More states turning to managed care providers

Source: Centene.com

Many state Medicaid programs are turning to Managed Care Programs as coverage is increasing.  According to American Medical News, it's the companies that are specialized that are seeing the best chances at winning new contracts. Centene recently won the rights to manage the Medicaid population in both Louisiana and Kentucky, after expanding their business with Texas earlier this month. The article notes that many of the large investor companies like United Healthcare and Wellpoint.

Why do you think states are going with more targeted Medicaid companies when choosing a Managed Care route for their state run Medicaid?

Health Insurance Exchange Roundup: Wednesday, August 24

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.  Today we have commentary from Washington, DC, Arkansas, Wyoming, Maryland and Utah.

Here's the top news from Wednesday, August 24:

Portfolio.com: National Health Plan Relieves Businesses' Insurance Headaches

Arkansas News: Govenor, surgeon general split on health care exchanges; third opinion possible

Trib.com (Wyoming): New model for health insurance exchanges?

Times News Magic Valley (Wyoming): Knowing When to Drop Idealism in the Health Care Debate

The Daily Caller (Washington, DC): Job #1 for the budget super-committee: cut the new healthcare enrollment's cost

Insurance & Financial Advisor: Maryland's health insurance rate review process improves

The Salt Lake City Tribune: Utah Health Exchange: ‘sideshow’ or national plan foil?

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

Health Insurance Exchange Roundup: Tuesday, August 23

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.  Today we have commentary from Nebraska, Pennsylvania and Oregon.

Here's the top news from Tuesday, August 23:

Lincoln Journal Star (Nebraska): Local View: Health reform has many benefits

Associated Press: States may get second chance at insurance exchange

Standard Speaker (Pennsylvania): State grapples with health insurance mandate

Governing.com: Coordinating More Care in Oregon

Watchdog.org: Kansas Governor Seeking Federal Grant for Key Component of ‘Obamacare’ Exchange

News Gazette (Illinois): Health care group sets meeting on insurance exchange

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

Health Insurance Exchange Roundup: Monday, August 22

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's the top news from Monday, August 22:

The Spokesman Reveiw: Lawmakers back Otter, say apply for grant for Idaho insurance exchange

Under the Dome (North Carolina): Setup of state health care exchange resumes

MinnPost: Private health exchange concept gathering steam in Minnesota

Clarion Ledger (Mississippi): Launch near for health care exchange

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and approaches to the Health Insurance Exchange. For more information about joining us, visit our webpage.

Health Insurance Exchange Roundup: Friday, August 19

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's the top news from Friday, August 19:

Syracuse.com: Health ‘Mandate’: Insurance requirement is key to reform's success

Billings Gazette: Wyoming panel to gather more information before making insurance exchange decision

Nevada Appeal: State moving on health care exchanges

Medcity News: Private health exchange concept gathering steam in Minnesota

Becker's Hospital Review: A Tale of Two States: Why Kansas and Oklahoma Rejected Federal Funding for Health Insurance Exchanges


The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and approaches to the Health Insurance Exchange. For more information about joining us, visit our webpage.

HHS releases clearer guidelines for exchanges

With January 2013 quickly approaching, the government released clearer guidelines that will help many consumers and patients participate in Healthcare Insurance Exchange models by way of promising tax credits and funding grants.

The government view this program as what should be a one stop shop for consumers to see what policies they are eligible for and tax credits they will receive upon enrolling in that specific program.  Small businesses and individuals will be able to work together in order to secure better rates along with the tax breaks they are eligible to receive.

The government also announced that 16 states and Washington, DC are receiving $185 million help build the exchanges.  Another desire of HHS is that all exchanges are required to have smooth connections between the state run and federal systems.  The New York Times reports that states have already received $50 million last year, and seven states received extra incentive as early innovators on the project.

The Healthcare Insurance Exchange Congress, taking place this November 9-11, 2011; will host an IT workshop entitled Examine the IT Infrastructure Requirements of Health Insurance Exchanges to examine how to identify how to create a user-friendly experience with the online health exchanges.  For more information on this program and the rest of the HIX Congress, download the brochure.

What are the other guidance do states need from HHS to move forward in establishing exchanges?

Is the Affordable Care Act unconstitutional?

Late last week, the 11th Circuit  US Court of Appeals ruled that the Affordable Care Act is unconstitutional due to the fact that it forces all Americans to enter into a contract with a private institution.  This was the first unconstitutional ruling from a Democratic judge.  This case is not settled, as the US Court of Appeals in Virginia and Washington, DC, are going to rule on this law later this fall.  It is likely that the US Supreme Court will have to serve final say on whether the ACA is valid or not.

The Supreme Court does have options, though according to the Wall Street Journal: Should the Supreme Court adopt that reasoning on "severability"—leaving the law in place except for the mandate—it could throw the health-insurance market into turmoil. That's because other parts of the law require health insurers to accept all prospective customers, even those who are already ill. In the drafting of the legislation, insurers were willing to accept the provision only if they were guaranteed an influx of millions of new customers through the coverage mandate. Minus the mandate, the law could encourage people to wait until they were sick to acquire coverage, and the partisan divide in Congress could make it difficult to amend the law to fix that problem.


