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HHS Chief Says 340B Changes are Coming

Health care providers and drug manufacturers should expect changes in the section 340B prescription drug discount program in the near future. That was the message conveyed by Health and Human Services Secretary Alex Azar during a recent conference held by the 340B Coalition. The 340B program, which provides discounts on the prescription drugs dispensed on an outpatient basis by eligible providers to their low-income patients, has become increasing controversial in recent years as it has expanded and pharmaceutical companies have objected to the discounts they must provide. Among the changes Azar suggested are coming are greater accountability among participating hospitals for how they use the savings they derive from the discounts and a narrowing of the difference between the prices … Read More

Posted in 340b, Uncategorized

Medicaid Managed Care Plans Suffer High Physician Turnover

The physician networks developed by Medicaid managed care plans suffer from a degree of turnover that threatens continuity of care for their members. While the number of Medicaid managed care plans using so-called narrow networks of providers declined by more than a third between 2010 and 2015, physician turnover is higher in those narrow network plans:  three percentage points higher after one year and 20 percentage points higher after five years than the networks of plans that do not employ narrow networks. Collectively, Medicaid managed care plans experienced physician turnover of 12 percent a year from 2010 to 2015. Learn more about physician turnover in Medicaid managed care plans in the Health Affairs study “Network Optimization And The Continuity Of … Read More

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Mixed Results for PA Overdose Admissions in 2017

2017 hospital admissions for heroin overdoses in Pennsylvania rose nearly 13 percent but admissions for overdoses of pain medication fell more than two percent that year, according to the Pennsylvania Health Care Cost Containment Commission. Nearly ten percent of those heroin patients died in the hospital, as did half that proportion of pain medication overdose patients. The average age of the heroin overdose patients admitted was 33 and nearly two-thirds of them were insured by Medicaid.  Of the pain medication patients admitted, the average age was 53 and 42 percent were insured by Medicare, 34 percent by Medicaid, and 19 percent by commercial insurers. Learn more about trends in hospital admissions for heroin and pain medication overdoses in the Pennsylvania … Read More

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Do “Narrow Networks” Jeopardize Care?

They may if they serve Medicaid patients. Or so suggests a new Health Affairs report. As growing numbers of Medicaid managed care plans reduce their provider networks as a means of managing costs, provider turnover appears to be growing.  According to the report, narrow networks tracked during a five-year period experienced a 20 percentage point greater rate of physician turnover than non-narrow plans. Such turnover is thought to be a potential problem for Medicaid patients who are socially or clinically vulnerable and present complex medical needs.  The loss of a physician can disrupt and complicate the care of such patients – and disrupt it in ways that may not necessarily be detected by current quality measures. This could pose a … Read More

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PA Awards Grants to Improve Coordination of Care for Medicaid Patients

The Pennsylvania Department of Human Services has awarded $8 million in grant money “…to increase efficiency in the delivery of health care services to Medicaid patients.” According to a DHS news release announcing the grants, The grants will help connect hospitals, nursing homes, and ambulatory practices to the Pennsylvania Patient & Provider Network, or P3N, which enables electronic health information exchange (eHIE) across the state through the connection of health care providers to health information organizations (HIO), and the participation of the HIOs in the P3N. Dividing the $8 million are the Clinical/Connect Health Information Exchange, the HealthShare Exchange, the Keystone Health Information Exchange, and the  Mount Nittany Exchange. To learn more, see this DHS news release.

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Hospital Financial Health Generally Stable, PHC4 Reports

General acute-care hospitals experienced up and downs in their financial performance in 2017, the Pennsylvania Health Care Cost Containment Council has reported. In 2017, net patient revenue rose 3.9 percent operating margins fell from 6.02 percent to 5.15 percent but total margins rose from 5.96 percent to 6.62 percent uncompensated care declined from $844 million to $761 million – the fourth consecutive year of decline For more on these and other measures of hospital financial performance, including data on individual hospitals, go here to see the new PHC4 report Financial Analysis 2017:  General Acute Care Hospitals.

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Short-Term Plans May Short-Change Purchasers

The short-term health insurance plans that the administration proposes making more available to consumers as an alternative to comprehensive health insurance that meets Affordable Care Act coverage requirements may leave consumers with greater out-of-pocket costs and less coverage for some critical services. According to a Kaiser Family Foundation review of available short-term, limited duration plans in 10 markets across the country, those plans: often do not cover mental health and substance abuse services and outpatient prescription drugs may turn down individuals or charge them higher premiums based on age, gender, or health status, including pre-existing conditions require greater cost-sharing by their purchasers do not cover maternity services at all Such plans are not required to comply with the Affordable Care … Read More

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Medicaid is Toughest Insurer for Providers

Medicaid is the hardest insurer for providers when it comes to billing. Or so reports a new study published in the journal Health Affairs. According to this analysis, Medicaid claims take longer to file, are more likely to be rejected, more likely to be challenged, and take longer to be paid than Medicare and private insurance claims.  While the biggest problem is Medicaid fee-for-service claims, even Medicaid managed care claims pose more problems than Medicare and private insurance claims. This can pose a special challenge to Pennsylvania safety-net hospitals because they care for so many more Medicaid patients than the typical hospital. Learn more about the challenges providers face when working with Medicaid in the Health Affairs report “The Complexity … Read More

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Tackling Social Determinants of Health

The growing awareness of the impact of social determinants of health comes at a time when health care providers are assuming unprecedented degrees of risk for the health of their patients, leaving many providers wondering how best to invest resources that will meet both their own needs as well as the needs of their high-cost, high-need patients. A new document from the Commonwealth Fund, “Investing in social services as a core strategy for healthcare organizations:  Developing the business case,” seeks to serve as a manual for providers seeking to move into this relatively new territory. The report takes providers through key steps in the process, including establishing a common definition of social service investment; identifying common barriers to social service … Read More

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340B Program Getting the Job Done

The oft-scrutinized section 340B prescription drug discount program is doing what the program is supposed to do, according to a new analysis published on the Health Affairs Blog. According to the report, 340B DSHs treat significantly more low-income patients than non-340B hospitals, provide a disproportionate amount of the nation’s uncompensated and unreimbursed care, and are more likely to provide specialized services that are critical to low-income patients but which are often underpaid. In addition, 340B …has saved billions in drug costs while providing free or discounted care to millions of patients who might otherwise be unable to get needed care. This is accomplished at no cost to taxpayers. In addition, the report concludes that 340B-eligible hospitals: care for significantly more … Read More

Posted in Medicare, Uncategorized
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