Smart Savings
CT Medicaid’s managed fee-for-service model saved $300 million last year
Updated 2/19/2019 We got very good news on Medicaid spending, again, at last week’s MAPOC meeting. Per member costs were down 2% from 2016 to last year, even despite hospital rate increases, saving taxpayers $300 million. The state’s share of Medicaid has barely budged since 2014, despite huge enrollment increases. CT remains behind other states…
Read MoreMixed results from great study on Medicaid behavioral health interventions
Yesterday’s MAPOC Complex Care Committee meeting focused on results of an adult high behavioral health need member initiative by Beacon, Medicaid’s behavioral health administrator. The program serves high utilizers of hospital services with behavioral health needs providing intensive care management by teams of clinicians and peer specialists. Medicaid members with high behavioral health needs were…
Read MoreCTNJ: Public Health has a Free Rider Problem
Public health is the best deal on the planet. Connecticut spends only $29 per person, less than most states, on public health but $9,859 on healthcare services, more than most states. But Connecticut expects our under-funded public health system to solve this intractable health problem while all the savings go to the inefficient healthcare system…
Read MoreICER seeking new members of comparative effectiveness panel
The Institute for Clinical and Economic Review (ICER) has opened nominations for their New England Comparative Effectiveness Public Advisory Council. The council, one of three in the US, is composed of leading clinicians, patient and public representatives, methodologists, and health economists. The group meets three times each year to consider ICER effectiveness reports on the…
Read MoreHealth Affairs: CHC, Inc. eConsult program saved on specialty care and improved access
This month’s Health Affairs includes a study on the effectiveness of eConsults for Medicaid members needing specialty care. Specialty referrals are rising, especially for Medicaid members, who often experience challenges getting that care. In response to this barrier for their patients, in 2011 Connecticut’s CHC, Inc. created a system to link primary and specialty care…
Read MoreAdvocates get no answers to questions about HUSKY experiment
Last month, a group of independent consumer advocates, the Medicaid Study Group, sent questions to DSS about the impact of PCMH Plus, their new $10.8 million experimental program of shared savings in HUSKY. Advocates have been concerned about PCMH Plus’s potential to deny needed care, raise costs in the program, and erase hard-won progress. Questions…
Read MoreMedicaid update: LTSS working to keep people out of nursing homes, hospitals
Friday’s Medicaid Council meeting focused on rebalancing long term services and supports allowing more members to stay at home, if they choose, and improve quality of life. Recipients of LTSS services comprise 6% of Medicaid members but 43% of costs. On average community-based care is less costly. The comprehensive strategy that began with a 2013…
Read MoreAnother reason to be glad HUSKY fired managed care
New favorite quote – “If you have a dumb incentive system, you get dumb outcomes.” Charlie Munger, quoted by 46brooklyn A new analysis by 46brooklyn highlights the extra costs to Medicaid managed care programs of drug industry middlemen. Ohio’s Medicaid program pays $224 extra in markups to Pharmacy Benefit Managers (PBMs) hired by managed care…
Read MoreCTNJ: Capitation vs. fee for service: Which team are you on?
is a sharp divide within Connecticut’s healthcare community over how to pay for care that’s as fervent as the Yankees vs. Red Sox split. Some believe that capitation is the holy grail, but others believe that fee for service isn’t the problem and isn’t broken. Read more
Read MoreICER to report on unjustified drug price increases
Early next year, the nonprofit Institute for Clinical and Economic Review (ICER) will issue its first report on US drug price increases that are not supported by clinical evidence. ICER is a leader in assessing the value of medical treatments, including medications. ICER’s benchmark price ranges for new drugs have been used by Medicaid programs,…
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