Archive for December 2015
The Affordable Care Act-inspired effort to find more effective ways to serve the so-called dual eligible population – mostly the disabled and low-income elderly covered by both Medicare and Medicaid – is not providing the kind of results policy-makers expected when they initiated new efforts to serve this high-cost population. But not all of the news is bad. On one hand, enrollment figures for those eligible to participate have not met expectations, with some of those eligible afraid they might lose their providers and some of those providers persuading their patients not to participate. In addition, some health plans that participated in the earliest efforts have withdrawn in the face of declining enrollment. On the other hand, employing care managers … Read More
The Pennsylvania Health Law Project has released the latest edition of its newsletter. The December 2015 edition includes features about Community HealthChoices, the state’s proposed plan of mandatory long-term services and supports for selected Pennsylvanians; the extension of the state’s contract with its current enrollment broker for participation in the Office of Long-Term Living’s waiver programs; the expansion of a pilot program for pregnant women with substance abuse disorders; and more. Find the newsletter here.
Pennsylvania Governor Tom Wolf has signed a bill that shifts responsibility for Pennsylvania’s Children’s Health Insurance Program (CHIP) from the state’s Insurance Department to its Department of Human Services (DHS). The move is designed to streamline the administration of the program and improve the delivery of services for the more than 150,000 children currently enrolled in CHIP. DHS already administers the state’s Medicaid program, which serves more than 2.5 million Pennsylvanians. Go here to see a state news release announcing the change.
The Pennsylvania Health Care Cost Containment Council (PHC4) has issued a report that offers a wide range of statistics describing the performance and quality of care provided by the state’s acute-care hospitals. The report presents regional and hospital-by-hospital mortality and readmission rates for a wide variety of medical conditions, doing so on a regional basis. It also tallies the volume of hospital patients according to medical conditions and describes who is paying for the different types of care hospitals are providing. Go here to see the PHC4 report Hospital Performance Report: 2014 Data.
Last week the commissioners serving on the Medicare Payment Advisory Commission (MedPAC) met in Washington, D.C. to discuss the group’s future recommendations to Congress. While MedPAC’s recommendations are not binding on Congress or the administration, they are highly respected and often find themselves worked into new law or regulations. Among the issues MedPAC addressed during two days of public meetings were: Medicare inpatient and outpatient payments the Medicare Advantage program star rating system payments to ambulatory surgery centers, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals payments for physician services, home health services, hospice care, and outpatient dialysis Find issue briefs on each subject, and copies of the presentations MedPAC staff made to commissioners, here on MedPAC’s … Read More
The National Association of Medicaid Directors recently held its 2015 fall conference. The following are presentations made at the conference by state and federal Medicaid officials, consultants, foundation officials, associations, non-profit groups, and others. A Medicaid Approach to Evaluation – Joe Parks Driving Value Getting Results – Beth Waldman Driving Value Getting Results – Darin Gordon Driving Value Getting Results – Gretchen Hammer Driving Value Getting Results – Rachel Nuzum High Cost High Need Patients – Meg Murry High Cost High Need Patients – Pam Greenberg Lets Get the Systems Talking – MaryAnne Lindeblad Medicaid at 50 Past, Present, and Future – Judy Moore Medicaid’s Matured Approach to Managed Care Contracting and Performance Oversight – Judy Mohr Peterson Medicaid’s Matured … Read More
When Pennsylvania put its HealthChoices contracts up for bid, the sizeable market to be served – more than 2.5 million people – was expected to draw interest from major national managed care organizations that serve Medicaid patients. It didn’t happen. Instead, of the nine companies that submitted bids, only one came from a national company that did not already participate in HealthChoices: Centene, a St. Louis company that serves six million Medicaid patients in 21 states. National Medicaid managed care organizations Anthem, Molina Healthcare, and WellCare did not bid. Three much smaller organizations submitted bids to enter the Pennsylvania Medicaid market: Accendia, a subsidiary of Capital Blue Cross; Meridien Health Plan, a Detroit-based company serving 700,000 Medicaid recipients in six … Read More