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Why Ohio is overhauling Medicaid – The Lima News

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The new OH MCO contract awards will focus on population health measures, and are expected to be announced January 2021.

 
 

Clipped from: https://www.limaohio.com/wire/state-wire/435620/why-ohio-is-overhauling-medicaid

The overhaul of Ohio’s Medicaid program has farther reaching consequences than CareSource.

The health insurance program for 3 million Ohioans with low incomes and disabilities is a major policy tool. It’s a key source of health care for the Dayton region, which is older and less affluent than the state as a whole, and also a source of funding for hospitals, doctors and other providers.

The change is designed to improve the care of the 2.7 million Ohioans who get their care get their Medicaid benefits through a system called Medicaid managed care where an insurance company that manages the plan and pays out the claims. Five insurance plans manage these policies in Ohio.

“We’re in a fairly unique group of states who have made a pretty near comprehensive commitment to manage care. So we want to keep pushing the envelope in terms of getting the best outcomes for people that we support,” State Medicaid Director Maureen Corcoran, in an interview after the procurement was publicly posted in October.

Some of the outcomes that the overhaul aims to improve have been documented in state and federal reports.

Loren Anthes, Medicaid researcher with Cleveland-based Center for Community Solutions, reported that the state had a “secret shopper” program that found trying to learn more about Medicaid member consumer experiences, the ability to schedule an appointment for routine care was less than 70%; the ability to schedule an appointment as a new patient was around 75%; on average, patients had to wait 27 days for an appointment; and only 7 in 10 contracted physicians accepted new patients.

When looking at the Healthcare Effectiveness Data and Information Set, which is a widely used set of performance measures in the Medicaid managed care industry, only 52% of Ohio children get their health checks completed, fewer than 2 in 3 children get regular vaccinations, and fewer than half of children have annual dental appointments.

Ohio is trying to create a new set of rules that gets better results. Gov. Mike DeWine’s office announced the request for proposals as part of a new vision for Ohio’s Medicaid program that focuses on people — not just the business of managed care.

“Since coming into office in January of 2019, my administration has been evaluating our Medicaid program to develop a vision of a better, healthier, and more productive state,” DeWine had said. “With input from Ohioans covered by Medicaid, physicians, hospitals, health care providers, and managed care plans, this will be the first major overhaul of Medicaid in 15 years.”

The overhaul has so far been a massive effort.

For the past 18 months, the DeWine administration has been doing the leg work leading up to this bid. This includes getting feedback from 1,100 different people and organizations.

Ohio Medicaid will let the winning bids know with award letters Jan. 25, 2021. The goal is for the newly rebid system to go live Jan. 5, 2022.

Some of the new conditions that Ohio Medicaid wants for insurance companies it contracts with include making the system easier to use, adding population health measures to keep people healthy, and the new conditions also add new accountability measures.

The method that will be used to score applicants like CareSource includes different points for different categories, with a total 1,000 points as the highest possible score.

The scoring method puts the highest emphasis on population health measures, where companies can earn up to 395 points. Qualifications and experience is the lowest weighted category, worth up to 85 points.

Some of the aspects of the bid includes that insurance companies are asked to describe how they will identify and address the need for reliable transportation to services, and they must submit a plan for how they will invest a portion of profits back into the community. The system also comes with a range of penalties for non-compliance, such as an insurance company getting an enrollment freeze until they fix the particular issue.

The new system is also supposed to make it easier for doctors and other providers to work with the system, such as having a single point for filing claims instead of the current system of working with up to five different plans.

“The thing I noticed in particular is there’s a big shift away from the interests of the managed care companies to the interests of patients and providers,” Anthes said.

 
 

https://www.limaohio.com/wp-content/uploads/sites/54/2020/11/web1_Ohio-15.jpg

By Kaitlin Schroeder

Dayton Daily News, Ohio (TNS)

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Ohio Medicaid launches program to curb long-term care loneliness

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

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OH Medicaid will have MCOs offer companionship-focused calls to nursing home residents.

 
 

 
 

Clipped from: https://www.modernhealthcare.com/post-acute-care/ohio-medicaid-launches-program-curb-long-term-care-loneliness

The Ohio Department of Medicaid is introducing a “friendly caller” program to reduce loneliness among residents in long-term care facilities.

Through the holidays, Ohio Medicaid, Ohio’s five Medicaid managed care organizations and the state’s Area Agencies on Aging will work together to pair residents with volunteers for 30-minute informal calls twice a week.

The Area Agencies on Aging will train volunteers on how to provide companionship over the phone. Volunteers also will be trained on the UCLA Loneliness Scale to identify residents who made need more intervention. The program will be open to any nursing home or assisted living facility with at least 50 residents receiving services through Ohio Medicaid managed care programs.

“Research shows us that the holidays are an emotionally challenging time for those residing in shared living facilities, a reality exacerbated by months of social distancing and limited interaction with loved ones,” Ohio Medicaid Director Maureen Corcoran said in a prepared statement. “We also know that depression can accelerate physical deterioration. This initiative gets to the heart of the matter by offering consistent, caring and highly interpersonal connections that are needed now and throughout the holidays ahead.”

Heading into the holiday season, the isolation necessary to protect long-term care residents from community spread will make the pandemic more challenging, long-term care leaders said. Families won’t be able to visit residents, group meals among residents won’t happen and volunteers won’t be able to come in to celebrate, they said. Instead, staff will turn to virtual visits and, in some cases, outdoor visits, said Katie Smith Sloan, president and CEO of LeadingAge, a national association of aging services providers.

Older adults are living at Ground Zero in the worst pandemic in a century,” Smith Sloan said. She and other long-term care leaders are calling on government officials and all Americans to help stop the spread of COVID-19.

Since April 15, about 21,000 residents in Ohio’s long-term care facilities have contracted COVID-19, about 3,100 of whom have died, according to Ohio’s COVID-19 dashboard. In Ohio, more than half of the deaths from the virus have been among long-term care residents. On Tuesday, Ohio saw its second highest daily number of total deaths – 98 – from COVID-19.

Nationwide, positive cases for nursing home residents rose 21% from the first week of November to the second, according to the American Health Care Association and National Center for Assisted Living, which represents nursing homes and assisted living communities. In the U.S., there were 12,429 resident cases the week of Nov. 8.

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InComm Healthcare Explores Medicaid Subscribers’ Health-Related Habits, Cardholder Experiences

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Medicaid members are using benefit and incentive cards for overall healthy activities during the pandemic.

 
 

 
 

Clipped from: https://apnews.com/press-release/pr-newswire/technology-georgia-government-and-politics-lung-disease-north-america-e1934baba96a2aeced83d6a45e9b7b73

ATLANTA, Nov. 23, 2020 /PRNewswire/ — InComm Payments, a leading global payments technology company, today released the results of its Medicaid subscribers research, which found that many Medicaid members are prioritizing healthy habits during the COVID-19 pandemic. The study was based on responses from 1,700 U.S. Medicaid subscribers during the month of October.

Medicaid enrollment is up this year, according to recent analysis completed by the Kaiser Family Foundation, a trend expected to continue as enrollment reflects changes to the economy. This trend was captured in the survey as 15% of respondents were new users who signed up for Medicaid within the past year. All respondents were asked about their health-related behaviors and attitudes regarding restricted-access network benefits and rewards/incentives cards.

“It’s no surprise that healthy habits and routine services are a top priority for many at this time,” said Brian Parlotto, Executive Vice President at InComm Payments. “It’s encouraging for health plans that members are paying attention to their long-term health and expressing an interest in plan incentives that may help maintain their healthy behaviors.”

Majority of Medicaid subscribers agreed that healthy habits are more important now than ever

  • Nearly all respondents (96%) said healthy habits are on their daily priority list.
  • However, 45% of respondents said healthy habits are difficult to maintain during the pandemic. The main factors impacting maintaining healthy habits were:

 
 

  • Stress (49%)
  • Expenses (24%)
  • Reduced access to gyms or classes (10%)
  • Over 40% of respondents said they were engaging in fewer in-person medical services.

 
 

  • But 59% of subscribers are using telehealth appointments more now than in the past.

Medicaid subscribers report willingness to engage in preventive care if incentivized
We asked respondents what they’d be willing to do to earn rewards dollars through an incentives/rewards card program. The top five activities were:

  • 68% said they’d complete annual wellness exams.
  • 58% said they’d complete a yearly dental visit.
  • 53% said they’d take annual vaccines, including the flu shot.
  • 50% said they’d complete screenings and risk assessments, such as cholesterol tests, mammograms or prostate exams, etc.
  • 42% said they’d participate in mental health coaching.

Subscribers express interest in restricted-spend/rewards card programs

Respondents who weren’t enrolled in restricted spend select product and incentives/rewards programs were asked about their interest in these plan benefits

  • 82% of Medicaid subscribers who aren’t currently able to use a rewards/incentive card said they would have some level of interest in such a program.
  • 83% agreed they’d be willing to complete some form of administrative activity (e.g., online logs, after-program tests, etc.) in order to join a rewards program.

Medicaid reward cards are overwhelmingly well-received by cardholders

  • 90% believe this benefit helps them achieve their health and wellness goals.
  • 90% rated their overall experience with the card as ‘4’ or ‘5’ out of five stars.
  • 67% use their card at least monthly.
  • 88% report using the card in-store is easy.

