Pioneer ACO’s- A 2013 Update

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Technology Trends in Medicaid

Did you miss last week’s Medicaid Matters Talk Show? Richard Yadon, show host interviewed Gwen Williams VP of Molina Medicaid about the latest trends driving the Medicaid eco-system forward toward 2013. Ms. Williams currently serves as the Chairwomen of the Private Sector Technology Group. Learn more about the PSTG by clicking here.

Listen in to the Medicaid Matters show recording below:

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How will the election change Medicaid?

It is a busy news morning following last nights debate. We wanted to make sure you saw this pre-debate interview with Phil Galewitz from Kaiser Health News. During the interview Mr. Galewitz addressed some of the most frequently asked questions about Medicaid. He also digs into to how Medicaid is factoring into this election season and potential impacts of each candidates proposals. Did you know that 7 out of 10 people in nursing homes are covered by Medicaid and that Medicaid spending represents about 10% of the federal budget.

Read entire article by CLICKING HERE

Medicaid Video Blog: Penny Wise/ Pound Foolish?

In this week’s Medicaid news an article about cost cutting measures in Maine caught our eye. In an attempt to reduce cost will a “cost effective solution” be thrown out the window?

Click here to read the full article

Search | Care Management Director

Are you a “roll up your sleeves and get it done” kind of leader?

An innovative, strategic and high impact Care Management Director can join one of the largest health care organizations in the US. Based in the mid-west, our client has been serving the Medicaid population for decades. They continue to be recognized as an innovator and one of the most admired companies in their state.

Listed as one the top places to work, employees enjoy a full range of comprehensive benefits, competitive salaries and bonuses, as well as community involvement and diversity. The company’s continued leadership in Medicaid creates significant opportunities for career advancement and personal and professional growth.

The High Risk Care Management Director will be the primary representative of the company in their city.   As the leader of this new program, the first responsibility is to further develop and implement the program. This includes creating partnerships with community based resources, presenting to organizations, and working with the Manager and field staff on a regular basis. In addition to program development, the Director will create and oversee a new staff development program. This will involve team and individual training across a wide variety of staff positions. Both the staff and program development responsibilities will result in this high risk care management program becoming the model for the industry. Additionally, the Director will also use their strategic and problem solving skills to assist the Vice President in special projects.

Care Management Directors with strong experience in program development are the first choice for this position. Expertise in care management protocols , experience in staff development, and experience in project management are equally prized by our client. This position is open to an RN, MSW, Clinical Counselor, or licensed Psychologist. Advanced business degrees or experience is also a plus.

Apply now to be considered. This kind of high-profile, career building position does not stay open very long!

Click Here to Contact Us

Does Medicaid Work? NPR Radio Segment

This week NPR broadcast an interview with Katherine Baicker, a Health Economist at Harvard. Ms. Baicker ran a rather unique study of residents of Oregon, who received Medicaid via a lottery system and those that did not. She was able to compare outcomes between the two groups. We think you will find the results interesting.

A new Medicaid trend, Walmart gift cards?

Is the aggressive recruitment of Medicaid recipients the latest trend? Is it legal?

We hear of cases of Medicaid fraud in which a member’s identity is obtained, they are enrolled in Medicaid and then never receive any of the services in which Medicaid is billed. Fighting this fraud continues to be one of the top areas of concern for the entire industry. This is clearly crossing the legal line.

Today we are struck by the number of times we are hearing about the legal line being pushed in regard to the recruitment of patients covered by Medicaid to go to a particular doctor, not fraud per say but a practice that many question. With millions of dollars at stake healthcare companies are becoming aggressive in the methods they use to attract patients who are covered by Medicaid.

One example is the for profit hospitals who are updating their facilities to make them more attractive to Medicaid patients who are normally served at the non for profit hospital across the street. We read with interest the following article about large dental practices in Texas that have 100’s of recruiters on the street looking to encourage patients to see the dentist. These recruiters give out gift cards or pizza coupons to encourage a Medicaid covered patient to visit the dental office that has hired them. Servicing Medicaid patients is big business and dentists in Texas are clearly scrambling to get a bigger piece of the pie.

