Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

CMS Proposed Rule Cuts State Authority to Divert Medicaid Payments

July 10, 2018 - CMS has proposed a new rule that would eliminate a state’s authority to divert Medicaid payments away from providers. The rule is intended to ensure beneficiaries have adequate access to healthcare services through direct state-to-provider payments. In 2014, CMS allowed state governments to divert Medicaid payments from providers to specific third parties, such as in-home personal ...


Articles

Medicare, Medicaid Home Health Benefits Stabilize Care Costs

by

Providing extended home health benefits for Medicare beneficiaries is likely to stabilize care costs for public payer programs, according to a new analysis from the Commonwealth Fund. Researchers from the Hilltop Institute and Johns Hopkins...The majority of expenses in the program were for personal assistance services, which cost $216 million, or 87 percent of total program costs, in 2016. Provider monitoring and training was the second largest expense, at $24 million in 2016, ...

Aetna Takes Amerigroup Spot in Kansas Managed Medicaid Contract

by

Aetna has received a Managed Medicaid contract from the state of Kansas for plan year 2019 and will replace Amerigroup as one of the state’s three managed care payers. The state received six bids from commercial payers and determined ...

How to Drive Enrollment in the ACA Health Plan Marketplaces

by

Payers and states wishing to increase enrollment in the ACA health plan marketplaces should  create targeted advertisements, benchmark silver-tier plans as their primary exchange plan, and help consumers navigate health plan purchases,...

MedPAC: Value-Based Payment, Post-Acute Care Boost Medicare Savings

by

MedPAC has advised Congress that value-based payment reform and encouraging the use of post-acute care can help the Medicare program increase savings and improve beneficiary outcomes, the group said in a new report. Revisions to payment met...

CMS Offers Opioid Coverage, Health IT Guidance for Medicaid Plans

by

CMS has issued new opioid coverage strategies and health IT guidance to help states improve opioid safety within Medicaid plans. The guidelines include advice for state programs about treating infants with neonatal abstinence syndrome (NAS)...

Medicare Bundled Payment Programs Primed to Produce Savings

by

Medicare’s bundled payment programs are in an opportune position to produce additional savings and create a more cost-effective public payer program with certain revisions, a new white paper from USC Brookings explains. CMS’s cu...

Unstable Future Predicted for Medicare, Depletion by 2026

by

The Medicare Board of Trustees (MBT)’s latest report anticipates that Medicare’s Hospital Insurance (HI) Trust Fund will deplete by the year 2026 as Medicare spending continues to outgrow the trust’s collective revenues. T...

HHS Made Nearly $90B in Improper Payments to Medicaid, Medicare

by

HHS made approximately $90 billion in improper payments to Medicaid and Medicare programs during 2017 and may require updated payment evaluation procedures to address improper payments, a new Government Accountability Office (GAO) report fo...

MSSP ACOs Taking on Downside Risk See Smaller Savings

by

Medicare Shared Savings Program (MSSP) ACOs that take on downside risk generate smaller savings than upside risk ACOs, according a Center for Healthcare Quality and Payment Reform (CHQPR) analysis. In 2016, the average annual cost of care p...

Medicaid Plans More Cost Effective, Stable than Exchange Plans

by

Medicaid health plans are more cost effective than federal exchange plans and could offer beneficiaries more affordable coverage options, according to a UnitedHealth Group analysis. UnitedHealth Group said that federal healthcare agencies c...

CMS Highlights Drug Price Transparency Data Dashboards

by

CMS has released redesigned drug price dashboards to provide information about manufacturer drug costs and advance the agency’s goals of promoting consumer price transparency. Patients, providers, and researchers are able to explore d...

MD Extends All-Payer Model, Targets $1B in Medicare Savings

by

Maryland Governor Larry Hogan and CMS have announced a five year extension of the state’s All-Payer Model, targeting an additional $1 billion in Medicare savings over the coming years, according to a public statement from Hogan’...

Medicaid Spending Drops When Members Transition to Community Care

by

Medicaid spending declined when beneficiaries transitioned from long-term institutional care into community care, a new report conducted by Mathematica Health Policy found. Researchers observed cost outcomes of Medicaid’s Money Follow...Healthcare expenditures for MFP beneficiaries averaged $7892 per month, with institutional care expenses accounting for nearly $4000 of total spending. The first year of the MFP led to a decrease in average monthly expenses of $6351 per mem...

Medicare Diabetes Prevention Program Offers Model for Chronic Care

by

CMS’s Medicare Diabetes Prevention Program (MDPP) aims to address diabetes prevalence within the Medicare program, and may help other payers develop a model for chronic care, based on the MDPP’s promising initial results. Diabet...

CMS Value-Based Payment Programs Show Satisfactory Performance

by

CMS value-based payment programs, including Medicare accountable care organization (ACO) initiatives, have met many of their goals in recent program years, although some work remains to accelerate growth and achieve federal targets, accordi...

Humana Launches Bundled Payment Model for Maternity Care

by

Humana has launched a bundled payment model to improve outcomes and lower costs of maternity by partnering with OBG-YNs across the country. Humana’s Maternity Episode-Based Model bundles payments that covers the cost of a mother&rsquo...

HHS Must Address Adverse Selection in Medicaid, Medicare Renal Care

by

AHIP is urging HHS secretary Alex Azar to address adverse selection related to Medicaid or Medicare end stage renal disease (ESRD) in order to ensure that vulnerable beneficiaries continue to receive appropriate healthcare services. AHIP as...

Health Plan Variety Does Not Boost Managed Medicaid Performance

by

Managed Medicaid performance does not increase as state Medicaid programs introduce more health plan variety, but a single health plan with value-based characteristics may be more effective in improving performance, a new JAMA commenta...

Medicaid Coverage Creates Significant Healthcare Opportunities

by

Medicaid coverage led to significant healthcare opportunities that rivaled commercial health insurance care quality, according to a new study from AHIP. Nearly 74 million adults and children who receive Medicaid were found to have significa...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks