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How states can fix their Medicaid programs; MHPA's Myers weighs in
Governing
All states will inevitably have to find ways to reform how they pay for Medicaid services. Right now, that way is looking like accountable care organizations. There's plenty of skepticism about ACOs and their ability to tame costs. MHPA President Jeff Myers, the biggest question is how managed care organizations or the state will share risk for costs and quality. In order for ACOs to lower costs in the long term, they'll have to take on the kind of risk that managed care plans assume with their capitated payments, he said.
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mhpa2014 is 1 month away; Best Practices Awards Luncheon honors
health plans
MHPA
Have you registered for mhpa2014 yet? It is one month away, Oct. 26-28 in Washington, D.C., and we hope you'll join us for what will be the premier event for our industry.
One reason not to miss it is the Best Practices Awards Luncheon. MHPA's Best Practices Awards honors Medicaid health plans for their exemplary programs which have improved the health of their enrollees. The winners, selected from submissions to our Best Practices Compendium, will be recognized in the following award categories:
- Making a Difference
- Technology
- Outreach
- Children's Health
- Cultural Competency
- Innovation
Select members of the Center for Best Practices Advisory Panel (who also will choose the winners) will present the awards. For a full list of Advisory Panel members, please click here.
For our updated agenda and registration information, please click here.
Researchers: Sovaldi analysis could be used in lawsuits against Medicaid
Inside Health Policy
Researchers at Harvard and Brown universities are analyzing state Medicaid programs' coverage restrictions for the expensive hepatitis C drug Sovaldi, and the findings could lay the groundwork for beneficiaries to sue states, although a Harvard law instructor said legal action is a last resort. Patient advocates are especially angry at states that refuse to give the hepatitis C drug to alcoholics and drug addicts, arguing the policy is discriminatory and has no medical basis.
IMS Health floats ways for health plans to afford high-cost drugs
Inside Health Policy
The consulting firm IMS Health on Sept. 23 suggested policies to help health plans afford expensive drugs such as Sovaldi, including mortgaging drug costs, using loans or insurance and only paying for drugs when they work &mdashl ideas that policymakers began discussing in May. IMS' recommendations place most of the burden on insurers and ask little from drug makers, other than that they consider giving insurers more time to pay or adjust their prices when drugs don't work as well as expected.
Drug Pricing News: A new service from InsideHealthPolicy.com
Inside Health Policy
Drug pricing policies have prompted a major fight among insurers, pharmacies, healthcare providers, drug makers, patient advocates and healthcare managers at the state and federal levels. The stakes are potentially huge, and you can't afford to miss a beat in the drug-pricing debate.
That's why InsideHealthPolicy.com has created Drug Pricing News — an email alert service on the latest news and developments in the fight over setting drug prices. Sign up for a free one-month trial to InsideHealthPolicy.com, and get access to Drug Pricing News.
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Complex Clinical Reviews. Dependent Audits. And More.
Contact HMS today!
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Senators: Widen Medicaid program for frail seniors
The Associated Press via ABC News
More than a dozen U.S. senators from both parties are calling on the Obama administration to broaden a Medicaid program for the nation's frailest seniors, calling it a proven alternative to pricier nursing home care as states seek to limit long-term medical costs.
Using Medicaid for prisoner healthcare saves states millions
Modern Healthcare (registration required)
States around the country are taking advantage of a once little-used policy that allows them to bill Medicaid for the healthcare expenses of prisoners who leave a correctional institution for treatment.
North Carolina lawmakers talking more about Medicaid overhaul
The Charlotte Observer
Legislators who couldn't agree this year on how to overhaul North Carolina's Medicaid program plan to spend more time talking about the issue before the General Assembly reconvenes early next year. A legislative oversight panel subcommittee charged with examining Medicaid reform and reorganization scheduled its first meeting. Another oversight panel also examining Medicaid governance held its first meeting this month.
GOP resistance to Utah governor's Medicaid plan remains
The Associated Press via The Kansas City Star
Utah Gov. Gary Herbert says he's made great progress negotiating an alternative Medicaid expansion plan with officials in Washington, D.C. But he may still have a tough sell at home. Some Republican state lawmakers remain skeptical of the plan and a watered-down requirement that participants work in exchange for health coverage.
Healthcare.gov gets makeover for fall enrollment drive
The Hill
The Obama administration is giving a makeover to its much-maligned health insurance website this fall, promising smoother and simpler sign-ups for thousands of people. About 70 percent of new customers will be able to use a new, shorter form when they log onto the federal website, Healthcare.gov, on Nov. 15.
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Oct. 1 Webinar Wednesday: ''Pharmacogenetic Testing in the Clinical Setting' by Millennium Health
Millennium Health
Join Maria Chianta, Pharm.D., director of clinical strategy and programs at Millennium Health, to define pharmacogenetics and find out how it may influence medication efficacy and toxicity. She will discuss how the valuable information provided by pharmacogenetic testing may assist clinicians in providing more personalized medication therapy, leading to improved patient and financial outcomes by reviewing information from the medical literature. Lastly, Dr. Chianta will review current evidence supporting its incorporation into medication management.
Did you miss our Sept. 24 Webinar Wednesday?
MHPA
Get a free copy of the well-attended "Federal Government Oversight of Medicaid at the State Level and How Health Plans Can Prepare" by Cody Consulting, as well as other past webinar presentations here.
Missed our previous issues? See which articles your colleagues read most.
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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