“We’re happy to see that health plans are able to make such a positive impact in Medicaid members’ overall health and satisfaction,” said Parlotto. “We’re excited keep growing our offerings at InComm Healthcare while assisting health plans in supporting the long-term health of their members; for example, our Healthy Foods Card can help plans distribute funds for healthy, nutritious foods, assisting members who may be struggling with food insecurity due to stress or cost.”
 

InComm Healthcare helps health plans to offer their members supplemental benefit and incentive dollars. InComm Healthcare currently serves more than 500 health and wellness programs for over 300 health plan partners, reaching over six million OTC Network cardholders. The cards in its product suite are accepted at more than 60,000 retail locations, including national retailers and independent pharmacies.
 

About InComm Payments
InComm Payments is a global leader in innovative payments technology. Leveraging dynamic technology and proven expertise, InComm Payments delivers enhanced end-to-end payment platforms and emerging financial technology solutions that help businesses grow across a wide range of industries including retail, healthcare, tolling & transit, incentives, mobile payments and financial services. By enabling omnichannel connections to an ever-expanding consumer base in an increasingly digital ecosystem, InComm Payments creates seamless and valuable commerce experiences across the globe. With more than 25 years of experience, over 500,000 points of distribution, 386 global patents and a presence in more than 30 countries, InComm Payments leads the payments industry from its headquarters in Atlanta, Ga. Learn more at www.InCommPayments.com.

Media Contacts:
 

Anthony Popiel
Dalton Agency
404-876-1309
apopiel@daltonagency.com

Nilce Piccinini
Sr. Communications Manager
InComm Payments
404-935-0377
npiccinini@incomm.com

View original content to download multimedia: http://www.prnewswire.com/news-releases/incomm-healthcare-explores-medicaid-subscribers-health-related-habits-cardholder-experiences-301178497.html

SOURCE InComm Payments

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Obamacare cut death rate for 3 major cancers, study shows – UPI.com

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

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Increased Medicaid spending on early detection shows a 2% decline in deaths for breast, lung and colon cancer.

 
 

 
 

 
 

Clipped from: https://www.upi.com/Health_News/2020/11/05/Obamacare-cut-death-rate-for-3-major-cancers-study-shows/3531604599429/

Expanded Medicaid passed in some states as part of the Affordable Care Act has significantly reduced deaths from newly diagnosed breast, lung and colon cancers, a new study finds.

Death rates from these cancers are lower in states that opted for expanded Medicaid than in those that didn’t. The positive trend is largely due to earlier diagnosis, which increases the odds of survival, the researchers said.

Expanded Medicaid captures more low-income people by including those at or below 138% of the federal poverty level.

Earlier studies have shown that Medicaid is associated with increased cancer screening and earlier diagnosis.

RELATED Study: Obamacare repeal may leave young cancer patients in the lurch

For the study, the researchers used the U.S. National Cancer Database to track more than 523,000 patients who were newly diagnosed with breast, lung or colorectal cancer from 2012 through 2015.

“We found that Medicaid expansion was associated with a significant decrease in mortality compared to states without such expansion,” said researcher Dr. Miranda Lam, from Dana-Farber, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, in Boston.

Under expanded Medicaid, there was a 2% decline in death from the pre- to post-expansion period, the researchers found. No change was seen among states without expanded Medicaid.

RELATED Study: Obamacare cut out-of-pocket costs, but many still struggle

If the 2% reduction in deaths was seen in all states, then among the approximately 69,000 patients diagnosed with cancer in those states, 1,384 lives would be saved each year, the researchers calculated.

This suggests that the decline in deaths linked with Medicaid expansion is mostly due to diagnosing cancer at an earlier stage, the study authors said.

“Increased Medicaid coverage may remove barriers to accessing the health care system for screening and timely symptom evaluation, and that can translate into better outcomes for patients,” Lam said in a Dana-Farber news release.

RELATED Medicaid expansion increased earlier cancer detection by 15%, study finds

“We were reassured to find that patients living in areas of the lowest quartile of median household income showed a modest decrease in mortality after Medicaid expansion,” Lam said. “We also found that the mortality improvements occurred in both Black and white populations.”

The report was published online Nov. 5 in JAMA Network Open.

More information

For more on expanded Medicaid, head to HealthCare.gov.

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Budget shortfall may cause cuts in Ohio’s tax-funded Medicaid program

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Ohio Medicaid needs to make cuts, but stakeholders like hospitals are messaging they need a bailout.

 
 

 
 

Clipped from: https://www.dispatch.com/story/news/healthcare/2020/11/06/budget-shortfall-may-cause-cuts-ohios-tax-funded-medicaid-program-poor-disabled-because-covid/6165391002/

 
 

Medicaid caseloads have surged during the coronavirus pandemic, topping 3 million this year, up 9%, from last year.

