Friday, June 29, 2012
Wednesday, June 27, 2012
Tuesday, June 26, 2012
Monday, June 25, 2012
Health insurers owe $19.8 million in rebates in Georgia - Atlanta Business Chronicle
About 244,000 Georgia
The rebates will average $134 per family in Georgia
The health care law generally requires insurance
companies to spend at least 80 percent of consumers’ premium dollars on medical
care and quality improvement. Insurers can spend the remaining 20 percent on
administrative costs, such as salaries, sales and advertising.
Insurers have to notify customers how much of their
premiums are spent on medical care and quality improvements, and companies that
do not meet the 80/20 standard must provide a rebate to policyholders by Aug.
1. Insurers can send a rebate check through the mail, make a lump-sum
reimbursement to the account that was used to pay the premium if it was paid by
credit or debit card, or reduce future premiums. Employers who paid for health
care insurance can also take those steps, or apply the rebate in a way that
benefits employees, HHS said.
Across the U.S.
The 80/20 Rule: Providing Value and Rebates to Millions of Consumers | HealthCare.gov
Insurers Pushing for Increased Use of Retail Clinics
Insurers Pushing for Increased Use of Retail Clinics
By Rebecca Adams, CQ HealthBeat Associate
Editor
Insurers see retail clinics as one potential way to reduce costs and avoid
emergency department visits, experts said Monday at an Alliance
“Retail clinics will play a role as health care reform is implemented,”
said WellPoint regional vice president Manish Oza. If the U.S. Supreme Court
upholds the 2010 health care law, tens of millions of U.S.
Oza said that the insurance company had created a series of ways to inform
patients about options besides emergency care departments, including retail clinics.
The prompts include a print brochure, an online tutorial that explains which
conditions do not require urgent care and emergency department wait times and a
Google map that allows patients to type in their zip code and find a retail
clinic or other low-cost alternative nearby. The insurer also has developed a
smartphone version of the Google map but is still refining it.
RAND Corp. policy analyst Ateev Mehrotra said that the quality of care in
retail clinics is the same or better than that in other settings, such as a
physicians’ offices or urgent care centers. Mehrotra’s research also found that
retail clinics prescribed antibiotics at about the same rate as professionals
in other settings.
One concern about retail clinics has been that if patients visit a clinic
instead of a primary care physician that they regularly see, then the
patient-physician relationship could be disrupted and doctors may not know what
types of medication or care their patients are receiving. However, Mehrotra
found that this fear was overblown for a simple reason: most retail clinic
customers don’t have a regular physician who oversees their care. Fewer than 40
percent of clinic customers reported that they routinely see a physician.
Experts on the panel were asked whether they agreed with new state laws
that attempt to discourage patients from visiting emergency departments when
they have minor sicknesses. For instance, Washington
But experts at the forum said that it is hard for patients to accurately
judge when a medical concern is a true emergency and that the policy could
backfire by discouraging patients who really do need emergency care from
seeking it.
“I actually have a lot of concerns about that approach,” said Mehrotra.
“It’s a little like Monday morning quarterbacking” to determine what was urgent
and what was not.
Oza agreed that ”what Washington
Rick Kellerman, the chair of the Department of Family and Community
Medicine at the University of Kansas School of Medicine in Wichita United States
Friday, June 22, 2012
Thursday, June 21, 2012
Tuesday, June 19, 2012
Monday, June 18, 2012
How gloomy is the prognosis for Medicaid in Georgia?
How gloomy is the prognosis for Medicaid in Georgia?
Revenue shortfalls have long been a fact of life for Georgia’s Medicaid program, and the problem is not going away anytime soon.
In a financial briefing for the state Board of Community Health last week, Vince Harris noted that major money shortages in Medicaid will need to addressed in the current state budget and for the next three or four fiscal years after that.
Harris, the chief financial officer for the Department of Community Health (DCH), said the projected deficit for the remainder of fiscal year 2012, which ends June 30, is $81.7 million for Medicaid and $8.9 million for PeachCare, a total deficit of $90.6 million.
The deficit is projected to expand in fiscal year 2013 to $295.1 million for Medicaid and $13.1 million for PeachCare – a total of $308.2 million.
“The budget numbers we have are pretty daunting,” DCH Commissioner David Cook said. “We will need $100 million in the supplemental budget just to catch up with this year.”
Beyond the upcoming fiscal year, the deficit could be aggravated even more by the requirement of the federal Affordable Care Act that Medicaid be expanded to cover an estimated 650,000 additional people, Harris noted.
That would add an estimated $79.6 million to the Medicaid shortfall for fiscal year 2014 and $224.9 million in fiscal year 2015.