Recruiters Scramble for Texas Dental Patients

This is an interesting trend since we often hear from Medicaid experts/guests on the Medicaid Matters Talk Show that finding providers can be one of the main issues in delivering quality care. We may be seeing the tables turn and providers looking to capitalize on serving Medicaid patients rather than turning them away. We will keep you posted.

Technology Making a Difference for Medicaid Participants

Richard Yadon, Host of Medicaid Matters had the opportunity to interview the team from United Health Care at the MHPA Awards Forum. They shared the details about their award winning program and how it is making a difference on the Navajo Nation. Please join us in congratulating the entire UHC team on this award.

More about the award winning program:
Telemedicine for the Navajo Nation

UnitedHealthcare Community & State operates the Children’s Rehabilitative Services (CRS) program in Arizona that serves about 24,000 medically complex children with congenital anomalies. A particular concern is that patients and parents living in rural, hard to reach communities often face hundreds of miles of travel to reach specialty care. In addition to long drives, these trips can mean lost wages and lost school days for the child and their siblings.

Enter telemedicine. Telemedicine means delivering health care services when the clinician and patient are at different locations using data, images, audio and video. It’s a proven way to relieve the travel burden on caregivers and make more efficient use of scarce medical resources.

Most recently we expanded the program into Tuba City, on the Navajo Nation in northern Arizona. This is a landmark program for CRS and the Navajo Nation. By matching patients with Phoenix based neurologists through telemedicine, we are able to more effectively meet the complex needs of this medically fragile population.

In the next phase we will explore expanding the program to other locations and to include pediatric cardiology, metabolic genetic and orthopedic members.

BIO- Dr. Harvinder Sareen

BIO- Dr. Harvinder Sareen

Harvinder Sareen, Ph.D., is the Clinical Programs Director for WellPoint’s Medicaid business unit. Dr. Sareen plays a key role in leading WellPoint’s initiative to promote healthier lifestyles and address childhood obesity. Under her leadership, the initiative has facilitated innovative BMI training and other resources for primary care physicians as well as partnered with academic institutions to generate evidence for school fresh fruit and vegetable bars and furthermore support legislation on child nutrition and salad bars. Her work focuses on leveraging clinical best practices, instituting functional health literacy to improve health outcomes, advancing patient-centered medical homes in Medicaid and evaluating innovative approaches such as “exergaming” for health promotion.

Dr. Sareen has spearheaded several collaborative projects with leaders in the arenas of healthcare, research, and public service including the National Committee for Quality Assurance, to pilot test the feasibility of a performance measure in childhood obesity; the Centers for Disease Control and Prevention and California Child Health and Disability Prevention Program, to promote standard screening for obesity and BMI measurement; the California Governor’s Council on Physical Fitness and Sports to promote healthier lifestyles among young adolescents in low-income communities; and the University of California, Los Angeles, to evaluate the effectiveness of the fresh fruit and vegetable bar program for the Los Angeles Unified School District.

In addition to the above, Dr. Sareen has developed SimpleSteps, a pilot wellness program for employees under the umbrella of WellPoint’s Choose Better Health program. She also co-chaired the California WellPoint Associate Wellness Committee for five years.

Dr. Sareen holds a doctoral degree from the UCLA School of Public Health with a minor in Anthropology. Her previous work includes working closely with underserved populations in northern India, the Women, Infants, and Children program in South Los Angeles, the California Healthy Start program, AIDS Project Los Angeles, First 5 Ventura County, California, and the American Academy of Pediatrics.

Dr. Sareen serves on the advisory boards of the National Institute of Health Care Management Maternal, Child and Adolescent Health Council and the Medicaid Health Plans of America (MHPA) Center for Best Practices. She is an active member of the Society for Research on Child Development and the American Public Health Association. Dr. Sareen was inducted into the Delta-Omega National Honorary Society in Public Health in 2004 and was the recipient of the MHPA Joy Wheeler Leadership Award in 2011.

