Archive for April 2016
For the first time in more than 20 years, the federal government is introducing major changes in how it regulates Medicaid managed care. The Centers for Medicare & Medicaid Services describes the 1425-page rule as aligning Medicaid managed care with other health insurance programs, updating how states purchase managed care services, and improving beneficiaries’ experience with Medicaid managed care. To learn more about what CMS has proposed, go here to see the rule itself. Go here to see CMS’s news release accompanying the new regulation. Go here to (under the link “final rule”) to find nine fact sheets summarizing key aspects of the new regulation. And go here for a commentary on the new rule and the context in which it was released by CMS acting administrator Andy … Read More
The Pennsylvania Health Care Cost Containment Council has released a report on complications from hip and knee replacement procedures performed at Pennsylvania hospitals. The analysis looks at more than 56,000 procedures performed in 2013, quantifying complications, lengthy hospital stays, readmissions, and more. Find the PHC4 report here.
Amid indications that assisting with permanent supportive housing can be a cost-effective, evidence-based way of helping to address the behavioral health needs of some Medicaid recipients, housing and behavioral health groups are beginning to take a closer look at how Medicaid resources might be used to help support such housing. In a new report, the National Council for Behavioral Health examines the possibility of using Medicaid resources to finance the delivery of services in supportive housing for Medicaid beneficiaries facing behavioral health challenges. The report examines the policy context for developing integrated permanent supportive housing options in state Medicaid programs; opportunities for Medicaid to finance and deliver housing-related services; and the implications for behavioral health authorities and providers. For a … Read More
It’s a new twist on an old concept: employ peers of low-income patients to go out into the community and work with those recently hospitalized to ensure that they are getting the care and assistance they need to recover from their illnesses and injuries. Traditionally employed by local health departments and other government agencies, community health workers are increasingly being hired by hospitals to reach out to challenging patients and help prevent readmissions to the hospitals for which Medicare (through its hospital readmissions reduction program), and increasingly state Medicaid programs as well, penalize them. And the early results are encouraging: some hospitals that employ community health workers have lowered their Medicare readmissions and avoided federal penalties. Among the challenges hospitals … Read More
Medicare’s goal of reducing hospital readmissions 20 percent – a key aspect of its hospital readmissions reduction program – may be too ambitious, researchers have concluded after evaluating the results of a special Connecticut effort to reduce readmissions. In that program, a new approach to reducing readmissions tested on 10,000 older patients considered at high risk of readmissions employed interventions, transition support, education, follow-up telephone calls, and assistance finding community resources and assistance. The result? It cut Medicare hospital readmissions nine percent – less than half the 20 percent goal Medicare has set. The study’s creators concluded that Our analysis revealed a fairly consistent and sustained but small, beneficial effect of the intervention on the target population as a whole. … Read More
Despite Affordable Care Act policies that have enabled millions of Americans to obtain health insurance, the health care safety net is still needed. Or so concludes a new report from the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms. For the report A Tale of Three Cities: How the Affordable Care Act is Changing the Consumer Coverage Experience in 3 Diverse Communities, researchers visited and examined conditions in Tampa, Columbus, and Richmond (Virginia), and among their conclusions was: We still need a safety net. Safety net programs in existence before the ACA were expected to become less necessary once the ACA coverage expansions took effect. And to some extent that has indeed been the case. But what was deemed affordable … Read More