However, the U.S. Supreme Court is expected to rule very soon on the constitutionality of the federal healthcare act, also known as Obamacare.
If a majority of the Supreme Court, as many legal observers expect, rules the act to be unconstitutional, then those numbers for fiscal years 2014 and 2015 presumably would no longer be a problem for Georgia.
Medicaid now provides health insurance coverage for about 1.6 million low-income Georgians. About 25 percent of that population consists of people in the ABD (aged, blind, disabled) category – but ABD recipients account for 54 percent of the program’s expenditures, Harris said.
In the proposed redesign of the Medicaid program, DCH is expected to move the ABD recipients away from fee-for-service coverage and into managed care programs administered by the CMOs that coordinate care for other Medicaid participants.
“There’s pretty broad agreement that when you coordinate care, you not only get better care but you save money,” Cook said.
The economic downturn of the last four years has had a significant impact on the percentage of the state budget that is spent on Medicaid services.
In fiscal year 2007, Medicaid expenditures made up 14.3 percent of total state revenues (excluding lottery funds and motor fuel taxes), Harris said.
Today, Medicaid accounts for 17 to 18 percent of the yearly budget, Harris said. DCH spends more than $2.7 billion a year in state funds on Medicaid.
© 2012 by The Georgia Report
Thursday, June 14, 2012
Wednesday, June 13, 2012
Tuesday, June 12, 2012
Monday, June 11, 2012
Ohio drops 2 for Medicaid contracts, adds 2 others
Ohio
drops 2 for Medicaid contracts, adds 2 others
Thursday June 7, 2012 8:15 PM
ANN
SANNER
The Associated Press
COLUMBUS,
Ohio (AP) — Ohio officials dropped two managed care organizations Thursday that
had been tentatively awarded new Medicaid contracts and picked two other plans
after weeks of legal review and further examination over how each application
was scored.
The
decision came after five of six companies that lost bids for contracts filed
formal protests with the state, claiming flawed and inaccurate scoring in the
application process.
The
eventual contract winners will provide health care services to more than 1.6
million poor and disabled people, or roughly two-thirds of the state's Medicaid
population. The contracts provide billions in government work to the companies.
In
April, the state selected the winning bidders: Aetna Better Health of Ohio,
CareSource, Meridian Health Plan, Paramount Advantage and United Healthcare
Community Plan of Ohio. The winning organizations were the highest-scoring
applicants in the state's contract process.
The
plans were judged on certain components, including experience, care management
and clinical performance. The provider network was also a factor, but not as
heavily weighted.
Ohio
Medicaid Director John McCarthy said Thursday that a review of the applications
changed how points were awarded, and meant Aetna Better Health of Ohio and
Meridian Health Plan of Ohio would no longer get the contracts.
Instead,
Molina Healthcare of Ohio Inc., a subsidiary of Molina Healthcare Inc., and
Buckeye Community Health Plan, a subsidiary of Centene Corporation, were
picked.
The
contract awards are preliminary. The organizations must first pass an
assessment, in which they must prove that they will be ready and able to
provide care when enrollment begins in January.
"There
were some specific areas that plans had pointed out that when we reviewed, we
needed to make changes," McCarthy said.
For
instance, the review found that Meridian Aetna lost a large amount
of points for experience because it did not provide evidence of full liability
for certain plans with other states.
McCarthy
said he didn't know whether contract changes as a result of protest were
unusual, only that they can happen.
About
$5.1 billion in state and federal money was paid to all the managed care plans
in the fiscal year that ended June 30, 2011, according to the Ohio Department
of Job and Family Services. The state is restructuring its Medicaid contracts
as part of a package of changes expected to save more than $1.5 billion over Ohio
Among
other changes, state officials are raising performance expectations in the
contracts by linking part of each Medicaid managed care plan's payment to
standards aimed at making people healthier. The plans also will have to develop
financial incentives for hospitals, doctors and other providers that are tied
to improving quality and patients' health.
Absence of Reliable Data Hinders Effort to Curb Medicare, Medicaid Fraud
Absence of Reliable Data Hinders Effort to Curb Medicare,
Medicaid Fraud
By Emily Ethridge, CQ Staff
A lack of reliable data from states is impeding the government’s efforts to
improve prevention and detection of waste, fraud and abuse in Medicare and Medicaid,
witnesses told a House subcommittee hearing Thursday.
Although the Centers for Medicare and Medicaid Services (CMS) has made
improvements in monitoring Medicare for fraud and abuse, the agency still has
far to go when it comes to Medicaid — and both programs remain vulnerable.