But as needs intensify, declining state revenue and a projected budget shortfall will challenge the $23 billion health-care program for poor and disabled Ohioans, Medicaid Director Maureen Corcoran said during a virtual post-election conference Thursday.

“We are looking at several-billion-dollar shortfall in this current fiscal year,” Corcoran said.

More:Ohio reports 4,961 new COVID cases, again breaking record; new health officials appointed

Economic downturns tend to cause a spike in Medicaid demand.

“Medicaid is always counter-cyclical with the economy and it lags a little bit,” Corcoran said. “As we think about the recovery, that may take several years, that pressure will be on people who need their health-care services until they get back to a job.

“As tight as our state economy is going to be, it’s going to be important that we continue to support Ohioans, many who have not been out of a job or had the kind of economic experience that we see today.”

She projected that it will take years for Ohioans to recover, and in the meantime, “we do expect the budget to be very difficult … we’ve got some very difficult decisions ahead of us.”

During an hour-long discussion on health care and Medicaid during Impact Ohio’s post-election conference, Corcoran and representatives of the health-care industry said the coronavirus has strained the system, but also spurred improvements.

Mike Abrams, president and CEO of the Ohio Hospital Association, called COVID an “economic broadside for hospitals,” causing them to suspend elective procedures, straining supply chains and forcing staff furloughs as hospitals emptied.

“Ohio hospitals lost $4 billion and counting due to the stoppage of elective procedures,” Abrams said. “A portion of that has been recouped largely by federal aid … maybe 50-55%. For many hospitals it was a lifeline. They were faced with urgent economic circumstances, even making payroll.”

Abrams predicted Ohio will still see some hospital closures because of the economic hit.

But hospitals have been able to keep up with demand for treating victims of the pandemic. Currently, Abrams said Ohio hospitals are treating more than 2,000 COVID patients, about 73% of capacity, with ample supplies of much-needed ventilators and personal protection equipment.

Kelly O’Reilly, president and CEO of the Ohio Association of Health Plans, said insurance companies also have adjusted and tried to pitch in to help.

The plans expanded coverage for telehealth services, continued coverage for furloughed workers, delayed employer premium payments, waived COVID testing fees and expanded services to vulnerable populations including pregnant women and the elderly with food assistance and prescription delivery.

But the pandemic also has created uncertainty for the industry, which is making it difficult for insurers to set rates.

“We don’t know what the impact of that deferred care is going to do in terms of the impact on the system and cost of health care. We don’t know what the long-term impacts of COVID are in terms of the people who have recovered and what the medical impact on their ongoing health looks like.”

ccandisky@dispatch.com

@ccandisky

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Medicaid hemorrhaging $100B on Americans ineligible for the program

Curator, Roundtable Show, Fraud, Waste and Abuse

 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

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Suspension of eligibility audits for several years has hidden $100B in spending on people who are not Medicaid eligible. The author advocates for Trump to finalize MFAR before leaving office.

 
 

Clipped from: https://nypost.com/2020/11/28/medicaid-hemorrhaging-100b-on-americans-ineligible-for-the-program/

Enlarge Image

 
 

ObamaCare ushered in rapid Medicaid expansion, but checks on fraud were stymied, leading to record waste — which Trump can tamp down before he leaves office. NY Post photo composite

Medicaid is meant to cover health care and long-term care for lower-income Americans. But a new report reveals the government — both in Washington and in state capitols across the country — is failing to ensure that only people who are eligible for Medicaid are enrolling.

The federal government’s improper Medicaid payments now exceed $100 billion a year. This means that more than one-in-four dollars flowing out of Medicaid — our nation’s third-largest government program — do not meet program rules. This staggering failure doesn’t just reduce health-care access for the truly eligible, it also harms taxpayers who fund it.

The main problem is that states are not verifying people’s eligibility. In fact, “the required verification of eligibility data, such as income, was not done at all” in many cases, according to the report from the Centers for Medicare and Medicaid Services (CMS). The report also suggests that many people remain on Medicaid well past the time they were initially eligible.

CMS examined states each year from 2017-2019 for its 2020 report — which was entirely pre-coronavirus. The report showed an improper payment rate of 21.4 percent — a total of $86.5 billion — but the actual amount is much higher, because eligibility audits were not conducted in the year 2017. If you only count the two years where an eligibility audit was performed, the improper payment rate is actually 27 percent — and improper federal spending totals more than $100 billion.

The Obama administration canceled the eligibility audits from 2014 to 2017 — the first four years of ObamaCare’s Medicaid expansion — to build political support for its signature law by maximizing enrollment, even if it was unlawful. They were successful. Millions of ineligible people enrolled in Medicaid.

ObamaCare created a new class of Medicaid enrollees — non-disabled, childless, working-age adults — for whom the federal government reimburses no less than 90 percent of the cost. Since their coverage is financed almost entirely by federal dollars, states loosened eligibility reviews and increased payments to health insurers, who reaped massive profits from ObamaCare’s Medicaid expansion.

