Topic: Medicaid

The New “80/20 Rule” in Government Health Programs

John Gorman

The New “80/20 Rule” in Government Programs

Everyone in health finance and policy knows the “80/20 Rule:” 20% of patients account for 80% of health expenditures. It’s also well-established that about one-third of health outcomes are determined by genetics and access to healthcare. That means two-thirds of outcomes are attributable to social determinants of health. For 2017, we need a new 80/20 rule for Medicare Advantage and Medicaid health plans and their delegates: 80% of the services we provide beneficiaries should address social determinants and make the health services we provide more effective.

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How Market Monster Centene Sees the World Post-Trump

John Gorman

Last week market monster Centene held its annual year-end investor day where it laid out its earnings estimates for 2017 and the assumptions behind them.  Centene is the ultimate “canary in the coalmine” for President-Elect Donald Trump’s health agenda to repeal and replace ObamaCare, with its significant exposure to Medicaid and exchange/subsidized markets, and its rapidly-growing Medicare Advantage portfolio.

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Whither Medicaid, CHIP, and the Mega-Reg?

John Gorman

Most attention in health policy since the election has been on the looming repeal of the Affordable Care Act’s Exchanges and subsidies, but the far bigger story is what the incoming Trump Administration and the Republican Congressional majority are about to do to Medicaid, the Children’s Health Insurance Program (CHIP), and the Medicaid “mega-reg.” Literally 50 years of the social safety net could be shredded in the first weeks of 2017.

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21st Century Cures Bill Slips in Some Changes to Medicare and Medicaid Programs

Olga Walther

What do medical research, Medicaid provider adequacy, and Star Ratings have in common? The 21st Century Cures Act. On January 7, 2016, Congress overwhelmingly passed this piece of legislation – a package of proposals which will provide $6.3 billion for medical research over the next decade.

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Trump Transition Team Picks Price, Verma to Head HHS, CMS; Providing Predictions for 2017 Agenda

Olga Walther

This week, Representative Tom Price was named the nominee for the new Department of Health & Human Services (HHS) Secretary. This widely expected pick provides us some foresight into what type of agenda to predict from the Trump Administration. Tom Price is one of the strongest opponents of Obamacare, from the very passage of the Affordable Care Act (ACA). Putting such a firm critic of the law as the head of HHS immediately sends the message we will see “below the waterline changes” and chips away at Obamacare before any repeal is even voted on. Price will soon have control of the constant flurry of subregulations and guidance put out by the Centers for Medicare & Medicaid Services (CMS) on a daily basis. Need an example? CMS released its early preview of CY2018 Medicare Advantage rate book growth rates this week. While the 2018 preliminary baseline rate increase is 2.31%, the actual rate will be finalized in April 2017 by the new Administration.

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What Do the 2016 Presidential Election Results Mean for Government Programs?

John Gorman

In a shocking victory, Donald Trump is our new President-elect, and Republicans held on to control of the House and Senate. The sweep gives Republicans wide control to pass significant legislation and reshape the federal government, including the entire federal civil service and the Supreme Court, in the next four years.

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2017 Readiness Checklist – Valuable Tool or an Exercise in Redundancy?

Julie Billman

Some people are list makers and wholeheartedly embrace the value of checklists. They utilize lists to manage tasks, stay focused, and ensure high-quality results. A publication by the Institute of Health’s Committee on Quality of Health Care in America, titled “To Err is Human: Building a Safer Health System,” lays out the value of checklists in improving patient safety. We should view the Centers for Medicare & Medicaid Services (CMS) Readiness Checklist in that same view: it is a tool to allow health plans to improve the quality and compliance of their health plan and safety of their members.

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