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This drug costs $84,000 ... and there's nothing the US healthcare system can do to stop it; MHPA's Myers weighs in
The way the pharmaceutical industry developed, priced and sold Sovaldi is an instructive study in how the American healthcare system allows drugs to become expensive — an incredible, unprecedented, $1,000-per-pill type of expensive that the country has never seen before. The story of Sovaldi shows the American healthcare system is incapable of fighting back against these prices. The people who buy drugs — mostly private health plans and public insurance programs — are too fragmented to demand lower prices.
"I wish I could say I was optimistic that the future would be different, and prices would moderate," said Jeff Myers, chief executive of MHPA. "But I suspect that's not the case. What the companies have learned from the Sovaldi experience is that there are precious few ways for us to manage costs."
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Sneak peek at PwC Medicaid report at Dec. 9 webinar
PwC presents the "Expanded State of Medicaid," a preview of a report to be released on Capitol Hill that is a comprehensive look at Medicaid and managed Medicaid enrollment data and trends across the states. This free webinar features a comprehensive view of Medicaid composition, assesses the impact of Medicaid expansion and offers key takeaways for health plans, health services organizations and other interested parties.
Medicaid, CHIP coverage at risk for thousands of pre-ACA enrollees
Modern Healthcare (Subscription required)
Many states are struggling to re-enroll adults and children in Medicaid and the Children's Health Insurance Program, with hundreds of thousands of current beneficiaries at risk of losing coverage, advocates say. The enrollees who are at greatest risk are pregnant women, children and blind and disabled individuals who were enrolled in Medicaid prior to the effective date of two Patient Protection and Affordable Care Act provisions — the 2014 expansion of coverage to all adults with incomes up to 138 percent of the federal poverty level and the establishment of a new formula to define household income under the Modified Adjusted Gross Income standard.
Pay for success, social impact bonds: Request for proposals
Green & Healthy Homes Initiative
The Green & Healthy Homes Initiative will release a request for proposals from healthcare entities to develop asthma-related social impact bond/pay for success projects. GHHI and its partner, the Calvert Foundation, will provide technical assistance to five selected healthcare organizations. An informational webinar will be held on Thursday, Dec. 18. Proposals are due Thursday, Jan. 15.
GHHI and Calvert Foundation are proud recipients of a $1.011 million award from The Corporation for National and Community Service's Social Innovation Fund. With this funding, the organizations will work to build on the asthma-focused PFS currently being developed in Baltimore by a partnership between GHHI, the Calvert Foundation and Johns Hopkins HealthCare and the Johns Hopkins Health System. Visit the SIF and GHHI Pay for Success information pages for more details.
For FAQs on this project, click here.
For organizations interested in updates on this project, please sign up for our email list.
GHHI will be conducting webinars for interested healthcare organizations on Thursday, Dec. 18 and Monday, Jan. 5. To register for the Dec. 18 webinar, click here.
Supporters of Nebraska Medicaid expansion could turn to voters
Medicaid expansion could become the subject of Nebraska's next big petition drive if lawmakers don't act on the issue next year. "We are going to work as hard as we can this session to pass a 'Nebraska approach' to Medicaid expansion," state Sen. Jeremy Nordquist of Omaha said in an email. "If the legislature again does not want to act, we will talk to Nebraskans about a ballot initiative to ensure we end the cost-shift in our healthcare system."
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Georgia Medicaid chief to step down
Jerry Dubberly plans to leave his post as Georgia's Medicaid director effective Jan. 2. As Medicaid chief, Dubberly oversees the services for about 1.9 million Georgians in Medicaid and PeachCare and maintains a state budget of more than $2.5 billion.
Unequal treatment in Arizona: Swings in Medicaid access show
Los Angeles Times
For low-income adults, Arizona was once a trailblazer in healthcare, providing broad access to Medicaid, the government health plan for the poor. But during the last recession, Arizona cut coverage for tens of thousands of people. This year, the state expanded Medicaid again, although the decision faces a legal challenge. Arizona's on-again, off-again approach makes it a useful place to look at the impact of a program that covers more than 1 in 5 Americans.
Senate GOP leader wants Washington to fund Medicaid costs caused by Obama's immigration order
New York Daily News
New York State Senate GOP leader Dean Skelos wants Washington, D.C., to help pay for any surge in Medicaid costs caused by President Obama’s recent immigration order. Skelos recently released a letter to Sens. Charles Schumer and Kirsten Gillibrand asking their assistance in increasing Medicaid funding to New York to offset any unanticipated costs that arise from Obama's actions.