After Obama signed the Affordable Care Act, Americans weren’t tested for their Medicaid eligibility for four years — enabling millions to unlawfully enroll.

Because Washington pays nearly two-thirds of the total Medicaid tab, states do not spend with an eye toward value. Program integrity efforts, like ensuring only eligible people enroll, almost always get short shrift. But the primary job of executive branch agencies, like CMS, is to implement the law and ensure enrollees and taxpayers are well-served.

Before the year ends, the Trump administration can take one important and overdue step to address Medicaid’s improper payments, which have soared with ObamaCare’s expansion. CMS should finalize a fiscal accountability rule that would enhance Medicaid program integrity. This rule would require states to report to CMS where the $600 billion of Medicaid expenditures — including the $400 billion of federal tax dollars — is going. It also limits accounting gimmicks that some states use to rip off federal taxpayers.

While much more work needs to be done to reform Medicaid, including ensuring only eligible people are enrolled, greater transparency would be a good first step toward limiting widespread waste, fraud, abuse, and misspending.

Brian Blase served as a special assistant to President Trump at the National Economic Council, 2017-19. He is CEO of Blase Policy Strategies and a senior research fellow at The Galen Institute and The Foundation for Government Accountability.

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Published- Insurers’ strong financial performance continues in Q3 as they brace for a potentially rocky Q4 | FierceHealthcare

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

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National health plan messaging is suggesting a slowing of the profits seen in Q2/Q3 due to COVID-utilization suppression.

 
 

Clipped from: https://www.fiercehealthcare.com/payer/insurers-strong-financial-performance-continues-third-quarter-as-they-brace-for-a-potentially

 
 

Insurers continued to turn a significant profit in the third quarter, though the results were more subdued than they were in the first half of the year.

Major national health insurers continued to largely turn a significant profit in the third quarter, though numbers didn’t quite reach the sky-high figures reported in the first half of the year.

And some warned that the fourth quarter could be ugly, with pent-up utilization and costs related to COVID-19 coming to a head.

As with the prior quarter, UnitedHealth Group led the way on profit, bringing in $3.2 billion in earnings. That’s down slightly from the third quarter of 2019, where the company earned $3.5 billion in profit, and halved from the second quarter, when UnitedHealth posted an eye-popping $6.6 billion in profit.

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Cigna came in second for profitability in the quarter, reporting $1.4 billion in profit. Humana was close behind at $1.3 billion, as was CVS Health at $1.2 billion.

RELATED: Insurers saw sky-high profits in Q2. Now, Congress wants to take a look at their finances

Those companies all saw profit declines from the second quarter as well, where CVS posted $3 billion in profit and Cigna and Humana both reported $1.8 billion in earnings.

Anthem brought in $222 million in profit and, while that represents a massive decline from its $2.3 billion in earnings for the second quarter, it still beat Wall Street estimates. Centene Corporation and Molina Healthcare also reported declines in profits from the prior quarter, bringing in $568 million and $185 million, respectively.

Across the board, insurers said that the drop in profitability compared to the beginning of 2020 reflects care utilization returning to levels near those seen before the COVID-19 pandemic. Earlier in the year, most warned that while they were hugely profitable at the time, that was likely to change as utilization ticked back up.

Some are bracing for even stormier skies in the fourth quarter, too. Humana, for instance, gave investors a heads-up about an expected loss in the quarter as use continues to rebound and COVID-19-related costs increase.

Humana Chief Financial Officer Brian Kane said the company is expecting to pay $1 billion in COVID-19 treatment and testing costs alone this year.

CVS lead the pack on revenue for the quarter, bringing in $67.1 billion, followed closely by UnitedHealth, which reported $65.1 billion in revenue.

Cigna brought in $41 billion in revenue. Anthem and Centene were neck-and-neck for the quarter, reporting $31.2 billion in revenue and $29.1 billion in revenue, respectively.

Humana brought in $20.1 billion in revenue, and Molina lands in last place for revenue with $4.8 billion reported.

RELATED: VIDEO: FierceHealthcare discusses healthcare companies’ Q1 results in the wake of COVID-19—and beyond

Here are two more trends to watch in the final quarter of 2020:

PBM subsidiaries leading the way

Both UnitedHealth and Cigna have reported substantial growth in their pharmacy benefit management subsidiaries over the course of this year. Optum has been UnitedHealth’s growth leader of late, and in the third quarter posted 21% growth.

Much of Optum’s growth has been concentrated in its OptumHealth segment, which includes the company’s large provider footprint at OptumCare. OptumHealth providers treated 98 million patients in the third quarter, an increase of 3 million year over year, with revenue per customer served up 25% compared to the third quarter of 2019.

