Today Only! Register for MMCC & Save $400

It’s Friday the 13th but you are actually about to get lucky!

 

Today is the last day you can save up to $400 for IIR’s Medicaid Managed Care Congress (MMCC). Use the code XP2026BLOG to redeem your savings. Register now!

Download the updated agenda.

Hope to see you in Baltimore his May!

Join the Largest MMCC Ever | Last Chance to Register

The 22nd Annual Medicaid Managed Congress is less than a week away, and this year will be the largest and best attended meeting to-date. With more attendees and companies attending than ever before, you can’t afford to miss the industry’s leading event. Reserve your seat today before time runs out…

Don’t just take our word for it—the numbers speak for themselves:
350+ attendees representing 39+ states   
75 speakers representing 27 states   
187+ companies   
19 health plan case studies    
10+ hours of dedicated networking time   
9 luncheon roundtables hosted by government officials   

Reserve your seat before time runs out! Plus save 15% when using the code: XP1926BLOG

Register now & download the brochure to view the full agenda.

The numbers don’t lie—based on this year’s turnout, your healthcare peers are ready to harness the new opportunities due to healthcare reform including Medicaid Expansion, exchanges, providing higher quality care, partnering with ACOs and more! Join us May 19-22 in Baltimore as we drive next generation Medicaid managed care alongside health plan and government heavyweights.

P.S. Interested in decoding your exponentially-growing data points to drive data-driven decisions? Check out IIR’s all-new Healthcare Data Insights event here.

MMCC Podcast Series with Cindy Pigg of Magellan Medicaid Administration

Welcome to IIR’s Healthcare Podcast Series. Today we have Cindy Pigg, Senior Vice President of Pharmacy with Magellan Medicaid Administration. Click here to download the complete podcast. And make sure you join us at the 22nd Annual Medicaid Managed Care Congress taking place May 19-21 in Baltimore.

What are the unique challenges faced by states in Medicaid Managed Care Organizations? 

Cindy: Significant challenges and quite unique. Number one, how do you engage this population in managing their healthcare? We talked a little bit about this already, but we’ve got unique patient characteristics – the prevalence of mental health, the health literacy, the difficulty navigating the system, the cultural sensitivities. So, we’ve got opportunities to figure out how to engage this population. 

The challenge in managing their pharmaceutical care is that in this population, we lack two tools that are critical that we use on the commercial side that just don’t exist in the Medicaid space. Those being co-pays at a level that are significant enough to change behavior and mail order pharmacy – the home delivery pharmacies where we do a lot of utilization management using the pharmacists that are working in dispensing their mail order prescriptions. So, we’ve got to figure out that challenge of how to engage consumers with different tools unlike what we’ve used in the commercial market. 

I think a challenge that the states and the Medicaid Managed Care Organizations are going to face is really predicting the costs. There are so many unknowns. What is this patient population’s pent up demand that we talked about? What is the impact of specialty pharmaceuticals going to be in this population? I think the predictive modeling and the analytics to assist states in Medicaid Managed Care Organizations is an essential skill set that is going to be needed as we navigate these new waters. 

We talked about the access issue. There is going to be no access issue with pharmacies because you have probably have seen this in the press. There are actually more pharmacies than there are McDonald’s or Starbucks. If you just think about it, if you are looking at a pharmacy on this corner, there is probably a pharmacy on the other corner. So, access to pharmacies is not an issue, but access to physicians that we talked about is another unique challenge. 

Then we are seeing in the press every day now issues with Medicaid reimbursement. So, even if we did have enough primary care physicians, the payment mechanisms for Medicaid, I think, is a challenge that will be unique state-by-state in Managed Medicaid Organizations. 

I’d summarize this question by saying that the standardized PBM model just won’t work. These patients are unique. We talked about the challenges, but this need for a customized Medicaid strategy to deal with these unique needs is going to be absolutely essential to help the states and the Medicaid MCOs navigate these challenging waters for this Medicaid and subsidized exchange population. 


To hear more about this topic and many more, please join us at the 22nd Annual Medicaid Managed Care Congress, May 19-21 in Baltimore, MD. 

To save 15% off your registration rate, use the code: XP1926BLOG - Register Now!

MMCC Podcast Series with Perry Patton of the Camden Coalition of Healthcare Providers

 IIR's Healthcare Podcast Series

In this week’s podcast, we are speaking with Perry Patton, who will be presenting at the 2014 Medicaid Managed Care Congress in Baltimore May 19th through 21st.

