During the past few months, insurance industry insider Bob Laszewski has chronicled many of the failures of ObamaCare’s launch. He has raised some very important questions and concerns from the insurance industry about future policy and premium bumps that lay ahead under the ACA. Unfortunately, his recent attack on Republican governors and state lawmakers who have rejected ObamaCare’s misguided Medicaid expansion completely misses the mark. He contends that Arkansas’ “Private Option” is really just a block grant for Medicaid. But the truth lies in the fine print, and while there is no question the Private Option puts state taxpayers at risk, it also creates a new entitlement and ceded most of the control for the program to the federal government. It’s like putting the fox in charge of the hen house.
[Reuters] By Caroline Humer - Texas is reconsidering whether to impose strict limits on Gilead Sciences' $84,000 hepatitis C treatment for patients on the state's Medicaid health plan for the poor, at the urging of outside advisers, a state...
After fierce disagreement, the state Medicaid program and a coalition of doctors and hospitals devised a plan that last year helped cut nearly $34 million from expensive unnecessary emergency-room visits.
The National Committee for Quality Assurance, under increasing pressure to demonstrate the value of its recognition programs, previewed new patient-centered medical home standards intended to put more emphasis on team-based care, integrating behavioral health and sustaining practice transformation.
Texas Medical Association's insight:
TMA says: Promote the patient-centered medical home for every Texan
Consider that the costliest 1 percent of patients in the United States account for more than 20 percent of what the nation spends on health care. They are older patients with cancer, diabetes, heart disease, and other serious chronic conditions. Many have multiple health problems, and their relatives might not be helping with their care. Most have private insurance and are white and female.
As public and private payers look for ways to lower costs, improve patient outcomes, and ease burdens to access, they are turning to models of care that both increase economic efficiencies and enhance patient care. One of these is the patient-centered medical home (PCMH) model. A PCMH is a primary care physician or physician-led team who ensures that patient care is accessible, coordinated, comprehensive, patient-centered, and culturally relevant. The physician or team directly provide, coordinate, or arrange health care or social support services as indicated by the patient’s individual medical needs and the best available medical evidence. The model uses a team-based approach with the patient’s primary care physician leading the overall coordination of care. Trained teams and well-constructed electronic health records (EHRs) are key to a successful PCMH.
TMA supports the use of the PCMH model in Medicare, Texas Medicaid, and commercial insurance plans. Public and private payers have, increasingly, been looking to this model as a way to reduce fragmented care, lower costs, avoid repetitive and costly procedures, and improve patient outcomes. Given the budget constraints that Texas faces and a growing population with unique health care needs, the PCMH offers the potential for Medicaid cost savings as well as improved patient outcomes and physician and provider satisfaction.
As millions of newly eligble Americans sign up for Medicaid health insurance for the poor under the Affordable Care Act, pressure builds on states and their Republican governors that have balked at going along with the health law's expansion of the program. Under the law, states have a choice about whether [...]
After months of anticipation, Gov. Gary Herbert released a proposal Thursday to use federal money to help 111,000 low-income Utahns buy private health coverage, saying the state has a “moral obligation” to its citizens. “I believe we can accomplish the goal of taking care of the neediest among us in a fiscally responsible way,” Herbert said in announcing his “Healthy Utah Plan”. It is not, Herbert said, an expansion of ...
While Pennsylvania Gov. Tom Corbett, a Republican, awaits a federal decision on his request to link a work requirement to Medicaid expansion benefits, Democratic governors and GOP lawmakers in Missouri, Montana and Virginia have battled each other to stalemates on the expansion.
This issue brief provides an overview of health coverage and care in the South today, with a focus on demographics, the impact of the ACA coverage expansions, and ongoing efforts to improve the delivery system and safety net in the South.
Some industry experts are warning that states that chose not to expand Medicaid coverage under Obamacare could see higher insurance premiums next year as hospitals continue to shift the costs of uncompensated care to private insurers.
Snyder, who fought to persuade fellow Republicans in the Legislature to agree to the Medicaid expansion under the contentious federal health care law, said he expects 320,000 residents to sign up in the first 12 months. Early April had long been the target date for starting the "Healthy Michigan" program, but Snyder wanted to be cautious after the federal government's botched rollout of healthcare.gov, the insurance market for the middle class in 36 states including Michigan. The expansion establishes individual health savings accounts for adult recipients and requires them to pay up to 5 percent of their annual income toward the government health insurance program that Michigan runs through managed-care plans. Monthly premiums and copays can be reduced if participants engage in healthy behaviors â€" starting with completing a yearly health-risk assessment to identify smokers, substance abusers and those who are overweight or not up to date on vaccinations.
Healthcare providers in Nebraska, New Hampshire and Maine are anxiously monitoring hearings in their states as lawmakers debate whether Medicaid will be expanded, while providers in Utah and Virginia will continue lobbying in advance of likely special sessions to settle the issue.
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