In addition, OptumRx has invested heavily in growing its pharmacy services, including in specialty pharmacy, e-commerce and home infusion, UnitedHealth Group said.

Cigna also touted the performance of its newly rebranded Evernorth subsidiary in its earnings, a company that includes the nation’s largest PBM in Express Scripts. Evernorth’s revenues were up 20% in the third quarter compared to the second quarter, Cigna said.

Cigna is continuing to design and launch new solutions at Evernorth, CEO David Cordani said during an appearance at HLTH in October, with an eye on continued business growth.

Pandemic’s long-term impact on enrollment remains fuzzy

As shutdowns to prevent the spread of COVID-19 led to significant job losses, the healthcare industry braced for large numbers of people to become uninsured in the process.

However, insurers have found over the past several months that membership losses in the employer-sponsored segments were largely offset by growth in Medicaid and individual market enrollment.

What impact does this potentially have on the current open enrollment period for the Affordable Care Act’s exchanges? Centene CEO Michael Neidorff said enrollment has “been bouncing around a lot.”

The variability suggests we won’t have a clear picture of the pandemic’s long-term impacts on payer mix for some time.

“It is just a swinging variable and too many factors,” Neidorff said.

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Medicaid plans to offer transit | News, Sports, Jobs – Tribune Chronicle

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

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All MCOs in Ohio will provide free transportation for members to food banks.

 
 

 
 

Clipped from: https://www.tribtoday.com/news/local-news/2020/11/medicaid-plans-to-offer-transit/

WARREN — In an effort to “ensure our most vulnerable citizens maintain reliable access to food resources,” Ohio’s five Medicaid Managed Care Plans will offer free transportation services to and from food banks, food pantries, food clinics and grocery stores as part of the benefit plan.

People with Medicaid plans through Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage and United Heathcare Community Plan can access the benefit.

“This transportation service is essential to many of our members,” states an informational email. “By undertaking this united effort on behalf of every Ohio member, we can help get food on the table for Ohioans in need during this unprecedented health crisis.

Members of the plans can find more information by calling the Ohio Department of Medicaid Member Hotline at 1-800-324-8680.

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Molina Healthcare of California and Inland Empire Health Plan Join Forces to Provide Support for Job and Health Coverage Losses

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

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2 California MCOs are teaming up to let potential enrollees know about Medicaid and exchange coverage options after seeing a surge in unemployment in their area.

 
 

 
 

Clipped from: https://www.prnewswire.com/news-releases/molina-healthcare-of-california-and-inland-empire-health-plan-join-forces-to-provide-support-for-job-and-health-coverage-losses-301144251.html

SAN BERNARDINO, Calif., Oct. 1, 2020 /PRNewswire/ — Molina Healthcare of California (“Molina”), and Inland Empire Health Plan (IEHP) are joining forces to lead a new healthcare initiative called “Together4IE.” This collaboration will raise awareness about available coverage through Medi-Cal and the health insurance marketplace (Covered California) to support Californians affected by income or employment changes during the COVID-19 pandemic. The health plans launched a website and are offering a toll-free number (1-866-U2Apply) to learn more about securing affordable health insurance.

The California Employment Development Department reported that as of July 2020, more than 275,000 residents in the Inland Empire region were unemployed. The unemployment rates in Riverside and San Bernardino counties are both over 13%, having increased by approximately 4.7% and 4.4%, respectively, compared to the unemployment rates from 2019, which has led many to consequently lose health insurance coverage for themselves and their families.

“As many families face increased uncertainty during this time, Molina and IEHP are here to help them navigate the health care system,” said John Kotal, president of Molina Healthcare of California. “As a company with roots in this region for decades, Molina continues to advocate for quality access to health care for IE residents who need it most.”

Working together to support this population, the “Together4IE” initiative connects qualified residents to resources and works to reduce any stigma around government-sponsored health care. In addition to the resources made available, partnering organizations are actively engaging with individuals and families, as well as communities, to ensure that those interested in affordable health care are fully aware of the available options. 

Community agencies engaged in support of the initiative include: Covered California, Arrowhead Regional Medical Center, Riverside Department of Public Social Services, Riverside University Health System, San Bernardino County Transitional Assistance Department, Southern California Edison, Southern California Gas Company, and hundreds of local community organizations.

“This is about doing the right thing for the community we know and love,” said Jarrod McNaughton, IEHP chief executive officer. “Through collaboration and partnerships with agencies in the Inland Empire, we can rally around our neighbors to fill in the gaps in care, coverage and information. The health and wellness of our communities is our largest priority, and we will do all we can to ensure residents have access to the care and resources they need.”

For more information or to enroll, visit https://www.together4ie.com/ or call 1-866-U2Apply (866-822-7759).

