Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

How Pharmacy Benefit Managers Lower Prescription Drug Prices

September 19, 2017 - Payers in both the private and public sectors require new strategies that offset the rising cost of prescription drugs. Pharmacy benefit managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS programs with the goal of lowering prescription drug costs, improving convenience, and ensuring patient safety for payers and their beneficiaries. As...


Articles

Arkansas Slips Up on Supplemental Medicaid Payments

by

A lack of administrative oversight led Arkansas to miss supplemental Medicaid payments, make several payments to Medicaid-ineligible providers, and receive excess Medicaid dollars, found a report from the Office of the Inspector General (OIG)....

State Medicaid Orgs Struggle to Provide Behavioral Health Services

by

State Medicaid organizations may need more than flexible funding in order to provide for the growing behavioral healthcare needs of their adult populations. In a report from the Government Accountability Office (GAO), six state Medicaid programs...

Competitive Bidding Curbs Medicare Durable Medical Equipment Costs

by

A research team from the Health Care Cost Institute (HCCI) found that the Competitive Bidding Program (CBP) lowered Medicare costs on durable medical equipment (DME), bringing spending down to levels experienced by many commercial payers. The...

Medicaid Reform Requires Outcomes-Based Innovation, Better Data

by

Medicaid has steadily provided low-income patients with quality healthcare coverage and could further improve by addressing problematic areas through outcomes-based innovation and data analytics infrastructure, according to commentary published...

Payers May Be Neglecting a Growing Medicare Advantage Market

by

Payers may be able to secure more of the growing Medicare Advantage (MA) marketplace by expanding their member messaging efforts and improving consumer education about what the supplementary plan has to offer, according to a new J.D. Power survey....

Low Medicaid Payment Rates Decrease Residential Care Quality

by

Low Medicaid payment rates discourage providers to serve Medicaid beneficiaries in residential care services (RCS) that in turn can cause beneficiaries to purchase more expensive long-term support services (LTSS) according to a new study from...

CMS Approves State Capitated Medicaid Program in Florida

by

Florida received CMS approval to operate a state capitated Medicaid program and a low-income pool (LIP) to improve care for uninsured individuals, the federal agency announced. The state submitted a request to extend Florida’s Managed Medicaid...

Medicaid Tops Private Insurance in Consumer Satisfaction KPIs

by

Medicaid critics have argued that enrollees are not receiving adequate care under the program, but recent consumer surveys indicate that beneficiaries are highly satisfied with their options.   According to a new J.D. Power poll, Medicaid...

Socioeconomic Data Improves Public Health, Payer Programs

by

CMS programs recognize that the social determinants of health (SDOH) play a large role in the health of their beneficiaries and, when neglected, can create negative health implications for beneficiaries covered by Medicare, Medicaid, and CHIP....

CMS Proposes Medicare Home Health Agency Payment Changes

by

CMS proposed Medicare home health agency payment changes in a new rule intended to reduce provider burdens and advance flexible, transparent payment models in the next two years. “CMS is committed to helping patients and their doctors make...

CMS to Host Summit on Behavioral Health Payment, Care Delivery

by

CMS has opened registration for a one-day summit where healthcare experts can discuss ideas about innovative behavioral health payment models and related care delivery systems. The Behavioral Health Payment and Care Delivery Summit will take...

Medicare Hospital Insurance Trust Fund Depleted by 2029

by

A statement released by HHS and CMS’s Medicare Board of Trustees (MBT) indicates that the Medicare Hospital Insurance Trust Fund is likely to be depleted by the year 2029. The report suggests that the difference between Medicare income...

Medicaid Beneficiaries Satisfied with Coverage and Access

by

A recent Harvard Chan School of Public Health analysis found that Medicaid beneficiaries are overwhelmingly satisfied with their coverage and access to providers.  The nationwide survey of more than 60,000 beneficiaries also evaluated enrollees...

Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut

by

A significant rollback of Medicaid coverage in Tennessee has led to a spike in late stage diagnosis for breast cancer, according to a new data analysis published in the American Cancer Society journal Cancer. The research team led by Virginia...

Texas Requests Medicaid Waiver Extension for $6.2 Billion

by

Although Texas refused federal funds in the 2014 ACA Medicaid expansion, it has recently submitted documents requesting its second Medicaid waiver extension for $6.2 billion.   Originally approved in 2011, the 1115 Medicaid Waiver was...

CMS Uses Gender, Race For Quality of Care Medicare Study

by

The CMS office of Minority Health released a report with data on the quality of care received by Medicare Advantage (MA) enrollees by gender in four ethnic or racial categories.  The data generated by these reports was not used to evaluate...

Cigna Re-enters Medicare Advantage Market With CMS Approval

by

Cigna announced in a securities filing that it had received the green light from CMS to begin offering Medicare Advantage plans again after an 18 month suspension.  The insurer had been banned from offering the popular Medicare supplement...

Flexibility and Innovation Needed To Control Medicaid Costs

by

As state and federal regulators debate the future of Medicaid spending, health researchers have identified the need for flexibility and innovation in Medicaid policies involving payment models, delivery of care and drug costs. The recommendations...

Medicaid Enrollment a “Lifeline” for Rural Residents, Children

by

Medicaid enrollment rates are highest for adults and children in small town and rural areas, providing a “lifeline” for low-income beneficiaries, according to a new analysis by the Georgetown University Center for Children and...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks