Feb 20, 2019 | Medicaid, Medicaid Managed Care
Early this month, the North Carolina Department of Health and Human Services (DHHS) announced the five managed care organizations that will receive a combined $6 billion in annual Medicaid contracts, for a period of five years, starting in November 2019. This brief highlights awards and next steps. The announcement follows a multi-year process that began in 2015 when the state legislature ordered the Medicaid program to transition to managed care, with supporters of the switch arguing that it would help contain costs while improving the health of beneficiaries. Click to read more.
Feb 15, 2019 | Managed Care Friday
560,000: The number of referrals United Healthcare made over the last couple years to social services for its Medicare enrollees. United hopes to start creating diagnosis codes for social determinants of health, like housing, food and transportation…actual diagnosis codes (ICD-10 codes) have been rolled out first for helping address social determinants of health in Medicare patients. Medicaid related codes are next. About 1 million Medicare Advantage enrollees identified a social related issue connected to their health, a United spokesman confirmed. The Parkland Center for Innovation in...
Feb 12, 2019 | Legislation/ Budgets/ Macro, Medicaid
According to a report published by Politico last month, the Trump administration is currently drafting guidelines which would give states the ability to implement Medicaid block grants—fixed amounts of Federal Medicaid funding in exchange for flexibility in program design. This brief dives into the issue. Click to read more.
Feb 11, 2019 | Legislation/ Budgets/ Macro, Payers
There has been recent activity on Capitol Hill regarding so-called “surprise billing” and the President has indicated support for legislation to protect consumers from unexpected medical bills. The issue has historically pitted providers and payers, both powerful interest groups, against one another, and most legislative activity to-date has been at the state level. While some recent state laws may serve as models for Federal legislation, Congress’ ability to reach consensus is far from certain. Click to read more.
Feb 8, 2019 | Managed Care Friday
1. Where There’s Smoke: People with schizophrenia are 3 times more likely to smoke than other people and tend to smoke more heavily in an effort to control their symptoms related to their mental illness, according to the Mental Health Foundation. Of note, Rhode Island’s BCBS insurer just partnered with OutcomesMTM and schizophrenia is among the focus areas. Overall, patients taking 8+ Part D drugs and have incurred at least one quarter of their annual drug cost in the last 3 months are ‘targeted’. Patients pay nothing to be involved. 2. Diamonds Are a Doctor’s Best Friend: A care manager and...
Feb 7, 2019 | Medicare Advantage, Payers
With the recent release of proposed Medicare Advantage rates and policy updates for 2020, BRG is providing a series of briefs this week on Medicare Advantage, leading up to a discussion tomorrow on “the State of Medicare Advantage” at 11am EST (click here for more info). This brief uses the latest CMS data to provide an update on MA enrollment. Click to read more.
Feb 6, 2019 | Medicare Advantage, Part D, Payers
CMS released the 2020 Medicare Advantage (MA) Advance Notice and Draft Call Letter. The proposed rate updates are estimated to increase MA plan payments by +1.59%, with another +3.3% increase due to plan risk coding behavior. This brief discusses the proposed rate updates as well as proposed policy changes to MA and the Part D program. Click to read more.
Feb 5, 2019 | Hospice, Medicare Advantage, Payers
For several years, the CMS Innovation Center (CMMI) has been running a Value-Based Insurance Design model that allows Medicare Advantage plans to use innovative benefit design in limited geographies. CMMI has now announced expansion of the model nation-wide as well as additional plan flexibility. Click to read more.
Feb 1, 2019 | Managed Care Friday
If You Build It….Psych Field Gets Boost In Iowa What It Means to the Emerging Trend in Psych Services Wait times for seeing psychiatrists or psychologists average 2-4 months, according to our poll of 231 school counselors, PCPs, and hospital discharge planners in Iowa, but there is hope in a new program out of Broadlawns Medical Center. The hospital has a new psych residency program. University of Iowa Hospitals had the only psych training program here until this one. Several Iowa hospitals closed their mental health units in recent years, not due to low demand but low supply, says Martin...