How We Really Hope the Supreme Court Will Rule on the Affordable Care Act

This is a guest post by Paul Gionfriddo, re-printed with permission. The original post can be found at The opinions expressed here are Mr. Gionfriddo’s and not necessarily the opinions of Managed Medicaid Services. Mr. Gionfriddo also will be sharing his thoughts on today’s Medicaid Matters Talk Show. Click Here to Listen Live at 1pm EST.

The Affordable Care Act has finally had its days in court this week.

And commentators who were certain on Monday that the Supreme Court would uphold the individual mandate were just as certain on Tuesday that it would not. Perhaps they have some special insight into the thinking of the Justices. I don’t. I’ll just wait for the decision.

In the meantime, I’m wondering not how each of us thinks the Court will rule, but how we hope it will rule.

The answer isn’t so simple, because we divide into – and often move among – three competing minority camps about health reform in general:

The Affordable Care Act represents the best compromise for insuring more people while preserving most of our current public/private payer system.
Expanding reform to a single payer system like those favored by other developed nations would be better.
Replacing ACA with a private market-based system is at least worth a try.

If we’re as uncertain as polls cited by the Kaiser Family Foundation suggest, I suppose we all could just close our eyes, vote for Mitt Romney, and assume from his record and rhetoric that we’ll get all three.

But the Court will decide first, so let’s consider the rooting interests of several interested and sometimes overlapping groups.

If you favor a single payer, “Medicare-for-all” program:

You want the Court to find the individual mandate unconstitutional, but severable from the rest of the bill.

Why? The individual mandate was originally the alternative to “single payer,” so you would like to get the individual mandate out of the way. Then single payer becomes an option again, but only if the rest of the law, including the Medicaid expansion and the consumer protections, remain in effect. This is because our private insurance market will become too expensive if people use those consumer protections to wait to buy insurance until they are sick.

If you want to reduce the size and scope of the state Medicaid programs:

You want the Court to rule the Medicaid expansion unconstitutional, but the individual mandate constitutional.

Why? This combination will most constrain Medicaid growth because lower income people will have to purchase health insurance in the private market. They’ll qualify for a subsidy, but not for Medicaid.

If you want more universal coverage, but don’t care whether it’s private or public:

You want the Court to uphold the entire law.

Why? Although philosophically impure, the combination of Medicaid expansions, Medicare cost containment strategies, Medicare tax increases for the wealthy, and subsidized private insurance for the middle class will lead to more coverage, and fewer uninsured.

If you or a child of yours has a chronic condition, such as diabetes, mental illness, or cancer:

You may not care whether the individual mandate is constitutional or not, but if it isn’t, you want it to be severable from the pre-existing condition coverage and community rating portions of the law.

Why? If the PCIP experience is any indication, you may not want to be forced to buy insurance. But when you do try to buy it, you don’t want to be denied affordable coverage because of your pre-existing condition.

If you are an early retiree on your former employer’s health insurance:

You want any provisions found to be (1) unconstitutional and (2) not severable from the pre-existing condition and community rating portions of the law to be severable from the rest of the law.

Why? This could gut much of the law, but not the provisions that subsidize your coverage. You won’t have to worry that you could either lose your health insurance or be forced to pay a lot more for it.

If you are a Medicare recipient:

You want any provisions found to be unconstitutional to be severable from Medicare expansions.

Why? If they aren’t, you’ll need an immediate bipartisan agreement in Congress to keep your donut hole prescription drug coverage and your free annual check-up in place.

If you want insurance that will cover long term care needs:

You’re already out of luck.

Why? That provision was axed from the law before it was ever implemented – and you don’t hear anyone talking about restoring it.

And, if you’re okay with denying or capping coverage for pre-existing conditions, allowing insurers to make as much profit on insurance as they can, having gaps in prescription drug coverage for elders, and paying for the sick and uninsured through increased premiums on people who have insurance:

You want the Court to find the whole law unconstitutional.

Why? That’s where we were when all this began.

Note: Click here for simple explanations about some of the Supreme Court issues that are discussed in this week’s column.

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