
Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The consulting firm headed by the man planning Mitt Romney's White House transition — should there be one — says most states eventually will expand Medicaid under the health law, if President Barack Obama is re-elected. A report completed by Leavitt Partners, led by Romney adviser and former Health and Human Services Secretary Mike Leavitt, noted the Obama administration would make expansion enticing for states. More

AmeriHealth Mercy Family of Companies health plans rank in nation's top 50 Medicaid plans
AMFC via Healthcare BizDev    Share    Share on FacebookTwitterShare on LinkedinE-mail article
AmeriHealth Mercy Family of Companies announced that three of its health plans — Keystone Mercy Health Plan, AmeriHealth Mercy Health Plan and Select Health of South Carolina — maintained excellent accreditation ratings, the highest possible rating, from the National Committee for Quality Assurance. More

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States' Medicaid expansion fraught with political consequences
Government Health IT    Share    Share on FacebookTwitterShare on LinkedinE-mail article
States are facing complex choices about whether to expand Medicaid coverage since it's their call now and they will not be forced to do so under the health reform law. Governors must weigh whether they should extend Medicaid coverage to millions of uninsured, even with initial 100 percent federal funding, at the same time that their budgets still are reeling from the effects of a weak economy and limited revenues. The decision carries significant political consequences for states that have Republican governors, GOP-led legislatures, or potential changes that will result from the imminent elections. More

DST Health Solutions helps control specialty drug costs for health plans
PR Newswire via El Paso Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
DST Health Solutions has announced the availability of its Medical Drug Management Service solution, which supports health plans in properly editing and paying specialty medical drug claims to help reduce compliance missteps and overpayments to providers. Health plans face extraordinary challenges to lower costs and enhance service, while improving the quality of healthcare delivery, outcomes and safety. More



Kitzhaber, touting Medicaid reforms, says Oregon plans to do ACA expansion
InsideHealthPolicy.com    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Democratic Gov. John Kitzhaber told Inside Health Policy that Oregon plans to expand its Medicaid program as allowed by the health reform law, as many other states continue to mull their options and await answers to key questions from CMS on the now-voluntary expansion before deciding how to proceed. When asked whether Oregon's latest Medicaid waiver assumed that the state would fully expand its program to 133 percent of the federal poverty level, Kitzhaber said that although the ACA expansion is now optional, "We plan to do it." More

CMS to launch Medicaid program integrity workgroup with states
InsideHealthPolicy.com    Share    Share on FacebookTwitterShare on LinkedinE-mail article
CMS is in the early stages of launching a Medicaid program integrity workgroup that states for months have been pushing the agency to set up as part of a holistic approach to overhauling the Medicaid program integrity arena. An agency official briefly mentioned the workgroup at a Sept. 20 House Oversight health subcommittee hearing where lawmakers highlighted billions of dollars in federal Medicaid overpayments to New York developmental centers. State Medicaid sources are closely watching to see if CMS' plan will match their call for a national effort to elevate the conversation about how Medicaid program integrity works — or in some cases does not work — and how the federal government and states can increase their collaboration. More

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New York City study: Harlem has most ER 'super users; ' Upper East Side fewest
WNYC-TV via Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
About 20 percent of New York City residents visit hospital emergency rooms annually — and in some neighborhoods, the rate is twice that, according to a new report. The study by the United Hospital Fund found dramatic variations in ER use across the city, and it's one of the first to analyze which people end up in the hospital the most. Those least likely to wind up in the ER are residents of the Upper East Side and Astoria, Queens. About 9 percent make ER visits each year. More


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Report: Medicaid expansion could add 111,500 in Idaho
The Associated Press via The Sacramento Bee    Share    Share on FacebookTwitterShare on LinkedinE-mail article
A study estimates that expanding Medicaid coverage in Idaho for more low-income people under President Barack Obama's healthcare overhaul could mean up to an additional 111,500 Idahoans in the program in 2014. The Idaho Department of Health and Welfare requested an analysis of newly eligible Medicaid individuals in April. The Times-News reports that Leavitt Partners consulting firm released the report earlier this week. It will be used by a 15-member panel appointed by Gov. C.L. "Butch" Otter to scrutinize whether Idaho should expand Medicaid coverage. More

Idaho Medicaid expansion workgroup to meet Sept. 27
Idaho Department of Health and Welfare via Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Idaho Medicaid workgroup, formed by Idaho Gov. C.L. "Butch" Otter to evaluate Medicaid expansion to low-income adults, will hold its second meeting from 9 a.m. to 3 p.m. Sept. 27 at the State Capitol, EW-40. Otter appointed 15 people from the public and private sectors to evaluate the potential impact to Idaho of expanding Medicaid eligibility to low-income adults. More



ACO success leads to new insurance products
FierceHealthPlayer    Share    Share on FacebookTwitterShare on LinkedinE-mail article
As accountable care organizations become more popular and successful, insurers have started launching new products wrapped around the ACO model to further cut costs and recruit new members, AIS Health reported. More

Expert video series from MHPA partner Truven Health (formerly Thomson Reuters Healthcare)
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Bob Kelley, senior vice president of Truven Health, recently discussed the current market trends and issues affecting health plans. Market trends and payer/provider relationships is the first of a free series by Truven Health. click the link to hear what he has to say. Coming up next week: How health plans can leverage data to better position themselves for reform changes.

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Insights webinar: 'Provider Networks' | rescheduled for 11 a.m. EDT Monday, Oct. 1
Sellers Dorsey    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Sellers Dorsey will brief MHPA members on the provider network requirements for Qualified Health Plans in State Health Insurance Exchanges, including requirement to contract with essential community providers, what constitutes an ECP, access standards, special hospital contracting rules and implication of these policies for network management and provider relations. This webinar is $69 for MHPA members; $79 for nonmembers. More info and REGISTER here.

Free webinar by Medagate: 'Member Engagement: Communications & Wellness Programs' | 3 p.m. EDT Oct. 10
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Approximately 25 percent of Medicaid members represent 70 to 80 percent of Medicaid spending. Unfortunately, many Medicaid members are transient by nature, which can make communicating and maintaining wellness programs a challenge. Join Fred Haumesser from ReadyWireless and Donny Tye from Medagate to learn about communication and wellness strategies that take advantage of Lifeline Medicaid programs to engage members. More

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Free webinar by MHPA partner LexisNexis: Why Identity Management Matters to Medicaid | 1 p.m. EST Nov. 8
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
As a Medicaid Plan you should not just be addressing the "what" of identity management — the technical side — but, more important, the question of "who?" How do we know who the person on the other end is who they say they are and what risks they may pose for the environments and systems they are attempting to enter? More

Take action for World Diabetes Day: Attend MHPA's free webinar by Novo Nordisk on diabetes trends to 2025 and resources for policymakers, patients | noon EST Nov. 14
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In an effort to help confront the epidemic of diabetes, Novo Nordisk commissioned and funded "United States' Diabetes Crisis: Today and Future Trends," the first study to provide detailed diabetes prevalence and cost forecasts individually for all 50 states out to the year 2025. The study not only provides insight into how the growing diabetes epidemic geographically will spread in the U.S., but also highlights how this demographic shift might affect local economies. This webinar will provide an overview of the study from lead researcher Dr. Bill Rowley and will introduce the Novo Nordisk Diabetes Barometer, an interactive tool and comprehensive resource that highlights important research about the current state of diabetes in the United States. Participants also will learn how to use the interactive map portion of the website to benchmark and compare diabetes prevalence and cost forecasts to 2025 for all 50 states. More



Insights webinar: Reduce Outsourcing Risk | 11 a.m. EST Dec. 20
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Details here.

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