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CMS report: More growth in Medicaid managed care, health plan enrollment
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Centers for Medicare and Medicaid Services 2011 Medicaid Managed Care Enrollment Report, released Nov. 8, showed that the number of Medicaid beneficiaries who were in some form of managed care increased in 2011. Medicaid health plans, in particular, saw a sharp rise in enrollment in 2011 compared to 2010. More



NCQA to finish dual-eligibles quality measures in time for state demos
InsideHealthPolicy.com    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The National Committee for Quality Assurance plans to come out with a report on the structure and process measures that states are expected to use for their dual-eligible demonstrations in time for the beginning of the later-starting demos and for the second year of the demos starting next year, NCQA officials said. However, early-demo states may be using an unreleased, draft version of the measures that NCQA has been developing with the states. Many states using the capitated model of the demo are withholding a small portion of pay, which providers will get back if they meet quality measures. Typically, states plan to withhold 1 percent in the first year of the demo and that percentage rises to 3 percent or 4 percent in the third year. More

Illinois names 8 healthcare plans for Medicaid and Medicare clients
Illinois Department of Healthcare and Family Services via Lincoln Daily News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Illinois Department of Healthcare and Family Services named eight health plans that were chosen to partner with the state as it moves the majority of people covered by Medicaid to systems of coordinated care. The announcement involves the Medicare-Medicaid Alignment Initiative, a groundbreaking joint effort with the federal Centers for Medicare and Medicaid Services under which Illinois is aiming to be one of the first states in the nation to reform the way care is delivered to clients eligible for both Medicare and Medicaid services. More

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Take action tomorrow for World Diabetes Day: Attend MHPA's free webinar by Novo Nordisk on diabetes trends to 2025 and resources for policymakers, patients | noon EST Wednesday, 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

Free webinar: 'Exchange Health Plan Management Functions: URAC Accreditation & Quality Measures for Health Insurance Exchanges' | 2 p.m. EST Wednesday, Nov. 14
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This complimentary webinar in which URAC will present an overview of its accreditation process and quality measures as they relate to qualified health plans that participate on Health Insurance Exchanges, will be held at 2 p.m. EST Nov. 14. For more information and to register, click here

Reminder: Submissions for Diabetes Care Best Practices Compendium due Nov. 16
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Medicaid Health Plans of America is calling for case studies from our member organizations that will help to highlight real-world examples of best practices related diabetes prevention and treatment. We invite member and partner organizations to submit information to be included in the MHPA Diabetes Care Best Practices Compendium, to be published in January. More



Wyoming lawmakers eye major Medicaid changes
Star-Tribune via Billings Gazette    Share    Share on FacebookTwitterShare on LinkedinE-mail article
A Wyoming legislative committee voted to proceed with a series of reforms designed to address escalating costs in Wyoming's Medicaid program. Lawmakers also want to study what would be a transformative change to the system: Paying private organizations to manage care for the entire Medicaid population. Under a managed care system, Medicaid recipients would receive services through third-party networks. In theory, managed care would save the state money, but it could also limit options for people who rely on Medicaid for coverage. More

New governors might change Medicaid outlook
POLITICO    Share    Share on FacebookTwitterShare on LinkedinE-mail article
New faces in a pair of state capitols could alter the future of Medicaid expansion. In New Hampshire, expansion now looks virtually assured. Democrat Maggie Hassan, a vocal proponent of the Affordable Care Act's optional Medicaid expansion, will take the keys from Gov. John Lynch, a more moderate Democrat. And voters sent Hassan reinforcements, giving her more room than Lynch had to advance the health law. Democrats reclaimed control of the state House and took six seats from Republicans in the state Senate, leaving the GOP with a slim 13-11 majority. In North Carolina, though, Gov. Bev Perdue — another Democrat who wouldn't take a firm position on Medicaid expansion — was also ousted. Republican Pat McCrory will take over in January. And he's not saying what he'll decide on the expansion. More

CBO: Repeal of ACA coverage expansion would save $150 billion in 2020
InsideHealthPolicy.com    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Congressional Budget Office said that repealing the health reform law's expansion of health insurance coverage would generate $150 billion in savings in 2020, the largest health deficit reduction option the office listed in a new report as Congress gets ready to pivot to address the looming "fiscal cliff." The report was released as House Speaker John Boehner, R-Ohio, told ABC News that "Obamacare is the law of the land" and the House would halt full repeal efforts, while adding there are parts of the law that should be on the table as lawmakers negotiate how to reduce the federal deficit. More