Edolphus Towns of New York
But problems with Medicaid have prevented some of CMS’s auditing programs
from successfully identifying overpayments and abuse, according to witnesses
from the Government Accountability Office and the Department of Health and
Human Services’ Office of Inspector General (OIG).
Not only does each state have its own distinct Medicaid program, with
varying rules that can confuse contractors, but states often provide inaccurate
data to federal overseers.
“National Medicaid data are not current, they are not complete, and they
are not accurate,” said Ann Maxwell, a regional inspector general at OIG. “We
absolutely need national standardized Medicaid data to make these programs
worthwhile.”
That lack of reliable data affects not only the National Medicaid Audit
Program, but also the Medicare-Medicaid Data Match program, designed to help
state and federal agencies analyze billing trends in both programs to identify
potential fraud.
Maxwell said both audit programs have had a negative return on investments
— returning less money to states and taxpayers than they spent trying to track
down the fraud and abuse.
“Only limited results are trickling out,” she said.
Rep. James Lankford, R-Okla.,
questioned why $60 million was spent on the Medicare-Medicaid Data Match
program, when it recouped only $58 million.
“That doesn’t seem like a great investment in the program,” he said.
Rep. Michele Bachmann,
R-Minn., questioned why Medicaid data had not yet been added to CMS’s One
Program Integrity System (One PI), a program meant to merge Medicare and
Medicaid data. Since 2006, CMS has spent more than $100 million developing the
system.
Although the collected Medicare data is largely reliable, the quality of
the Medicaid data is far from matching it, said Peter Budetti, deputy
administrator and director for the Center for Program Integrity at CMS.
He added that CMS does not expect the matching Medicaid data to be fully
included in the system’s data repository until 2014.
“There is a complete lack of reporting, collection and verification of
meaningful data in Medicaid. The same is not true of Medicare,” Bachmann said.
She also announced plans to introduce a bill this month that would “hold CMS
accountable” to ensure that audits of state data are conducted properly.
Subcommittee Chairman Todd R.
Platts, R-Pa., questioned what CMS is doing now, when it doesn’t anticipate
being able to use the Medicaid data in the One PI system until 2014.
“We can’t just sit and wait for those data to be available,” Budetti said.
He noted that CMS is currently conducting a demonstration program with 10
states to help identify the pieces of information it needs, to help develop a
new model for Medicaid data collection.
States actually have much more complete Medicaid data than they have been
sharing with the federal government, he said, so CMS is now collaborating
directly with the states.
Budetti hopes that engagement will help “so we’re not just dependent on the
data that flow to us.”
In general, Budetti said Medicare oversight programs are “in good shape”
and have adequate technologies and systems to conduct strong audits, but that
CMS needs to “translate that advancement to the Medicaid side.”
Thursday, June 7, 2012
ACO-Type Models Growing in Medicaid
ACO-Type Models Growing in Medicaid
By Rebecca Adams, CQ HealthBeat Associate
Editor
For the past couple of years, health policy makers have been developing new
ways of delivering care in Medicare, most notably accountable-care
organizations. But less attention has been given to similar models that are a
growing trend in Medicaid.
Within the next week or so, the Center for Medicare and Medicaid Innovation
is expected to announce a round of “innovation awards” that could support
Medicaid demonstration projects that test out methods of coordinating care in a
manner similar to accountable-care organizations (ACOs). Medicare ACOs require
medical providers to coordinate care for patients. They then share in any
savings from this new model of care and, depending on the amount of risk a
group is willing to assume, they could face penalties for not meeting savings
goals.
The Medicaid versions are not all labeled ACOs and, in keeping with the
experimental state-by-state nature of Medicaid, do not all have identical
features. But at least a dozen states have begun testing different types of
programs that emphasize closer communication and shared budgets among
providers. Many of the state-based models do not emphasize sharp payment
reductions for medical providers in ACOs that do not meet cost savings targets.
However, as in the Medicare ACO models, reducing costs is one goal. State
officials are interested in the ideas behind ACO-type payment models in part
because many are facing difficult fiscal situations and hope to lower costs
through more effective coordinated care.
The innovation center, which will have up to $1 billion in Innovation
Awards to give out, may serve as a significant catalyst for the expansion of these
types of arrangements. Demonstration projects that go through the innovation
center are expected to be able to begin operating more quickly than those that
go through Medicaid state plan amendment negotiations with Centers for Medicare
and Medicaid Services (CMS) officials.
The awards that will be announced this month will be the second round of
Innovation Award funding. The goal of the center’s grants is to reduce costs
while improving care for patients.
