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Inside Health Policy (Subscription required)
A health plan consulting firm said the increased oversight in CMS' proposed managed care regulation is necessary, but that Medicaid health plans may not be fully prepared for the shift to a more metric-driven system. But Jeff Myers, president of Medicaid Health Plans of America, said that quality and metrics are not mutually exclusive and Medicaid health plans historically have had many ways to measure quality. "The notion that Medicaid managed care plans aren't prepared for increased oversight is off base ... to say that Medicaid plans are in for a culture change because of a metrics issue misses the mark," said Myers.
He added Medicaid plans have to report on more measures than do commercial and Medicare Advantage plans, although he noted measures that Medicaid plans are not required to report some measures that are age-specific and largely for the elderly.
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The Hill
Healthcare spending rose to more than $3 trillion in the United States last year, jumping by 5.3 percent and marking the largest increase since 2007 as millions of people gained coverage under Obamacare. Medicaid spending alone increased at a rate of 11 percent, nearly twice its growth rate the previous year, as millions of people were added to its rolls. Spending on private health insurance increased 4.4 percent, compared to 1.6 percent before the marketplace was launched.
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The Hill
Republicans are closer than they have ever been to sending an Obamacare repeal bill to the president's desk. But it's far from a done deal. The House has voted 56 times to repeal all or part of Obamacare, but those Republican-led efforts have died in the Senate.
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Politico
Putting an Obamacare repeal on the president's desk would mark a major psychological — if not an actual — victory for Republicans. But it also could come with electoral repercussions that Democrats believe could boost their efforts to recapture the Senate in 2016. This week, Senate Majority Mitch McConnell is poised to clinch the elusive 51 votes he needs to pass a repeal after devising a bill to appease a small group of conservative Republican senators. But the new version also would gut an expansion of Medicaid that's put millions of Americans from low-income households on the insurance rolls.
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Complex Clinical Reviews. Dependent Audits. And More.
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The Associated Press via The Baltimore Sun
Republican leaders of Kentucky's state Senate said Wednesday they will not block about $250 million in state spending needed to pay for the health insurance of more than 400,000 people on the state's expanded Medicaid program.
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Great Falls Tribune
A Montana state panel was told Tuesday that the third-party administrator for the state's new expanded Medicaid program is ready to roll when the program kicks into gear on Jan. 1. And officials were told that 10,500 Montanans have enrolled in the program so far.
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Oklahoma Health Care Authority
Following five months of intensive planning, leaders of the Oklahoma Health Care Authority announced they will develop a Request for Proposals aimed at contracting for a fully capitated, statewide model of care coordination for Oklahoma Medicaid's Aged, Blind and Disabled (ABD) populations.
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Los Angeles Times
One of healthcare advocates' unspoken fears is being voiced by California state lawmakers who worry a projected multibillion-dollar budget surplus could weaken political resolve to revamp a soon-to-disappear tax that helps fund healthcare for low-income Californians.
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Kaiser Health News
If you're a low-income woman, you're more likely to get screened for breast cancer if you live in a state that expanded Medicaid under the Affordable Care Act than in a state that didn't. According to new research, low-income women who lived in a handful of early-adopter states that implemented Medicaid expansion by 2011 were 25 percent more likely to be screened for breast cancer in 2012 than women in non-expansion states. That's a big change from 2008, when low-income women in both sets of states had similar odds of being screened.
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Houston Chronicle (Subscription required)
Last month brought good news: The premature birth rate in Texas has declined significantly, down from more than 13 percent of births a few years ago, to just over 10 percent. Although Texas still has one of the highest premature birth rates in the country, we are making progress.
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With an emphasis on innovative initiatives and data-driven solutions, DentaQuest is partnering with health plans to fundamentally change the way oral health is delivered in America. Integrating preventive oral health programs not only offers members a wider portfolio of choice - it is also a proven driver of cost control.
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CareCentrix
CareCentrix, a leader in managing care to the home, has announced that Gary Jacobs has joined the company in the position of executive vice president. In this role, Gary will be responsible for accelerating CareCentrix's transition to value-based care
through external partnership development. Gary brings more than 25 years of public policy experience to CareCentrix, focused on creating more efficient collaborations between health providers and payers to benefit recipients of Medicare and Medicaid.
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MHPA
"What If We Knew The Future: A Prevention Approach to Safer Use of Prescription Opioids," an RxAnte webinar presented by Michael Ross, M.D., chief medical officer, and Amie Joyce, MPH, vice president of account management at RxAnte, took place on Nov. 18.
Download the presentation.
MHPA
Click on the session names to download select presentations. You may also access them through the online version of the mhpa2015 conference app — just click on the schedule icon for the sessions. The presentations are listed in the documents section.
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