Perry is talking with us today about a program that she works on as a part of the Camden Coalition of Healthcare Providers. What we’re hoping to do is get a general sense of what you and Jason are going to let folks know about at the Conference.

Why don’t you give me an overview of the program itself in terms of who the team members are, who the patients are, what the model is, where the care takes place – just kind of the basics of who, what and where.

Perry: Our program, is called the “Care Management Initiative”. What it is is a short-term – about 30-60 day intervention – that works with vulnerable patients in the Camden City area. Camden is a city in New Jersey, which definitely experiences – as does many cities across North America or a large population of people living in poverty. Many of these individuals also have complex medical problems, which sends them in and out of the hospital. What we do is target patients who utilize the hospital in the emergency room frequently.

Our patients generally --- the eligibility to be on our panel is that they have to have at least two in-patient stays or emergency department visits within the past six months and one or two of several chronic conditions that we work with like diabetes, asthma, things of that nature. So, our care team is interdisciplinary. We have a social work, RN, LTMs and intervention specialists and health coaches – that’s my role – all on board to help coordinate the care of these patients.

So, from the time that they are enrolled to the time that they graduate from the program, what we try to do is really help coordinate their care better across the board. Many of these patients are going in and out of the hospital because they don’t have the proper coordination between their different providers or just haven’t been to a primary care doctor in quite a long time. So, we help to reintegrate them into the healthcare system, get them connected to a primary care physician if they aren’t and also help connect them to other social services that will make it easier for them to take care of themselves – things like food delivery or food assistance if they need that, as well as connecting them to transportation, which is a big issue for many of our patients.



Download the rest of the Podcast here.

To hear more from Perry, please join us at the 22nd Annual Medicaid Managed Care Congress, May 19-21 in Baltimore, MD.


To save 15% off your registration rate, use the code: XP1926BLOG

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State plans for dual-eligibles face tough challenges

Via Modern Healthcare

On a bone-chilling day in January, Jennifer Turpin visited a wheelchair-bound patient named Olivia Richard at her small apartment in Boston. Turpin, a care coordinator, was conducting a home inspection for Richard, who had just joined One Care, a state program for low-income, chronically ill people who are dually eligible for Medicare and Medicaid.

Looking around the apartment, Turpin, who performs independent living assessments for the not-for-profit plan Commonwealth Care Alliance, was horrified at what she saw. Richard's sheets and dishes hadn't been washed in months, and her floor was black with dirt. Before she joined One Care, Richard did not receive consistent visits from home health aides.

“I didn't realize how bad the level of care I was getting was until that visit,” said Richard, who is 30. “If I were to get a sore on one of my legs and am lying on filthy sheets, I could get a life-threatening infection.”

Since late last year, 10 states have launched or are about to launch dual-eligible initiatives under the CMS' Financial Alignment Initiative to improve care for more than 9 million dual-eligibles by integrating Medicaid and Medicare benefits. They hope better care coordination will reduce costs for this very expensive population, currently totaling about $350 billion a year. It's estimated that about 2 million are eligible for the program in those 10 states.

But some experts question how many dual-eligible beneficiaries will voluntarily enroll in the newmanaged-care programs and whether private health plans participating in the demonstrations will get enough physicians and other providers to serve these challenging and time-consuming patients. In addition, there are questions about the quality of the plans themselves, and whether the demonstrations will produce cost savings.

While most dual-eligibles are 65 or older, around 40% are younger. Many duals under age 65 have multiple chronic health conditions, including mental-health and substance-abuse issues, or physical or developmental disabilities. Some are homeless, while others live in residential care facilities. Often the healthcare and other support services that they receive are fragmented because duals fall through the cracks of the two programs. Many duals need home- and community-based support in addition to medical and behavioral care.

While 26 states applied to participate, so far only California, Colorado, Illinois, Massachusetts, Minnesota, New York, Ohio, South Carolina, Virginia and Washington have received federal approval to start their programs. Massachusetts and Minnesota are the farthest along, having launched their programs last year. Illinois began enrollment in March, and the rest of the states are starting enrollment between April and October. Some states are targeting all their duals, while others are focusing on a subset, such as those under 65 or those needing long-term care.

