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States Adopt New Tools to Control Rising Medicaid Drug Costs

Faced with continued increases in the cost of prescription drugs in their Medicaid programs, states are pursuing new approaches in attempts to control those rising costs. In the past states have employed approaches such as beneficiary prescription limits, negotiating supplemental rebates from manufacturers, requiring prior authorization, implementing state maximum allowable cost programs, and operating preferred drug lists. Recently, however, states are turning to a number of new mechanisms to limit the growth of Medicaid prescription drug costs, including: introducing spending growth caps for Medicaid prescription drug costs, with unplanned increases in spending triggering a closer look at overall drug spending and a focus on specific drugs for utilization review; closed formularies; doing more to promote the use of generic drugs; … Read More

Posted in Uncategorized

NQF to Medicaid: Do a Better Job of Addressing Social Determinants of Health

State Medicaid programs need to do a better job of measuring and addressing the social risks their patients face, the National Quality Forum has asserted in a new report. To do so, NQF concluded, state Medicaid programs should “…work more with healthcare organizations and communities to better manage social disparities.” How? According to the NQF, state Medicaid programs should: Acknowledge that Medicaid has a role in addressing social needs that impact health. Create a comprehensive, accessible, routinely updated list of local community resources for healthcare organizations. Harmonize tools that assess social needs that impact health to ensure that they collect and document the same type of information. Create standards for inputting and extracting social needs data from electronic health records … Read More

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ED Myths Exposed

The uninsured do not use emergency rooms more than the insured. And the expansion of health insurance coverage increases rather than decreases ER use. So concludes the new Health Affairs study “The Uninsured Do Not Use the Emergency Department More – They Use Other Care Less.”  Find the study here.

Posted in Uncategorized

The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities

Physicians who serve large numbers of low-income patients are more likely to incur penalties under Medicare value-based purchasing programs. So concludes a new study in Annals of Internal Medicine. According to the report, Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare’s pay-for-performance programs to exacerbate health care disparities.  This result is based on a study of the Medicare Value-Based Payment Modifier program, which no longer operates, but could have implications for other programs that seek to reward or penalize practitioners based on the outcomes they produce. Such findings could lead practitioners to avoid serving such patients so they can avoid penalties, which in turn could jeopardize … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

New PA Website With Resources for Seniors and the Disabled

Pennsylvania has launched a new website called Pennsylvania Link to Community Care to help seniors and people with disabilities find resources to help them address the challenges they face in their lives. The site, a collaboration between the state’s Human Services and Aging departments, lists services in 12 categories:  advocacy, behavioral health, employment, finance, health care, housing, in-home services, legal, meals, protection from abuse, support groups, and transportation.  It also provides information to and links about programs, organizations, and services. To learn more, see this state news release about the new site or go here to see the Pennsylvania Link to Community Care site itself.

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Diabetes Admissions Up in PA

Hospital admissions for diabetes rose 13 percent in Pennsylvania between 2000 and 2016.  While admissions among older Pennsylvanians declined, the rate for younger people under the age of 45 increased 38 percent over that period of time. Diabetes admissions in Pennsylvania resulted in $205 million in payments to hospitals in 2016, but according to the Pennsylvania Health Care Cost Containment Council, about 86 percent of 2016 adult admissions could have been prevented with more timely and appropriate care and disease management. Learn more about the prevalence of diabetes admissions in Pennsylvania in the new PHC4 research brief “Pennsylvania Hospital Admissions for Diabetes,” which can be found here.

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PA Delays New Long-Term Care Program

The Pennsylvania Department of Human Services will delay for six months the introduction of its Community HealthChoices program in southeastern Pennsylvania. The program’s implementation in the five-county Philadelphia area, scheduled to begin on July 1, 2018, has been pushed back to January 1, 2019. Preparations are currently under way to launch Community HealthChoices in 14 southwestern Pennsylvania counties on January 1, 2018. Community HealthChoices is a new state program of managed long-term services and supports for Pennsylvanians over the age of 55 who are eligible for both Medicare and Medicaid. Learn more about the program’s delay in southeastern Pennsylvania in this Philadelphia Inquirer article.

Posted in Pennsylvania Medicaid policy, Uncategorized

PHC4 Reports on Hospital Performance

The Pennsylvania Health Care Cost Containment Council has released its annual report on hospital performance for discharges between October of 2015 and September of 2016. The report, which details the performance of all of the state’s acute-care hospitals and some children’s and specialty hospitals, looks at hospital-specific outcomes for 16 individual medical conditions and surgical procedures. Among the measures reported by PHC4 are number of cases, risk-adjusted mortality, risk-adjusted 30-day readmissions, and case-mix-adjusted average hospital charges. Among its findings, PHC4 reported that mortality and readmission rates decreased in most categories and did not increase significantly in any. The PHC4 report comes in different volumes for different parts of the state.  Find a description of the reports, a summary of their … Read More

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Survey Says: More Than One in Four Underinsured

28 percent of insured adults under the age of 64 were uninsured in 2016, according to a Commonwealth Fund survey. The survey also found that: More than half of the uninsured are insured through their employer. Nearly one in four insured through their employer are underinsured. More than one in four Medicaid recipients were underinsured. Half of the underinsured report problems paying their medical bills. Individuals with higher deductibles are more likely to report problems paying their medical bills. More than 45 percent of the underinsured report skipping care they need because of cost. Low-income people and those with chronic health problems are more likely to be underinsured. Learn more about the survey’s findings, its implications, and possible means of … Read More

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A New Twist on Telehealth

Residents of urban areas often have the same access-to-care problems as rural residents, although the latter receive far more attention. So concludes a new report published on the Health Affairs Blog. According to the analysis, urban and rural residents have similar access problems – and among urban residents, the problems in some instances are even greater.  One distinction: …while rural America has access problems because there are not enough doctors, urban America has access problems because there are not enough appointments. One potential solution to this problem, the report suggests, is focusing on access instead of geography and making telehealth services more available to rural and urban residents alike.  To date, most telehealth efforts have focused on serving residents of … Read More

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