August 17, 2016

Researchers from the Harvey L. Neiman Health Policy Institute suggest mammography may present an opportunity for the expanded use of bundled payments in radiology. Their study points out that breast cancer screening provides a framework for radiologist-led bundled payment models that can be implemented with different services depending upon a practice's specific patient panel. The researchers used Medicare claims and data from a private health system to develop a bundled payment model for mammography.

August 17, 2016

In a memo to the Bureau of Prisons, Deputy Attorney General Sally Yates told it to start reducing "and ultimately ending" the Justice Department's use of private prisons. The announcement follows a Justice Department audit that found that the private facilities have more safety and security problems than government-run ones. The Obama administration says the declining federal prison population justifies the decision to eventually close privately run prisons.

August 17, 2016

Spending on prescription drugs in Medicare Part D increased 17% from 2013 to 2014, according to data released by CMS. Drug costs in the program grew from $104 billion to $121 billion between 2013 and 2014, the data shows. The data set is compiled from drugs paid for by Medicare Part D, including 38 million beneficiaries. That's about 70% of all Medicare beneficiaries. The data comes from claims from more than 1 million providers.

August 17, 2016

Older dual-eligibles who presented to the hospital with myocardial infarction had better rates of medication adherence compared with those who were eligible only for Medicare, according to a study. However, the dual-eligibles had higher rates of 30-day readmissions, death at one year and major adverse cardiovascular outcomes at one year.

August 17, 2016

A UMass Medical School-led study aimed to assess the impact of a Massachusetts Medicaid policy change known as the Children's Behavioral Health Initiative (CBHI) on primary care practice examining the relationship of behavioral health screening to subsequent behavioral health service utilization. CBHI required and reimbursed behavioral health screening with standardized tools at well child visits and developed intensive home- and community-based BH services. The study found:

August 16, 2016

Ohio's Section 1115 waiver application proposal includes a number of changes that would affect Medicaid beneficiaries. The state wants to modify its existing waiver and to change coverage for non-expansion parents, pregnant women and other traditional Medicaid adults. Changes include:

July 12, 2016

As New York shifts the bulk of its Medicaid payments to value-based care, the state has an opportunity to use new payment models to transform care for its youngest patients, a report says. Written by Bailit Health and funded by the Schuyler Center for Analysis and Advocacy and the United Hospital Fund, it highlighted the fact that the default model of value-based care for adults doesn't work for most children, who tend to be healthy and use health care differently from adults.

July 11, 2016

Many babies born to mothers who are covered by Medicaid or CHIP are automatically eligible for that coverage during the first year of their lives. A federal policy that requires eligibility be reevaluated on their first birthday means many toddlers, likely still eligible for coverage, fall through the cracks. An analysis of data from the 2014 American Community Survey found children between the ages of 1 and 2 were less likely to be covered by Medicaid or CHIP than infants.

July 10, 2016

Medicaid dental benefits administrator DentaQuest said its partnership with MassHealth to manage the dental benefits of the state's Medicaid recipients will continue. DentaQuest said it'll implement new programs to improve outcomes and lower costs for Massachusetts.

July 07, 2016

A Commonwealth Fund report found tax credits offered through the ACA have made health care plans more affordable for those with low to moderate incomes, and are likely to alleviate any premium increases for that demographic in 2017. Its survey found:

July 06, 2016

CMS is placing primary care at the forefront when it comes to the proposed changes in the Medicare physician fee schedule. CMS Acting Administrator Andy Slavitt and Dr. Patrick Conway, acting principal deputy administrator and CMO, said the agency is placing a value on primary care and care coordination to keep people well and lower health care costs.

July 06, 2016

According to KFF, medications covered under the Part D prescription drug benefit amounted to 13% of the $97 billion Medicare spent on medications in 2014. Spending under Part B of the benefit accounts for 3% of that total. In the past few years, per capita Part D spending has risen 2.5% between 2006 and 2015, mainly due to treatments for hepatitis C.

July 05, 2016

Children covered by Medicaid and equally sick children not covered by Medicaid received essentially similar asthma treatment in a given pediatric hospital, according to a study co-authored by researchers from the Center for Outcomes Research at the Perelman School of Medicine at the University of Pennsylvania. The median patient cost was $4,263 for Medicaid patients versus $4,160 for non-Medicaid patients, very similar results.

June 22, 2016

In this interview, Lori Coyner, state Medicaid Director at the Oregon Health Authority, discussed the metrics report which reveals performance measures for the state’s Coordinated Care Organizations (CCOs), she also talks about the state’s 1115 waiver renewal process.

June 21, 2016

Milliman research into the administrative expenses associated with risk-based Medicaid managed care plans summarizes the calendar year 2015 experience for selected financial metrics of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners annual statement.