“I'm glad they're moving slowly,” said Judy Feder, a Georgetown University professor of healthcare policy who has closely followed the duals demonstration. “Taking a large, fragile population and moving them into an untried new system is a gamble. Slow is better.”

To continue reading this Modern Healthcare article, please click here.

And to learn more about dual eligibles please join us at the 22nd Annual Medicaid Managed Care Congress, May 19-21 in Baltimore, MD.

Save 15% off your registration rate when using the code: XP1926BLOG 

Register Now!

MMCC Podcast Series with Dr. Tomas Gonzalez of STAR+PLUS & Cigna-HealthSpring

 Medicaid Managed Care Congress Podcast Series

Here is a teaser from our podcast series with Dr. Tomas Gonzalez

Dr. Tomas Gonzalez, Senior Medical Director, STAR+PLUS, Cigna-HealthSpring

Download the complete podcast and transcript now.

I know you’ll be speaking at the 2014 Medicaid Managed Care Congress. So, hopefully this will give folks a little bit of a preview of what your talk is going to be like in Baltimore in May.
 
Tell us a little bit about the program itself, just the “who” in terms of the care providers, the patient profile, the “what” – the care model – and the “where” in terms of the care setting.

Dr. Gonzalez: Back when Medicaid Managed Care arrived in South Texas in March of 2012, we immediately saw a challenge with our most intense and high acuity psychiatric patients. When we did a financial analysis of those patients, we saw many readmissions to the same hospitals and a high utilization rate. In fact, out of our 20 most expensive and high-utilizing members, we found that more than half of them were psychiatric patients. Nevertheless, we decided that we had to do something about these high utilizers – very, very critical – so that they could live more independently in the community.

In South Texas, there is a group called: “The Psych Nurse”. That’s the name of the company – The Psych Nurse Incorporated. They were traditionally a home-health psychiatric nurse provider for the Medicare product because in Texas, home health for psychiatry is not a covered benefit under Medicaid. So, it was a challenge and, internally at Cigna-HealthSpring, we needed to figure out how to engage the Psych Nurse because they have a very good reputation in the community and because they have a history of doing good work with the utilizing psychiatric patients.

We felt we needed to take the opportunity to engage with the Psych Nurse to be partners and help us manage this population. So, what we did was engage the Psych Nurse and say: “I think you all have what it takes. Your model of looking at the entire person, looking at the health and looking at the well-being and the independence of the psychiatric patient instead of looking at a finite number of visits per patient is going to be the right approach.” So, it took several planning sessions and we finally came to an agreement with the Psych Nurse that we would send them our sickest and our highest utilizing, highest cost members.

The framework of the program was kind of open. It was an open approach in that I would send them the name of a patient with a prior authorization for an extended amount of time – 99 visits. The Psych Nurse was then given free range to see those high-utilizing psychiatric patients as often as they thought they needed to see them – daily, every other day, seven times a week, ten times a week – whatever it took to help the patients live independently.

Now, keep this in mind. This was not a hospitalization avoidance program. Many people like to slot this program into that kind of peg. That’s not what it was designed to do at all. The program is designed to help the patients to live independently out of jails, hospitals, nursing homes and live in their home or choice of homes out in the community. So, when the Psych Nurse engages one of these members, of course, like many psychiatric patients – and these are the sickest of the sick. These are the refractory schizophrenics, the non-compliant bipolar patients, the dual diagnosis patients with polysubstance abuse and other Axis I disorders. These are the patients who many, many have discarded, many have considered un-helpable and many have considered the drain on the system that no one can really fix. Well, as we engaged these members through the Psych Nurse and we had weekly rounds with me, the Medical Director and a Psychiatrist – I am a psychiatrist – we brainstormed plans, strategized how we’re going to help these members understand 1) their medication compliance, 2) their desire and hope and need for sobriety and 3) getting families involved as much as possible. I think the Psych Nurse is extremely skilled in getting these patients to understand their own health, their own need for continued and improved mental clarity and their families.

South Texas, as you probably know, is heavily Hispanic. Mostly Mexican American. About 90% of the population is Mexican American and many of our patients only speak Spanish. The Psych Nurse is homegrown, pretty much. They are RNs – and that is the only type of nurse that we allow to see the patient. RNs – Registered nurses – who will bond with these patients in their culturally appropriate and culturally sensitive way. Some only speak Spanish. Well, our nurses only speak Spanish. 