About Molina Healthcare of California
Molina Healthcare of California has been providing government-funded care for low-income individuals for 40 years. Molina’s mission has always been to provide quality health care to people receiving government assistance. As of June 30, 2020, the company serves approximately 572,000 members through Medi-Cal, Medicare, Medicare-Medicaid (Duals) and Covered California (Marketplace). Molina’s service areas include Sacramento, Los Angeles, San Bernardino, Riverside, San Diego, Orange, and Imperial counties. For more information, visit MolinaHealthcare.com and connect with us on Facebook, Twitter, Instagram and YouTube.

About IEHP
IEHP, Inland Empire Health Plan, is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. With a network of more than 6,400 Providers and more than 2,000 employees, IEHP serves more than 1.3 million residents in Riverside and San Bernardino counties who are enrolled in Medicaid or Cal MediConnect Plan (Medicare-Medicaid Plan). Through a dynamic partnership with Providers and Community, award-winning service and innovative products, IEHP is fully committed to advocating for our Members and providing them with quality, accessible and wellness-based health care services. For more information, https://iehp.org/

SOURCE Inland Empire Health Plan (IEHP)

 
 

Related Links

http://www.iehp.org
 

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How the Biden Administration Can Make a Public Option Work

Curator, Managed care, News Roundtable Show

 
 

 
 

Clipped from: https://hbr.org/2020/11/how-the-biden-administration-can-make-a-public-option-work

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Curator summary

A coupla researchers at HBR think Medicaid can be “easily folded in” to national, standardized Public Option (whose main feature is prepaid managed care).

 
 

The incoming Biden administration is expected to expand access to health care insurance coverage in the United States by adding “a public option.” In this article, the authors argue that it should be based on Medicare Advantage plans, which would accelerate the movement away from fee-for-service care to capitated payment tied to the quality of outcomes and patient satisfaction.

Under a plan proposed by President-elect Joe Biden’s camp, Obamacare would be expanded to include a “public option” health plan. Anyone without insurance could be automatically enrolled. In addition, people younger than 65 could obtain affordable coverage. Employers that decide not to offer employer-sponsored health plans could enroll their employees in the public option plan for a significantly smaller percentage of their employee salary cost (somewhere around 20%).

Rather than creating a new vehicle, we suggest a public-private option that we call the Better Care Plan (BCP), which would use as a model existing Medicare Advantage plans that provide Medicare benefits, including inpatient and outpatient coverage through a private sector health insurer. More than one-third of Medicare enrollees choose these plans today, and their satisfaction is very high.

The advantages of this approach are many, but one of the most important is to relieve the health care delivery industry of its addiction to fee for service — a payment system that encourages more visits, procedures, and services than are necessary, resulting in poor quality and high cost: in other words, low-value care. We propose a “capitated payment,” which, like Medicare Advantage plans, would prepay providers a fixed, risk-adjusted payment to care for all patients enrolled in it. This change in incentive would stop the pay-for-volume system and replace it with care for health outcomes. Under the present system, full hospitals mean higher revenue. If pay were tied to keeping people healthy, hospitals would become cost centers and the focus would be on avoiding hospitalization by better managing chronic disease.

In addition, upfront payment would encourage the development of new care models such as “hospital at home” operations like Atrius’s Care in Place and the independent Medically Home. This model allows for as many as 30% of patients who would have been hospitalized to be managed at home, reducing the cost of care by as much as 30%.

In a prepayment world, any care model that improves quality and reduces cost would be embraced much more quickly than has been the case with fee for service. Take telemedicine: clinicians seeing patients via video links. This technology has been available for more than a decade, but until insurers began to pay for virtual visits due to Covid-19, its use languished.

A third major advantage of BCP is it would provide a predictable revenue stream for providers. During the pandemic, hospitals and physician organizations across the United States have lost billions of dollars for two reasons: The amount they have been paid for their care of critically ill Covid-19  patients hasn’t covered its costs, and the postponement of elective surgeries has drastically reduced their revenues. In contrast, those provider organizations operating with upfront negotiated budgets have largely maintained their financial viability. What is more, they have been able to redeploy resources to focus on early detection and treatment of Covid-19 patients, helping them to manage the surges.

The following evidence suggests that the Better Care Plan would be better from a cost and quality standpoint than fee-for-service approaches:

  • Despite having a higher proportion of clinical and social risk factors, Medicare Advantage beneficiaries with chronic conditions experienced lower utilization of high-cost services, comparable average costs, and better outcomes.
  • Medicare Advantage enrollees with chronic conditions who were eligible for Medicare and Medicaid had better patient outcomes and lower costs compared to traditional fee-for-service Medicare members.
  • Humana recently reported that the medical cost of caring for seniors enrolled in its Medicare Advantage plans that have value-based payment contracts with physicians were 19% lower than those in traditional fee-for-service Medicare. Overall, the patients in its Medicare Advantage plans spent 211,000 fewer days in the hospital per year and had 10.3% fewer emergency department visits per year than Humana Medicare Advantage members receiving care from physicians in the traditional models.
  • Critics of Medicare Advantage plans claim that their better performance is the result of their cherry-picking the healthiest patients, but evidence suggests this is not the case.
  • Overall, the costs per patient in Medicare Advantage plans are about 40% less than fee-for-service Medicare. As a result, Medicare Advantage plan premiums are expected to decline about 11% in 2021.

