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- Gorman Health Group on Is This Condition For Real? CMS Compliance Program Audit Findings Tied to FDR Oversight
- Liz Robinson on Is This Condition For Real? CMS Compliance Program Audit Findings Tied to FDR Oversight
- Gorman Health Group on Industry Ducks Bullets in 2016 Medicare Advantage Rate Proposal
- Jessica K on Industry Ducks Bullets in 2016 Medicare Advantage Rate Proposal
- Daniel on 2016 CMS Applications: Highlights and Basics
At the Medicaid Health Plans of America (MHPA) meeting last week in Washington, DC, there was a lot of buzz surrounding the upcoming release of an updated Medicaid Managed Care regulation. Per CMS officials speaking at the conference, the last update was 12 years ago!
For months several Wall Street analysts and others have predicted near-total adoption of the Affordable Care Act’s Medicaid expansion by the states. To date, only 27 have, and I see little optimism for more than a handful to do so anytime soon.
Last week’s approval of Pennsylvania’s Medicaid expansion waiver by the Centers for Medicare and Medicaid Services (CMS) may have been good medicine for ObamaCare Derangement Syndrome among Red State governors. Growing numbers are beginning to see the light and resistance to expansion is beginning to crumble like stale crackers. Expansion momentum is building in Republican-led states after Pennsylvania’s change of heart. Indiana, Tennessee, Utah and now Wyoming (!) may be next in line seeking CMS approval for their conservative-oriented expansion proposals. These custom Medicaid expansion proposals include administration by risk-bearing private health plans, increased beneficiary cost-sharing, job search requirements, and mandatory health assessments, among other conservative tenets.
Last week the Center for Medicare and Medicaid Services (CMS) announced the approval of Pennsylvania’s Healthy Pennsylvania plan to expand Medicaid coverage to more than half a million low-income people, becoming the 27th state to do so under the Affordable Care Act (ACA) and the 9th Republican governor. Read more
One of the best pieces of advice I ever got in business was to “fish where the fishes is”, and for health plan strategists it holds up. In this Golden Age of Government-sponsored Health Programs, one of the biggest fishing holes is Long-Term Services and Supports, and a new primer from KFF lays out the opportunity beautifully. And the hazards: patients who require LTSS are of course the most vulnerable and complex patients in the entire US health system, literally the final frontier for health plans and coordinated care. Huge risk, huge rewards.
The Alliance for Health Reform held a briefing on August 5, 2014 on “Navigating the Health Insurance Landscape: What’s Next for Navigators, In-Person Assisters and Brokers?”
In this Golden Age of government programs, the health plan industry has never had more exposure to the generally poor performance of pharmacy benefit managers (PBMs). Performance metrics in Medicare, Medicaid and ObamaCare are directly tied to PBM execution, and the recent track record of these companies means they are the Achille’s Heel of insurers.