Dr. Gonzalez will be speaking at the 22nd Annual Medicaid Managed Care Congress, May 19-21 in Baltimore, MD. To learn more about the event, click here. Save 15% off the standard registration rate when you use the code: XP1926BLOG

Register here.

Join Us Next Week's Medicaid Managed Care Congress

The 18th Annual Medicaid Managed Care Congress which is taking place next week, May 17-19 in Baltimore, Maryland.

States and Plans Bending the Cost Curve Together Through Improved Quality, Operational Efficiency and Health IT Implementation. Join us and these companies at the Medicaid Managed Care Congress:
AARP * Alabama Children's Health Insurance Program * AmeriHealth Mercy * Aquarius Capital * Arizona Cost Containment System * Arkansas Foundation for Medical Care * Association for Community Affiliated Plans * Availity LLC * Avenir * Avesis Inc * Blue Care Network of Michigan * BMC Healthnet Plan * Bristol Myers Squibb * Broadthinking LLC * Brookings Institution * CalOptima * Care Management Technologies * CareSource * Centene Corporation * Children's Mercy Family Health Partners * ClearStone Solutions * Community Health Choice Inc * Cook Children's Health Plan * Council of State Governments * Data Niche Associates * DCA Solutions * Department of Health & Human Services * Department of Health and Mental Hygiene Department of Public Welfare Bureau * DMEnsion Benefit Management * Excellus Blue Cross Blue Shield * Fallon Community Health Plan * Family Health Network * Forest Laboratories Inc * Genzyme Corporation * Government & External Affairs * Health Integrated Inc * Health Management Associates * Health Partners * Health Plan of San Mateo * HealthLeaders InterStudy * HM Strategies * HMS Permedion * Horizon New Jersey Health * Hudson Health Plan * Inspiris * Keystone Mercy Health Plan * Liberty Resources Inc * Mathematica Policy Research Inc * Maxim Health Services * Maximus Inc * MDwise Inc * Medicaid Health Plans of America * Medical Transportation Management * MedSolutions *
Merck & Company Inc * Metropolitan Jewish Health System * Molina Healthcare of Michigan * Molina Healthcare of Ohio Inc * Monroe Plan for Medical Care * Montgomery County Dept of Health & Human Services * Montgomery County Government * National Conference of State Legislature * NCQA * Neighborhood Health Plan of Massachusetts * Neighborhood Health Plan of Rhode Island * New York State Dept of Health * New Hampshire Dept of Health & Human Services * Novartis Pharmaceuticals Corporation * Nurse Response * Opticare Managed Vision
Optimetra Inc * Oregon Evidence-Based Practice Center * Pennsylvania Department of Public Welfare * PerformRx * Plasma Protein Therapeutics Associates * Preferred Care Partners * Prestige * RI Department of Human Services * SC Department of Health & Human Services * Sellers Dorsey * South Carolina Department of Health & Human Services * State of Indiana * State of Maryland Medicaid * Superior Healthplan Inc * Tejashrri Intermediateries Pvt Ltd * Texas Health & Human Services * The HSC Foundation * TMG Health Inc * UCare Minnesota * UnitedHealth Group * US Script * Virginia Premier Health Plan * Walgreens * WellCare Health Plans Inc * Wellpoint *

Visit the webpage to find out more about this year's event.

Medicaid Managed Care Congress this week!

This week, the 17th Annual Medicaid Managed Care Congress takes place in Baltimore, Maryland. The conference kicked off this morning.

Some of the highlights of the today's events are:

- A packed room of over 50 Medicaid Managed Care executives attended an intensive primer on Medicaid Managed Care including Jim Frizzera, Principal, Health Management Associates; Cindy Adams, Chief Operating Officer, Superior Healthplan; Pamela Coleman, Director of Health Plan Operations, Texas Health and Human Services Commission; and Vernon Smith, PhD, Health Management Associates.

Some of the highlights included:
-More states need to focus on rewarding quality to improve hedis scores with NCQA.

-Holding all things constant Medicaid growth may level off however growth is expected in the aged and disabled populations. However significant expansion is still expected.

-Others joined in an a health literacy workshop lead by list speakers.

If you're attending the 17th Annual Medicaid Managed Care Congress and would like to share your insights about what's being discussed at the event, post your thoughts in the comments or email jpereira@iirusa.com!