Can States Substantially Reduce Medicaid Spending Through Delivery System and Financing Reform?
To achieve federal Medicaid savings and make federal expenditures more predictable, the American Health Care Act (AHCA) and the Better Care Reconciliation Act of 2017 included a Medicaid block grant and per capita caps. In these proposals, if Medicaid program costs exceed the funding limits set by the cap, states will have to increase state spending or reduce spending to stay within the budget ceiling.
This approach is not new. Presidents Ronald Reagan and George W. Bush proposed Medicaid block grants, and Congress passed a Medicaid block grant, which was vetoed by President Bill Clinton and did not become law.
Although bl...
Source: Health Affairs Blog - September 7, 2017 Category: Health Management Authors: Joshua M. Wiener, Melissa Romaire and MaryBeth Musumeci Tags: Costs and Spending Long-term Services and Supports Medicaid and CHIP Payment Policy Medicaid block grants per capita caps RTI International Source Type: blogs
Medicaid Coverage For Residential Substance Use Disorder Treatment: Addressing The Institution For Mental Disease Exclusion Policy
This article was informed and adapted from a proprietary report created for the Medicaid Evidence-based Decisions Project (MED), a self-governing collaborative of 19 state Medicaid agencies, supported by the Center for Evidence-based Policy (the Center) at Oregon Health and Science University. The Center produces evidence and policy reports requested by the MED collaborative to help state policy makers make evidence-based decisions for improving health outcomes. For more information about MED or the Center, please call (503) 494-2182 or visit centerforevidencebasedpolicy.org.
This report was approved for publication by the...
Source: Health Affairs Blog - August 31, 2017 Category: Health Management Authors: Kelsey C. Priest, Allison W. Leof, Dennis McCarty and Valerie King Tags: Insurance and Coverage Medicaid and CHIP Population Health Institution for Mental Disease exclusion policy opioid crisis Section 1115 waiver substance use disorder substance use disorder treatment Source Type: blogs
Patient-Centered Medical Home: A new model for medical care
The world of primary care is challenging right now. It can be frustrating for both patients and doctors.
From the patient’s perspective
Let’s say you’re basically healthy, but overweight. You can’t quite get your diet under control. You’d like your doctor’s help and maybe some testing, like thyroid. So you call your primary care doctor. You work through the practice’s phone tree and leave a message for the nurse. The nurse may get back to you within a day or a few days, and after you talk, she or he will pass the message on to your doctor, who says you should come in. Then it takes a week or so to get an appo...
Source: Harvard Health Blog - August 30, 2017 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Health Managing your health care Source Type: blogs
On the Ethics of Accountable Care Research
This study provides some evidence of how one large … ACO appears to have achieved its stated savings….”). [5]
On May 1, Partners’ flagship hospital, Massachusetts General Hospital (where six of the eight authors are employed) aggravated these sins by issuing a press release about the paper that stated, “Today, researchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.… The entire ACO population … reduced health care spending $14 per participant ...
Source: The Health Care Blog - August 25, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Harvard Medical School Partners Source Type: blogs
Managed Care Companies Should Publish Lessons Learned From Studying Their Own Big Data
In this era of big data, managed care companies have comprehensive data sets from which to extrapolate and report precise and meaningful findings about health services. With pay-for-performance models championed by the Affordable Care Act and pursued by the Centers for Medicare and Medicaid Services, the value and relevance of these data in improving health is likely greater than ever. That is why we agree that managed care companies have an imperative to participate in quality improvement initiatives, conduct rigorous, transparent research with our data, and widely share and disseminate those findings so that others may l...
Source: Health Affairs Blog - August 18, 2017 Category: Health Management Authors: Stuart L. Lustig and Liana D. Castel Tags: Diffusion of Innovation Featured Insurance and Coverage Population Health Quality big data health services research managed care companies peer-reviewed studies quality improvement initiatives Source Type: blogs
Health Wonk Review Archives: 2006-2017
September 28, 2017 - Brad Wright - Wright on Health
September 14, 2017 - Louise Norris - Colorado Health Insurance Insider
August 17, 2017 - Peggy Salvatore - Health System Ed Blog
July 21, 2017 - Steve Anderson - healthinsurance.org
June 23, 2017 - Joe Paduda - Managed Care Matters
June 1, 2017 - Andrew Sprung - xpostfactoid
May 18, 2017 - Jason Shafrin - Healthcare Economist
May 4, 2017 - Julie Ferguson - Workers Comp Insider
April 20, 2017 - Brad Wright - Wright on Health
April 6, 2017 - Hank Stern - InsureBlog
March 23, 2017 - Louise Norris - Colorado Health Insurance Insider
March 9, 2017 - Peggy Salva...