We suggest the following six steps for implementing the BCP:

1. Develop standardized benefits packages. They could be similar to the Affordable Care Act’s (ACA’s) tiered set of benefit plans (bronze, silver, gold, and platinum), which would offer a range of premium and out-of-pocket-expense options. For example, the uninsured would qualify and be automatically enrolled in the equivalent of the ACA’s silver plan with low premiums and deductibles. Any out-of-pocket expense would be based on income and could be zero at certain income levels. Subsidies would be provided to limit out-of-pocket spending to 8.5% of a person’s income, which is much less than many Americans on Medicare pay today. The plans could be offered through the various existing federal or state exchanges established by the ACA or by employers through newly created private exchanges.

2. Fold Medicaid into the BCP. Many Medicaid programs today have contracts with insurers that offer Medicare Advantage plans. These plans could be easily converted to the BCP and designed to meet the needs of current Medicaid enrollees. Uniform base-eligibility rules for Medicaid enrollees could be established at some percentage (e.g., 150%) of the federal poverty level. States could increase this threshold if they deemed that necessary and could decide which BCPs to offer to Medicaid enrollees.

3. Negotiate the prepaid health budgets. One of the most difficult problems will be establishing the baseline monthly per-member payment rates to health systems. There have been several ideas floated on how to do this, but the experience in states that are offering a public option suggests that initial payments to hospitals may need to be 1.5 to 2 times the current Medicare rates or higher.

The negotiated budgets would need to consider the wide national differences in current payments to providers by Medicare, Medicaid, and commercial insurers. With a consistent and predictable cash flow not dependent on volume of care, hospitals and physician organizations would have strong incentives to redesign care to provide better value. There would be incentives to utilize staff at the highest level of their license, which would result in major productivity improvements in care delivery. The focus would be on delivering the highest quality, lowest cost care — as opposed to filling hospital beds or doing unnecessary procedures.

4. Give employers an opportunity to provide a BCP option. Employers that decide to participate would pay into a risk pool, which would cover their entire employee population. We believe that the fee would be approximately 20% of employee salary cost, which is lower than the 25% to 35% that most employers pay today. This would allow employers to access multiple competing BCPs. They still would have control over which plans were offered to their employees through the public or private exchanges of their choice. The difference is they wouldn’t be negotiating the rates with insurers every year; these rates would be established by a commission of government and private sector representatives.

5. Focus on disparities. The BCP would enroll many of the uninsured in the African American, Hispanic, Native American, and other underrepresented communities. Payments between insurers and health systems would be risk-adjusted by age, sex, and selected clinical indicators, reflecting a person’s health status. But risk adjustment should also include social determinants of health, which could be represented by the deprivation index. This would provide health systems with incentives to redesign their care model, which might include better outreach utilizing pharmacists and home care agencies to proactively address chronic diseases in the underserved population. There would be a reason to develop better integration of primary care with existing public health and mental health services and community resources such as food pantries and religious institutions. Finally, we would think about access differently, utilizing care navigators, nontraditional avenues for education — for example, hairdressers have been shown to be trusted to give advice about breast cancer screening.

6. Promote competition to improve quality and lowers cost. Insurers who chose to offer BCPs would be required to annually provide transparent and uniform cost, utilization, quality, and patient experience data to the public. The BCPs would compete on the basis of this performance information. The existing Medicare Advantage NCQA star ratings, which measure the quality of the various plans, would be expanded, utilizing more health outcomes measures such as complications from chronic disease or from elective procedures such as heart surgery.

Medicare Advantage plans have more narrow or “selective” networks of providers than traditional fee-for-service Medicare. Providers are chosen based on cost and quality, which critics argue means less consumer choice. But as discussed above, the quality of the health care obtained via Medicare Advantage is better and the costs much lower, and Medicare members are highly satisfied with plans. However, in rural areas, where providers are scarce, BCP plans may need to share providers or allow patients to travel outside of network without penalty. As virtual medical delivery continues to change, expanding broadband service to rural areas where providers are scarce will be important.

Ultimately, the United States must improve the quality and lower the cost of care delivery. The Better Care Plan’s competitive approach may be the best way to create agreement among the many disparate stakeholders in the health care system and address many of the coverage and access problems that exist today. The track record of Medicare Advantage plans proves it could work.