Full Speed Ahead!

By Richard Yadon, President and CEO, Managed Medicaid Services, Host of Medicaid Matters talk show

Yesterday I visited the Navy Memorial in Washington DC. Being a Navy veteran it has special significance to me. Being there brought back a flood of memories from my days of active duty and reserve service. Those days weren’t always easy. I can remember being on the naval gunfire line off the coast of Beirut supporting the Marines at the airport in 1983. This was just a few day after the devastating terrorist attack which killed over 200 Marines. Nobody knew if or when something bigger might be aimed at the US military. Despite the uncertainty and anxiety, our ship’s crew always operated with precision and success.

It would be easy to let the uncertainties and anxieties in Medicaid managed care get you down. There are many challenges being discussed here at the Medicaid Managed Care Congress. In the sessions I attended this morning I’ve heard from everyone from state officials to health plan presidents. Topics such as provider capacity, ambiguous exchange regulations, and the integration of behavioral care in the community have all been discussed. Each topic represents a significant operational and financial challenge.

At the back of everyone’s mind is what will happen with the Supreme Court ruling. It could mean the end of the federally mandated expansion of Medicaid. This only adds to the uncomfortable atmosphere of uncertainty. Not an easy thing to manage given the amount of money entrusted to Medicaid managed care organizations and the millions of people they serve. I can think of several industries in which similar challenges and uncertainties would cause businesses to stop in their tracks.

That is not the case here. This broad collection of Medicaid health plan and state leaders has no intention of letting the uncertainly stop them. They are all moving forward as if nothing were threatened, as if there was no uncertainty. It is clear that they intend to continue to succeed, and serve, in spite of the challenges in front of them. Listening to the speakers and the questions from the audience suggest only one thing – Full Speed Ahead.

#MMCC 2012 Live: Thurston Howell III vs. the Professor

By Richard Yadon, President & CEO, Managed Medicaid Services and Host of Medicaid Matters talk show

Thurston Howell III vs the Professor is how political analyst and commentator Paul Begala characterized the upcoming presidential election during his comments at the Medicaid Managed Care Congress today. This was in response to a question from the audience about whether health care is a Right or a Privilege. As pointed out by Mr. Begala, it is not a constitutionally guaranteed right; however, most Americans recognize that access to health care is the right thing to provide.

The real question being asked here is “What will happen with Medicaid this year?” There are two big events coming in the next several months that have potentially significant impacts on the future of Medicaid. One event is the Supreme Court’s decision in June about ACA and the second is the presidential election. Mr. Begala’s answer to this question is that no one really knows. One thing that could happen, however, is that we all lose sight as to what Medicaid is really about.

Whether it is a right or a privilege is immaterial to the Medicaid population. They are people who need help accessing and affording essential health care. The debate about how to best pay for this is a legitimate discussion. We have the means and expertise to help those who need it most. That is what everyone at this Congress is focused on. We will be hearing a lot about Block Grants, budget proposals, eligibility limits, constitutional considerations, and campaign promises for the rest of this year. Let’s not let all that talk take away from the real mission at hand.

#MMCC2012: The ACA as an Opportunity for Pharma Companies to Increase the Proper Use of Medication

Monday at the 20th annual Medicaid Managed Care Congress, Cindy Pigg, SVP of Pharmacy at Magellan Medicaid Administration shared that the ACA is the largest opportunity for the pharmaceutical industry since Medicare Part D. By 2019, there’s expected to be more than 25 billion dollars spent on pharmaceutical drugs. This is a huge increase, especially considering during the recession, a lot less people went to the doctor’s office, and of those, a fair amount got prescriptions but never got them filled. Therefore, as a part of the ACA, pharmaceutical organizations have not only the opportunity to grow, but also to give lifechanging medical access to those who have not had access in years.

However, funding is limited, so pharma companies need to demonstrate the increase in the value of the drug (the trifecta of access, quality and cost). States are increasingly looking for comparative effectiveness studies, although at this point the data is quite limited. It doesn’t matter how your drug may hold up against the placebo, what matters is how it increases the patient’s overall health, including patient adherence. Judi Grupp, CEO of Physicians Pharmacy Alliance, suggested that PCMHs and ACOs are one way to increase the patient’s health, and ensure they’re taking the right amounts of the right prescribed medications.

What are other ways pharmaceutical organizations and MCOs can work together to increase adherence?