3 insurers to split $151 million in Medicaid contracts
Indianapolis Business Journal
Three health insurance companies will divide up an estimated $151 million over the next four years in state Medicaid contracts to manage the health care of blind, disabled and senior Hoosiers. Anthem Blue Cross and Blue Shield, MDwise Inc. and Managed Health Services of Indiana were selected by the Indiana Family and Social Services Administration to provide health care services under the new Hoosier Care Connect program. The roughly 84,000 Hoosiers that qualify as aged, blind or disabled can choose any of the three companies to manage their Medicaid health benefits.
Molina Healthcare of Florida completes acquisition of Florida Medicaid assets from First Coast Advantage
Molina Healthcare, Inc. announced that, effective Dec. 1, its wholly owned subsidiary Molina Healthcare of Florida, Inc. has closed on its acquisition of certain assets relating to the Florida Medicaid business of First Coast Advantage, LLC. As a result of the transaction, First Coast Advantage's current Medicaid members will transition into Molina Healthcare of Florida as part of the Managed Medical Assistance component of the Statewide Medicaid Managed Care program.
Dec. 10 Webinar Wednesday: 'Care Transitions in Behavioral Health'
Janssen Pharmaceutical Companies of Johnson & Johnson
Take a deeper look at transitioning patients in the current mental health landscape. The consequences of inadequate care transitions, the care transitions policy landscape and an update on how the mental health community is responding to change in the transitions sector. Join Charles Ingoglia, MSW, senior vice president of public policy and practice improvement for the National Council for Behavioral Health where he leads the national charge to ensure people have access to their potential to live full and complete lives.
Capitol Hill briefing on health plan roles to reduce preterm birth on Dec. 11
MHPA's report, "Preterm Birth Prevention: Evidence-Based Use of Progesterone Treatment — Issue Brief and Action Steps for Medicaid Health Plans," will be featured at a Capitol Hill event to educate legislators and their staff on how health plans target the problem of preterm birth, the leading cause of infant morbidity and mortality in the U.S.
IIR's FDA/CMS Summit for Payers featuring MHPA's Jeff Myers | Dec. 11-12, Washington, D.C.
Institute for International Research USA
Hear from the FDA and CMS under one roof, along with C-level executives from top health plans, at the FDA/CMS Summit for Payers. The entire healthcare continuum is coming together to understand how to better interact with the government to remain compliant, adaptive, and successful as our landscape evolves to become more patient-centric. Collaborate with the most influential people in health care, including speakers MHPA's president and CEO Jeff Myers and Janet Woodcock, M.D., director of the Center for Drug Evaluation and Research, FDA. Click here for more information.
Dec. 17 Webinar Wednesday (rescheduled): 'Why All Medicaid Managed Care Organizations Need an ACO Strategy'
Epstein Becker Green and Health Policy Source, Inc.
The growth and persistence of the state accountable care organizations (ACO) movement is being fueled by CMS' State Innovation Model grants and by state implementation of Medicaid ACOs — 17 states have already implemented some form of Medicaid accountable care. Join Clifford Barnes, partner at Epstein Becker Green, PC, and Jenny Gladieux, senior health policy analyst for Health Policy Source, Inc., as they provide the tools to develop an understanding of how Medicaid ACOs affect Medicaid managed care and provide the rationale on why Medicaid managed care needs to develop state-specific ACO strategies.
MHPA's Myers to speak at Sixth Annual Medicaid Innovations 2015 Forum | Feb 3-5, 2015 | Orlando
Medicaid Innovations Forum
Join MHPA President and CEO Jeff Myers at the Sixth Annual Medicaid Innovations 2015 Forum in February 2015. This meeting offers a unique combination of forward-thinking perspectives including first-hand case studies and examples of true innovation from both Medicaid managed care plans and state government agencies. The forum, which gathers hundreds of representatives from states, health plans and solution providers in one room, goes beyond policy to explore the specific strategies these organizations are leveraging to improve quality of care, reduce costs and position themselves for success in serving the rapidly expanding Medicaid population. Use Discount Code MHPA200 to receive $200 off the current rate.
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MHPA's Myers to chair WHCC 4th Annual Medicaid and Medicare Reform Summit | March 2015 | Washington, DC
MHPA President and CEO Jeff Myers will chair the WHCC 4th Annual Medicaid and Medicare Reform Summit, a meeting that convenes executives from health plans, hospital systems and policy organizations to share, learn and discuss approaches to improve the quality of government programs and achieve payment and delivery reform. For conference details, agenda and registration, please visit here.
Job opportunity: Clinical director, Homecare & Managed Care
First Quality, a leading manufacturer of disposable home health care products, is seeking a clinical director for our Homecare & Managed Care Business. This candidate will provide leadership and have a focus on clinical education, utilization management protocols and programs and operational program development within home care and managed care markets.
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