The Hub took a moment to explain the current situation:



This November at the Healthcare Insurance Exchange Congress, Andrew Berenato, Director of Government & Corporate Relations, Southern Region, AmeriHealth Mercy, will be leading a panel of experts to debate the Healthcare Exchanges and the ACA. For more information the event,download the brochure.

 Do you think the ACA is infringing on individuals’ rights by penalizing those who don’t want insurance?

CMS AMPlifies Anxiety As Industry Wrestles With Non-Guidance

“MDRP Perspectives” Explores Impending AMP Ruling Implications: How To Do When All You Know Is What Not To Do?

By Marc Dresner, IIR USA

A veteran attorney and lobbyist for the pharmaceutical industry once told me that the name of the Bill speaks volumes: Whatever the title says, the inference is that the industry targeted has been doing the opposite.

Consider the Patient Protection and Affordable Care Act passed in March 2010. Based on counsel’s insight, that’s pretty cynical rhetoric.

A more appropriate title might've been the Calculation Crystal Clarity Act, because for the second time in just four years (the first being 2007’s Deficit Reduction Act) the US government turned AMP calculation into a guesswork methodology.

Jennifer Norton, iMany

According to Jennifer Norton, Senior Director of Life Sciences Strategy and Solutions at iMany—a contract performance management solutions provider—CMS has done an admirable job of telling manufacturers what not to do since 2010, but they’ve been rather vague when it comes to guidance on what to do.

As a result, manufacturers are banging their heads against the wall trying to comply with rules that to date only exist in CMS’s imagination.

But there’s a light at the end of the tunnel: CMS is expected to issue an AMP ruling soon, and chances are whatever you’re currently doing may not be completely wrong.

In this episode of MDRP Perspectives, Norton provides a comprehensive overview of the situation, identifies potential potholes to watch out for, and offers sound advice on how to best avoid becoming a casualty of well-intentioned, ham-handed regulation.

Just bear in mind that getting direction from CMS is like asking what’s the fastest route from New York to Honolulu and being told not to walk…

Listen to the podcast here.

Download the transcript here.

Author’s note: Jennifer Norton will be speaking on “New Contract Management Strategies and Practices Following Healthcare Reform” at the 16th Annual Summit on the Medicaid Drug Rebate Program (MDRP) September 14-16 in Chicago.

For more information or to register, please visit www.medicaiddrugrebates.com

And for further background and a good chuckle, check out Jen Norton’s stint as field correspondent covering the government pricing nerd uprising at CMS headquarters in Baltimore here.

ABOUT THE AUTHOR/INTERVIEWER
Marc Dresner is an IIR USA communication lead with a background in trade journalism and marketing. He is the former executive editor of Pharma Market Research Report, a confidential newsletter for market research professionals specializing in the pharmaceutical, biotech and health care industries. He may be reached at mdresner@iirusa.com. Follow him @mdrezz.

The Debt Ceiling is not affecting Medicare. Yet.

On Wednesday, Congress and Obama came to an agreement about the current debt the United States is facing.  In that, Medicare has been spared from immediate budget cuts.  Due to the number of senior citizens that rely on the system, no immediate cuts will affect their budgets.

According to the LA Times, the government does expect to see doctors, hospitals, and Medicare providers begin to monitor their expenditures and cut back.  What this may indirectly do is affect the amount of time and money primary care physicians can spend seeing those with Medicare as their insurance providers.  And if a plan is not reached to reduce the debt by the end of the year,  [the debt plan] the plan requires the federal government to impose a 2% across-the-board reduction in payments to Medicare providers starting in 2013.

Do you think Medicare will ultimately be affected by the budget cuts? In your opinion, what can be done to avoid the 2% reduction?

Florida Governor Refusing Healthcare Dollars

Florida Governor Rick Scott doesn't believe that the Affordable Care Act is constitutional.  Therefore, taking steps to share this with the rest of the 49 states, he has refused to accept any of the federal money being given to states that help them transition into the Affordable Care Act and the Healthcare Insurance Exchange by 2014.  The governor has even gone as far as to refuse any of the grants available to the state.  One of Gov Scott's main arguments with the law is that the Affordable Care Act isn't compatible with Florida and will ultimately create payment burdens that his citizens cannot afford.  According to the New York Times, They are reviewing each grant for Medicaid on a grant-by-grant basis to make sure it fits the needs of their state.

While the Gov. Scott believes this, many  lawmakers in his state disagree including Representative Kathy Castor, a Democratic Representative from Tampa Bay. She stated, “It’s simply unconscionable that they’re turning back federal tax dollars that our citizens and businesses pay and sending those tax dollars to other states. Florida’s economy has been hit very hard, and we need every dollar and every job in our state.”

At the Healthcare Insurance Exchange Congress this November, Healthcare professionals from around the United States will gather to debate the pros and cons of healthcare exchanges, lead by Andrew Berenato, Director of Government & Corporate Relations, Southern Region, AmeriHealth Mercy. For more information on the speakers and presentations at the Health Insurance Exchange Congress, download the brochure.

Do you think that turning down federal funding is in the best interest of Floridians?