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Monday Morning Medicaid Must Reads: Dec 10th, 2018

Helping you consider differing viewpoints. Before it’s illegal.

In this issue…

Article 1:  Medicaid Access & Coverage to Care in 2017 (MHPA’s Institute for Medicaid Innovation, Oct 2018)

Clay’s summary:  The industry survey from this leading Medicaid health plan association doesn’t disappoint.
Key Excerpts from the Article:  … Key findings from the data were noted in the high-risk care coordination, value-based payment models, women’s health, and behavioral health sections. For instance, results from the survey demonstrate that the majority of Medicaid MCOs in 2017 performed a number of core functions in providing comprehensive, high-risk care coordination. The most commonly performed core functions included developing a plan of care for members, supporting adherence to the plan of care, engaging a care team of professionals to address the needs of the member, and conducting risk assessments….The findings also indicate that Medicaid MCOs are increasingly using value-based payment (VBP) models when providing care for their members. In 2017, half of Medicaid MCOs indicated that they were piloting population-specific VBP models, while over 15 percent were expanding successful pilots. Finally, approximately 10 percent of MCOs surveyed reported that they had extensive VBP arrangements in place in 2017. As barriers to VBP adoption are removed, we anticipate an increase in the number of Medicaid MCOs transitioning from the pilot phase to fully implemented arrangements….
Read full article in packet or at links provided

Article 2:  Who can be believed in medical research? Charles Barta, Nov 21 2018

Clay’s summary:  An AZ physician provides an overview of bogus medical and health systems theories throughout the years. Including that old chestnut about how expanding Medicaid would reduce ER in Oregon (that one’s a real knee-slapper!)
Key Excerpts from the Article:  … One interesting fact that has not been reported involves the idea that increasing Medicaid would clearly lower inappropriate emergency room visits and the expense these visits cost the public. We would save money…Oregon decided to prove this in 2009. It vastly increased the number of residents eligible for Medicaid. Unfortunately, the state didn’t have the funds to pay for this, so they put a lottery in place. Half the people eligible were given Medicaid while the other half became a “control group.” This was a scientifically perfect, randomized experiment. …The results? Two years later, the covered group had a 40 percent increase in unnecessary ER use. When a social experiment doesn’t work, the usual excuse of “we didn’t fund it enough — we need more money” wasn’t applicable. The next excuse, “The newly enrolled didn’t have time to get used to the system so they didn’t attempt to make (free) appointments with their doctors.” Two years later, a follow-up study was done. Surprise! The increase in unnecessary ER rose dramatically. The only news organization that reported this was NPR….
Read full article in packet or at links provided

Article 3:  Our opinion: State budget reforms are needed, Houma Today Editorial Board, Nov 19, 2018

Clay’s summary:  A small town newspaper comes out in favor of income verification and work requirements for Medicaid eligibility. They must be evil, GOP-loving, Trump worshiping [Insert current set of slurs media tells you to append to people with opinions non-leftist).
Key Excerpts from the Article:  … But some of these reforms make a lot of sense. For instance, income verification for Medicaid can limit paying out benefits to those who don’t qualify while making sure those who do qualify get the help they need….A recent state audit claimed that as much as $85 million could have been spent over the past several years on people who didn’t qualify for Medicaid. That’s because Health Department officials check income only once, at the time of the enrollee’s initial application for the program. They don’t check again until 12 months later, when the person applies for renewal of coverage. In the meantime, the person could have gotten a new job or increased income, becoming ineligible for Medicaid….
Read full article in packet or at links provided