红领巾瓜报 Insights: Your source for healthcare news, ideas and analysis.
红领巾瓜报 Insights 鈥� including our new podcast 鈥� puts the vast depth of 红领巾瓜报鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.
In conjunction with the Kaiser Family Foundation (KFF), a team of 红领巾瓜报 experts have published survey results and analysis examining administration of the Medicaid pharmacy benefit. 红领巾瓜报 contributing colleagues were Kathleen Gifford, Anne Winter and Linda Wiant.听Rachel Dolan,听Marina Tian, and听Rachel Garfield from KFF also contributed.
The report, , summarized the survey conducted in all 50 states and the District of Columbia.
The survey outlines Medicaid pharmacy policy areas and key issues to watch based on feedback from the states in several categories including pharmacy benefit administration, cost-containment and utilization controls, payment and rebates, 340B management and long-term priorities.
Working in conjunction with Arnold Ventures, a team of 红领巾瓜报 consultants has written an issue brief, Medicare-Medicaid Integration: Integrated Model Enrollment Rates Show Majority of Medicare-Medicaid Dual Eligible Population Not Enrolled. This brief presents key findings on their examination of the availability of integrated programs in states, the growth in enrollment rates, and differences in enrollment and programs across the country.
The 红领巾瓜报 team cited several reasons why Medicare-Medicaid integrated program options are not equally available nationwide and why enrollment is limited in places where programs exist. The result is that millions of people are not enrolled in whole-person, integrated program options 鈥� a reality that is inefficient, and worse yet, inequitable.
The 红领巾瓜报 team, led by Managing Principal Jon Blum and Principal Sarah Barth, includes Narda Ipakchi, Ellen Breslin, Mindy Cohen, Sharon Silow-Carroll and other 红领巾瓜报 subject matter experts.
A team of 红领巾瓜报 behavioral health experts have developed a and white paper addressing changes to California鈥檚 county behavioral health programs and provide a guide to help counties and stakeholders determine the best path forward.
Individuals with behavioral health needs often find themselves involved with law enforcement or in hospital emergency rooms during times of crisis. 红领巾瓜报 (红领巾瓜报) has released a model framework examining a third option for care 鈥� Crisis Diversion Facilities.
红领巾瓜报 Community Strategies (红领巾瓜报CS) experts have released a pair of evaluation reports commissioned by the City of Los Angeles and the County of Los Angeles.
红领巾瓜报CS worked with the Los Angeles Housing + Community Investment Department (HCIDLA) to facilitate the inaugural, interactive Los Angeles Poverty Prevention Summit and produced a report and policy recommendations.
红领巾瓜报CS is involved in continued work to address homelessness, poverty and other social determinants of health in Los Angeles County and beyond with the goal of improving health and wellbeing, particularly for at-risk patients and families.
The 红领巾瓜报CS teams, led by Principal Charles Robbins, also included Catherine Guerrero, Nayely Chavez, and Rathi Ramasamy as well as Michael Stiffler and Kara Riehman.
Starting in 2021, Medicare beneficiaries with End-Stage Renal Disease (ESRD) will be able to enroll in any Medicare Advantage (MA) plan. The Anthem Public Policy Institute asked 红领巾瓜报 to explore some of the potential issues associated with how MA plans are currently paid by the Centers for Medicare & Medicaid Services (CMS) for individuals with ESRD, and identify any possible modifications that CMS or Congress could make to more closely align payment with costs.
This white paper was prepared for Anthem Public Policy Institute by 红领巾瓜报 Managing Principal Jon Blum, Principal Eric Hammelman, and Senior Consultant Narda Ipakchi.
On January 30, 2020, the Missouri Hospital Association issued a press release outlining a report prepared by 红领巾瓜报. .
The report, Medicaid Expansion in Missouri – Economic Implications for Missouri and Interviews Reflecting Arkansas, Indiana, and Ohio Experiences, was prepared by 红领巾瓜报 MMS Managing Director Matt Powers and Managing Principal Sharon Silow-Carroll, and Jack Meyer. They conducted interviews with leaders directly involved with expansion in Arkansas, Indiana, and Ohio to evaluate the policy and operational adjustments they undertook to design a budget-conscious program while maximizing state value. Those interviews allowed clarification of many of the questions raised about state-level costs and budget savings of a potential Missouri expansion.
The report was commissioned by the Missouri Hospital Association and Missouri Primary Care Association and released in partnership with stakeholders from the healthcare community.
This report is an update to a previous report examining hospital markups for separately paid drugs. Our prior analysis examined hospital charges and reimbursement for 20 drugs and found that hospitals marked up charges for those drugs, on average, 487 percent of their acquisition cost. We also found that hospitals receive 252 percent of estimated hospital acquisition cost from commercial payers. Hospital reimbursement data was obtained from the Magellan Rx Management Medical Pharmacy Trend Report™: 2016 Seventh Edition (the Magellan report) and charges were calculated from Medicare claims data. For more information, please refer to our prior analysis.
In previous editions of The Michigan Update (most recently in August) we have reported on the Michigan Department of Health and Human Services鈥� (MDHHS) release of a Request for Proposals (RFP) to re-procure its Medicaid managed care contracts. The RFP was released in early May with bidder responses due in early August. This procurement is for at least five years, with the possibility of up to three one-year extensions. The total cost of the procurement for five years is estimated to be $35 billion. On October 13, 2015 the State of Michigan announced the much anticipated results of the re-procurement.
Since the prices paid to the contracted HMOs are set by the state, the health plan selection was based solely on technical scores. The HMOs were required to bid on entire regions, which were configured differently than in the past. The reconfiguration required a number of the HMOs to expand their service areas to meet the 鈥渆ntire region鈥� requirement. The new regional configuration appears in the map below:
Note: Region 2 and Region 3 were required to be bid together.
The RFP included a proposed number of HMOs that would be awarded contracts for each of these regions. To minimize disruptions for Medicaid enrollees, in each region (other than the Upper Peninsula) the number of plans selected was one more than the proposed maximum number of awards for that region. Proposals from the HMOs were evaluated based on demonstrated competencies and also statements of their proposed approaches to many new initiatives related to population health, care management, behavioral health integration, patient-centered medical homes, health information technology and payment reform.
Not every HMO was successful in each region for which it submitted a bid. Two plans were not successful in any region. One is Sparrow PHP, which is an incumbent plan in Region 7. The other is MI Complete Health (Centene/Fidelis SecureCare) which is not currently a Medicaid plan in any part of the state but does have an Integrated Care Organization contract to serve dual Medicare/Medicaid enrollees in Macomb and Wayne counties as part of Michigan鈥檚 dual eligible demonstration.
The following table indicates the regions for which each bidding HMO was and was not successful. In addition, the numerical values show the rank of that plan based on their evaluation scores among the successful bidders for each region. If an HMO is a current contractor for all counties in a region, their result is shaded green. If the HMO is a current contractor for some but not all counties in a region, their result is shaded yellow. The number of Medicaid enrollees currently served in each of the regions, eligible through both 鈥渢raditional鈥� Medicaid and the Healthy Michigan Plan, appear in the bottom row on the table; across all regions, this is more than 1.6 million Medicaid enrollees.