Among the applicants waiting for news on the awards is the Boston Medical
Center (BMC), which hopes to work with community health centers and health
plans in a three-year project that will prepare the integrated system to become
a Medicaid ACO. About half of BMC patients are Medicaid beneficiaries.
Last summer, the health center had talked to White House officials about
participating in a multistate Medicaid demonstration project that would have
used global capitation rates. The demonstration project had been included in
the 2010 health care law (PL 111-148,
PL 111-152) with the help of Sen. John Kerry, D-Mass. Officials in Boston
had teamed with other health industry executives in Colorado, Florida and New
York to push for the demonstration to proceed. They estimated that costs would
decline by about 3 percent per year.
Federal officials did not move ahead with the five-state demonstration
project but did tell the group about the innovation center awards. BMC and the
Denver Health and Hospital Authority, another participant in last summer’s
proposal for a demonstration project, both applied for the innovation center
grants and are optimistic that their proposals will be funded.
“There is a hunger at the state level to do better,” said Kate Walsh, BMC’s
president and CEO.
The Denver Health and Hospital Authority, an integrated system with a
hospital and health plans, is already participating in a state-run Medicaid
program known as the Accountable Care Collaborative (ACC). State officials
divided Colorado
David Brody, the medical director of Denver Health’s managed-care plans,
said funding from the innovation center could help build the type of
infrastructure that is needed to expand capitated payment systems and hopefully
improve patients’ care through more coordination.
Brody said it has been helpful to apply for the grant and better think
through plans for the future. He said the current fee-for-service system
doesn’t drive the right kinds of changes that are needed to improve patients’
care.
“Even if we don’t get the challenge grant funding we’re requesting, we’ve
moved forward since we submitted our proposal,” said Brody. “As we look toward
the future, I’m convinced that at some point we’ll move more patients into a
capitated system of care.”
Wednesday, June 6, 2012
Obesity Report Recommends Nutritional Guidelines for Babies, Toddlers
By Jane Norman, CQ HealthBeat Associate
Editor
Recommendations in a new report on obesity issued Tuesday reach all the way
down to babies and toddlers, as policy makers increasingly seek ways to prevent
childhood obesity before it begins.
Two former Health and Human Services secretaries and two former Agriculture
secretaries teamed up to back the report by the Bipartisan
Policy Center
that offers what its Democratic and Republican authors termed possible “real
life” solutions to the very difficult problem of how to curb obesity in the United States
One recommendation is that the HHS and Department of Agriculture develop,
implement and promote national dietary guidelines for the first 1,000 days of a
child’s life, including for pregnant women and toddlers up to the age of 2.
Current guidelines, which are published every five years, begin for children at
the age of 2.
While the federal guidelines aren’t mandatory for individuals, they form
the basis of federal nutrition and food assistance programs and also may
influence state and local policies on taxation or limitations on food and
beverages.
The center’s report wasn’t specific about how guidelines should be set or
what they should consist of for this group of very young children. But former
Agriculture Secretary Ann M. Veneman said the discussion should begin because
obesity among children has become so pervasive that there are predictions that
today’s children may have lower life expectancies than their parents. Veneman
and the other former secretaries attended Tuesday’s event where the center’s
report was released.
Half of severely obese adults were obese as children, and one in five U.S.
Taste, habits and even metabolism are established very early on, and
setting guidelines earlier in life could be important, she said. “Finding
opportunities early in life to improve health outcomes is among the most
strategic, humane and cost-effective ways to prioritize our resources,” Veneman
said.
The U.S.
On the same morning that the center’s report was issued, first lady
Michelle Obama was present for an announcement by The Walt Disney Co. that food and beverage ads carried on its programming
and products will meet nutritional guidelines tied to federal standards. A new
“Mickey Check” icon will mark nutritious food and drink options in its stores,
online and at Disney parks and resorts.
The Institute
of Medicine Clinton
The two other former secretaries involved with the report were Donna
Shalala, secretary of Health and Human Services under Clinton, and Michael
Leavitt, HHS secretary under George W. Bush.
The center’s other recommendations include that:
• National physical activity guidelines should be developed for children
under age 6.
• USDA should ensure all its nutrition assistance programs reflect and
support federal dietary guidelines.
• Hospitals, employers, communities and insurers should unite to support
and promote breastfeeding.
• Schools should require 60 minutes a day of physical activity.
• The Centers for Disease Control and Prevention should develop a database
of exemplary workplace wellness programs and include a rigorous cost/benefit
analysis.
• USDA should do more to figure out ways to increase the affordability of
fruits, vegetables and legumes, including establishment of a generic fruit and
vegetable promotion board.
Tuesday, June 5, 2012
Monday, June 4, 2012
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