Reforming Medicaid, a Solution?

As health care budgets continue to increase at a higher rate than inflation, government officials suggest that the solution is cuts to the Medicaid budget. Starting as early as this summer,Oregon will begin to cut Medicaid funding, and states like Arizona have proposed to do the same. To offset the costs of Medicaid, Arizona announced yesterday that they hope to start to charge a fee of $50 for smokers and those considered to be obese as an incentive to lead a healthier lifestyle. Penalizing recipients for leading an unhealthy lifestyle will also force providers to treat patients more effectively. “There is no financial incentive for a provider to reduce the number of hospital admissions, for instance, because that drives down the bottom line. We want Medicaid to move away from that concept to one that supports and financially rewards health plans and providers for supporting quality.” The fee will not apply to families with children, the elderly, people with diseases including cancer, or the disabled.

In Oregon, the state Medicaid program, Oregon Health Plan, covers about 585,000 Oregonians. “Under lawmakers' plan, payments to providers will be cut by 11.5 percent, instead of 19 percent as proposed in the governor's 2011-2013 budget.” Oregon is hoping to be able to generate extra revenue with this percentage increase, which will be used to pay back the hospitals tax and also ensure that provider’s rates won’t be cut. “They'll put the money up, but they'll get every penny back," said Republican Rep. Tim Freeman of Roseburg.

Medicaid also plays a role in the latest Planned Parenthood cutbacks. “48 percent of Planned Parenthood patients are Medicaid patients, and 60 percent of women who use health care clinics like Planned Parenthood say [these clinics] are their main health care providers.” Since so many families depend on services Medicaid offer, there’s no telling how budget cuts may affect these individuals, and if there will be a ripple effect for communities as a whole.

At the 2011 Medicaid Managed Care Congress many discussions revolved around how to do more under tighter budget constraints, and it’s sure to be a topic that we cover in-depth at next year’s event.

Call for Speakers: First-ever Health Insurance Exchange Congress

We are pleased to announce the First Annual Health Insurance Exchange conference, scheduled for November 9-11, 2011 in Baltimore. We have created this event to meet the demand for quality information on exchanges, and due to the popularity of this year’s Medicare Congress and Medicaid Managed Care Congress.

Speaking opportunities on the following topics are still available:

• • Address the Needs of the 24,000,000 Expected to Take Advantage of Exchanges
• • Compare and Contrast Basic Health Plans and Health Insurance Exchanges
• • Decide which Products to Offer in Order to Remain Competitive (health plan POV)
• • Re-Structure Broker Compensation (health plan POV)
• • Set Criteria for Qualified Health Plans and Establish or Adopt a System of Certification (state government POV)
• • Establish or Outsource the Infrastructure for Enrollment - Identify Criteria Needed to Encourage Enrollment (state government POV)

If you are interested in speaking on any of these topics, or would like to suggest another topic, please email Sarah Gordon at SGordon@iirusa.com.

If you would like to sponsor or exhibit at our Health Insurance Exchange Congress, please contact Sarah Scarry at SScarry@iirusa.com. If you are interested in becoming a media partner, please contact Allison Millner at AMillner@iirusa.com.

Innovation is the way to change US Healthcare

Steve Denning at the ReThink blog recently spoke with Jason Hwang, one of the authors of The Innovators Prescription, a book published in 2008 about how America's healthcare system needs to face disruptive innovation in order for the country to avoid bankruptcy and provide healthcare to all its citizens.  While the Affordable Care Act did result in providing healthcare to more citizens of the US, it failed to change how the delivery system worked.  Without a change in the fundamentals of how Americans access healthcare, the national debt will keep rising and rising while giving out more care without changing how the care is provided.  National healthcare is successfully provided in Norway and Finland, but they have an all encompassing system that has health systems that do not operate under silos, like our current systems with doctors, hospitals, health care clinics, etc.  The true answer for healthcare reform will come from a disruptive innovation that will reduce the cost of the processes in our national system as well as widen the access and improve the quality that American citizens provide.

What type of disruptive innovation do you finally see making a difference in the American healthcare system?  Do you think the government will be responsible or will it be a private organization that will be responsible for correcting America's healthcare system?

Patient Protection & Affordable Care Act could save as much as $120 billion in five years

With improving efficiency, the Department of Health and Human Services says that at least $120 billion can be saved over the next five years with teh Patient Protection and Affordable Care Act.  Through altering payments to caregivers by setting benchmarks for the quality and efficiency and linking them to payments, Health and Human Services is looking to save $55 billion.  Other forms of savings through this act include curbing excessive payments to Medicare Advantage Providers and saving money through patient safety programs.  Read the full story at Feirce Healthcare here.

Should states continue to move towards Managed Care programs for Medicaid?

With 16 million people expected to be eligible under the new healthcare law, state governors are looking for a way to properly finance their Medicaid programs. Many are looking at Managed Care as the answer. Managed care programs will set up an established network of providers for the enrollees to use with set reimbursement rates to those doctors, hospitals and nursing homes enrolled.

However, hospitals, doctors and nursing homes are concerned with these new programs. For doctors and hospitals, the main fears are lose of local control and a decrease in significant amounts of money due to the patients they have to continue to treat but who are unable to pay for their procedures. But for the enrollees, the Managed Care Network provides access to hospitals and physicians who strive to provide the best preventative and primary care. These measures reduce the overall cost of healthcare in the first place.

What are some of the benefits for doctors and hospitals to be included in a Managed Care Programs?

Source

The 19th Annual Medicaid Managed Care Congress takes place next week in Baltimore, Maryland.  Join other states and Medicaid Managed Care experts to help you catch up with the industry as well as gather knowledge to create a managed care program for your state.  Download the brochure here for more information and register to join us today!

ACAP's Meg Murray joins MMCC for an exclusive podcast

With the 19th Annual Medicaid Managed Care Congress right around the corner, we’d like to present the PreConference Podcast featuring Meg Murray, CEO of the Association of Community Health Plans. Gain insights into reform and learn how to deal with the estimated 16 million newly eligibles.

Download the podcast here.

Ms. Murray will be joining us for the “Health Plan CEO Panel: Increasing Quality While Keeping Costs in Check” presentation Thursday, May 19 at 3:30 in addition to the closing panel. Download the brochure to find out more about the 2011 Agenda.

Visit the webpage and register to join us today!

The New 2011 MDRP Summit Agenda is Now Available

If you haven't seen the agenda for the 16th Annual Summit on Medicaid Drug Rebate Program and Other Public Sector Reimbursements Program yet, we've just updated it. It's available here and only requires a quick sign up.

So why is this the ONE MDRP Event you Must Attend?

• The Most senior policy and operational experts on over 110 person speaking faculty
• The Most USDOJ, NAMFCU, HHS & VA OIG Compliance officials
• The Most access to government contacts for MDRP, 340B, VA, & DoD
• The Most dispute resolution meetings with 16 states and counting!
• The Most Exhibitors and Sponsors and expanded networking time
• Don’t miss the All New Healthcare Reform Compliance Symposium

** Also don't forget to...

submit your nomination for the 2011 MDRP Lifetime Achievement Awards

take a guess at the keynote for a chance to win an iPad 2! Click here to compete