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Utah health system touted by Obama is not yet endorsing Medicaid expansion
Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Intermountain Healthcare, the Salt Lake City-based hospital system praised by President Barack Obama as being a model for low-cost, high-quality care, says it is not convinced Utah should expand Medicaid under the federal healthcare overhaul. The system wants those who would gain Medicaid coverage from the law to have the choice to obtain private insurance, which generally pays higher rates to hospitals and doctors. About 58,000 people would gain coverage starting in 2014 if Utah widens eligibility for Medicaid, the state-federal health insurance program for the poor, to cover everyone with incomes under 133 percent of the federal poverty level, or $31,000 for a family of four. More

Kansas group urges Brownback to expand Medicaid eligibility
Kansas Health Institute    Share    Share on FacebookTwitterShare on LinkedinE-mail article
About 100 people rallied outside the Kansas Statehouse, urging state officials to expand Medicaid eligibility as provided for in the federal health reform law. A Lawrence pastor cast the expansion as a Christian imperative during a call-and-response exercise with the crowd. "If Jesus was up in the Capitol, would he make a choice to keep 130,000 people without care?" said the Rev. Joshua Longbottom, associate pastor at Plymouth Congregational Church in Lawrence. "No," the crowd shouted. More

South Dakota healthcare providers urge Medicaid expansion under federal law; governor pondering issue
The Associated Press via The Republic    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Now that President Barack Obama's re-election has cleared the way for the full implementation of his healthcare law, doctors and hospitals in South Dakota are urging the state to expand its Medicaid program so thousands of additional low-income residents can receive coverage. But Republican Gov. Dennis Daugaard says any expansion of coverage is unlikely for at least several years while the potential costs are examined. More



Expanded Medicaid plan for Texas expected to improve access to care
The Dallas Morning News (Subscription required)    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Thousands of North Texans who have struggled to find adequate healthcare could see improved access to medical services under an expanded Medicaid plan expected to bring $4 billion to local doctors and hospitals over five years. So far, in the first phase, 95 new medical projects would target Medicaid recipients in Dallas, Denton and Kaufman counties. The projects range from expanded chronic care management at Parkland Memorial Hospital to improved diabetes treatment at Methodist Dallas Medical Center. For more than a year, healthcare officials from the three counties have been hunched over plans that would improve care for those insured under Medicaid, a state-federal program that provides care for low-income Texans. Although Gov. Rick Perry has vowed not to allow the state's Medicaid coverage to grow under President Barack Obama's Affordable Health Care Act, statewide efforts to revamp the program have continued. More

Arkansas Medicaid program prepares for 'significant' cuts in services to fill budget gap
The Associated Press via The Republic    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The director of the Arkansas Department of Human Services said that the state's Medicaid program faces "significant" cuts next year because of an expected shortfall of at least $100 million, even if lawmakers agree to a proposal to increase funding and use one-time money to help the agency. The Department of Human Services told members of the Joint Budget Committee it needs $359 million in additional general revenue for the state Medicaid program, which serves nearly 800,000 Arkansans, but Gov. Mike Beebe has proposed only $160 million in new money for the program. Beebe has proposed boosting the program's funding by $90 million and using $70 million from the state surplus to help. More


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Obama administration extends deadline for state exchanges
Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Obama administration gave states more time to submit plans to set up state-based health insurance exchanges, a concession to the reality that many states had delayed planning until they saw who won the presidential election. States will have to tell federal regulators that they plan to go ahead by Nov. 16, but they will have until Dec. 14 to submit plans for state-based, online markets, according to a letter to governors from Health and Human Services Secretary Kathleen Sebelius. Those who want to partner with the federal government to set up the markets have until Feb. 15. More

ProgenyHealth's Dr. Ellen Stang named among Ernst & Young's Entrepreneurial Winning Women for 2012
Ernst & Young    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Dr. Ellen Stang recently was named among Ernst & Young's Entrepreneurial Winning Women for 2012. These women entrepreneurs join an elite network of the country's best high-growth companies and now will participate in the customized leadership program designed to connect them with the advisors, resources and insights they need to scale their businesses. ProgenyHealth provides care management solutions for insurers and employer groups, managing the treatment of premature infants admitted to a neonatal intensive care unit. More



