Dec 11, 2018 | Behavioral, Medicaid
Last month, CMS announced a new demonstration opportunity to expand Medicaid inpatient mental health treatment services. A long-standing restriction has prohibited the Medicaid program from paying for services provided to adults in an institution for mental disease (IMD), but recent federal activity, including this demonstration, has significantly loosened the IMD exclusion. Waiver approval is contingent on states providing a complete continuum of care, with actions that are linked to CMS-defined goals and milestones. 12 states have already expressed interest in this type of waiver, and more...
Dec 7, 2018 | Managed Care Friday
1. 4: The number of vitamin D tests you can do per year, starting in January, if treating United California Medicaid patients with certain conditions, as a result of what the plan calls ‘recent clinical evidence about the test’. We would not be surprised to see this policy find its way into United coverage policies beyond California. 2. Homeless Healthcare: One woman’s story chronicles the positive impact of a program in Massachusetts designed to address gaps in care for this population: click here 3. Sound Off--Sorry Moms: United’s Community plan for Medicaid patients will no longer...
Dec 3, 2018 | Legislation/ Budgets/ Macro
Amidst real and persistent challenges of structural upheaval, political uncertainty, and change resistance, the US healthcare market abounds with opportunities for private equity managers. Healthcare represents 17% of US gross domestic product this year and is projected to account for more than 20% within the next 10 years, virtually assuring top-line growth for many ventures across the entire sector. BRG experts John Kelliher and Bryan Cote discuss these opportunities here. To read more pieces published by BRG’s ThinkSet, click here.
Nov 30, 2018 | Managed Care Friday
1. 41: The percentage of parents in our poll who said they are hiring a home health aide for their mom or dad to help prevent another fall. Falls have increased in New England (during the winter months ), largely due to dehydration, lack of a consistent diet, orthostatic/BP issues, and a range of dementia or psych influences, parents said. Of those hiring an aide, 46% said their mom or dad has a Medicare Advantage plan with Humana, United Healthcare, or BCBS, though nearly all (90%) said they aren’t sure what if any of these aide services are covered by insurance. About 85% of those hiring...