Source: Health Wonk Review - August 16, 2017 Category: Health Management Source Type: blogs
A Line in the Sand
By JONATHAN HALVORSON
Eventually, the share of the American economy absorbed by healthcare will stop rising. The question is when, and how much more collective damage will be inflicted in the process. As it turns out, there is a solution under our noses that is nearly ubiquitous in business, personal finance, and government programs worldwide.
And it can be used to bring manageable, relatively predictable transformation, rather than sudden wrenching change. It is a called a “budget.” It is well past time to embrace the discipline of budgets in healthcare financing.
The basic idea is clear: set a limit on how much money...
Source: The Health Care Blog - August 7, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
MinnesotaCare Buy-In: Maybe Not A Long Shot
States are developing creative policy options to address the high cost of premiums for those purchasing coverage in the individual market. Given the inaction and lack of leadership at the federal level, states need to continue to move forward. Minnesota, of course, is leading the way.
Under a proposal introduced in the Minnesota state legislature earlier this year, Minnesotans shopping for health insurance on the individual market would have been able to purchase public coverage through MinnesotaCare, Minnesota’s Basic Health Plan (BHP). The public buy-in was supported by the Democratic-Farmer-Labor (DFL) Party Governor ...
Source: Health Affairs Blog - August 2, 2017 Category: Health Management Authors: Lynn Blewett Tags: Featured Following the ACA Medicaid and CHIP Minnesota MinnesotaCare Section 1332 waivers State Innovation Waivers Source Type: blogs
With The ACA Under Fire, Can Health Conversion Foundations Patch The Safety Net For Low-Income Americans?
With the threatened repeal of the Affordable Care Act (ACA), a surprising source is emerging as the nation’s largest pool of philanthropic dollars for health: health conversion foundations. Together, 228 conversion foundations represent some $27.5 billion of assets, according to our estimates.
What’s more, conversion foundations are already often the largest health funders in their geographic area, dispensing more than $1.3 billion a year, based on our research, to enhance the health and well-being of mostly low-income Americans and patching a fraying safety net in the process.
Sometimes called health legacy foundation...
Source: Health Affairs Blog - July 27, 2017 Category: Health Management Authors: Taz Hussein and Mariah Collins Tags: GrantWatch Hospitals health conversion foundations health insurers health legacy foundations Health Philanthropy Health Reform mergers and acquisitions Safety Net Social Determinants of Health Source Type: blogs
Diffusion Of Community Health Workers Within Medicaid Managed Care: A Strategy To Address Social Determinants Of Health
Clinic notes from a Community Health Worker:
A 63 year old client and her 70 year old husband had been evicted from their apartment while they were hospitalized and were living in a motel. I was able to assist the elderly couple in finding a new apartment… I’ve helped other clients find housing, jobs, and medical homes, no longer living on the streets.…Another client has been sober for one month, attending church which helped her through the trauma of being a victim of human trafficking…We then helped a woman escape a violent relationship and obtain affordable legal help. We…helped [her son] grapple with his own ...
Source: Health Affairs Blog - July 25, 2017 Category: Health Management Authors: Carolina Nkouaga, Arthur Kaufman, Charlie Alfero and Claudia Medina Tags: Diffusion of Innovation Featured Medicaid and CHIP Organization and Delivery Population Health Public Health Quality Medicaid Managed Care Social Determinants of Health Source Type: blogs
Are Section 1115 Waivers A Panacea For Draconian Medicaid Funding Reductions?
From a structural perspective, what makes the pending Medicaid legislation so extraordinary is that, without changing any of the program’s fundamental contours, both the House and Senate bills would simply superimpose arbitrary spending caps onto the statute’s federal funding contribution formula. In the near term, the loss of enhanced federal funding for the optional ACA adult expansion group would cause the most financial damage. But over the long term the true injury to Medicaid would come from holding back federal funding otherwise due under the financing agreement that has been the program’s statutory hallmark f...
Source: Health Affairs Blog - July 17, 2017 Category: Health Management Authors: Sara Rosenbaum Tags: Following the ACA Medicaid and CHIP Section 1115 Waivers Source Type: blogs