HMS wins prestigious information technology awards
Business Wire via Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
HMS Holdings Corp. announced that Ventana Research named the company the winner of the analytics category at its 7th annual Leadership Awards. Mike Klinkenberg, senior director of business intelligence for HMS, also won the Overall IT Leader Award. The San Ramon, Calif.-based Ventana Research is a business technology research and advisory services firm. The Leadership Awards recognize organizations and supporting technology vendors that have achieved superior results through people, processes, information and technology while applying best practices within specific business and technology categories. More

Cardiology Consultants of Philadelphia among 1st specialty providers to implement Keystone Mercy's unique PerformPlus program
Globe Newswire via Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Keystone Mercy Health Plan, a member of the AmeriHealth Mercy Family of Companies, and Cardiology Consultants of Philadelphia, P.C. announced that they have entered into a "pay for performance" agreement to promote quality care and outcomes and encourage efficient care. The contract is KMHP's first such agreement with a cardiology specialty care provider. More

New Keeping You Healthy Video: 'Reduction of ER Visits'
Horizon NJ Health    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Improper utilization of hospital emergency facilities by members enrolled in managed care plans continues to be an issue for health plans nationwide. Drs. Brian Bastecki and Philip Bonaparte discuss how Horizon NJ Health developed and implemented an initiative focused toward reducing member visits for nonemergency issues.

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Free webinar: 'Medication Adherence & Identifying Nonadherent Patients' by Merck | 1 p.m. EST Nov. 27
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Merck cordially invites you to a medical education program for healthcare professionals only. Merck is sponsoring this program, and the speaker is presenting on behalf of Merck. The program is a non-CME event. The information presented in this program will be consistent with FDA guidelines. The format is an interactive live webcast titled A Profile of the Concept of Medication Adherence and Strategies to Identify Nonadherent Patients Learning Objectives:
  • Define medication nonadherence and understand its prevalence among patients with chronic disease
  • Recognize the drivers of nonadherence and understand the importance of appropriate communication
  • Use the 10 Tenets model of medication adherence and the Adherence Estimator screening tool
Click here for more information or register here for the live webcast.


Free webinar: 'Optimizing Pharmaceutical Care and Measuring Outcomes in a Collaborative Drug Therapy Management Program' | 1 p.m. EST Nov. 28
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Medication-related problems and medication mismanagement are massive public health problems in the U.S. Experts estimate that 1.5 million preventable adverse events occur each year that result in $177 billion in injury and death. In response to these problems, PerformRx, in collaboration with the AmeriHealth Mercy Family of Companies, successfully have developed a collaborative Drug Therapy Management program that has demonstrated significant reductions in emergency room visits and inpatient admissions, as well as significant costs savings. More



Health Insurance Exchanges Summit; MHPA's Thomas Johnson guest speaker | Nov. 29-30 | Las Vegas
Healthcare Education Associates    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Join Healthcare Education Associates Nov. 29-30 at the Tropicana Las Vegas Hotel for the Health Insurance Exchanges Summit. This health insurance exchanges conference will deliver real, actionable takeaways for effective exchange implementation. MHPA members are eligible for a 15 percent registration discount. Mention Priority Code HMP122 during registration to enjoy this offer. More

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

Free webinar by LexisNexis 'Why Identity Management Matters to Medicaid' postponed to Jan. 9
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The challenges of identity risk management can be boiled down to these two words: "Who's there?" At its core, this is the essence of security. Government efforts are driving much of the focus on identity management — a primary concern for the healthcare industry. Medical identity theft or improper access to sensitive records, as well as liability issues, are of paramount concern. Patients want to know what steps are being taken to ensure their privacy. As a Medicaid plan, you should not just be addressing the "what" of identity management — the technical side — but also the question of "who?" How do you know people are who they claim to be and what risks do they pose for the environments and systems they are attempting to enter? Clint Fuhrman, director of Government Health Care Programs for LexisNexis Risk Solutions, addresses these issues in a FREE 60-minute webinar. More

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