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Medicare, Medicaid, Health Reform

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Monthly Archives: December 2004

Lessons of Welfare Reform for Medicare’s Prescription Drug Benefit

Congress could improve the newly created Medicare prescription drug benefit by applying the lessons of welfare reform, according to an excellent new article by Paul Barringer. In American Outlook, the Hudson Institute's quarterly journal, Mr. Barringer lays out what made welfare reform successful: ● Pay for performance: bonuses for performing well across a spectrum of quality measures. ● Encouraging partnerships with local...

Disease Management in Medicaid: Resources for States

As a tool to control costs and improve care for vulnerable patients, disease management is now used in some form by over half of all state Medicaid programs. To help states craft their disease management programs, a variety of technical resources are now available. The National Pharmaceutical Council offers a series of reports detailing best practices and evidence-based protocols for...

Pay for Performance: MedPAC, JCAHO, and AMA

The pay-for-performance (P4P) movement continues to grow: 1. The Medicare Payment Assessment Commission (MedPAC) is calling on Congress to incorporate quality incentives in Medicare payments to hospitals, physicians, and home health agencies. In 2003, MedPAC released similar P4P recommendations for Medicare managed care plans and dialysis facilities. MedPAC says the Centers for Medicare & Medicaid Services (CMS) should earmark between...

Medicare Advantage Plans: Lower Costs and More Services for Seniors

Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Congress increased payments to Medicare Advantage plans. The objective is to increase participation by health plans and thereby create more choices for Medicare beneficiaries. While many pundits have criticized the payment increases as a

Risk Adjustment for Medicare Drug Plans

Prescription drug utilization varies dramatically among individuals. To make sure Medicare payments to Prescription Drug Plans (PDPs) reflect the health status of enrollees, the Centers for Medicare & Medicaid Services (CMS) is developing a risk adjustment methodology. Risk adjustment is a statistical process used to identify and adjust for variation in patient costs that stem from differences in key...

Medicare Drug Formularies: CMS Guidelines Released

Under the new Medicare prescription drug benefit, drug plans will have a fair amount of discretion in setting formularies. The idea is to encourage competition among drug plans and offer Medicare beneficiaries choice. The Centers for Medicare & Medicaid Services (CMS) will review the benefit designs of drug plan bidders to ensure the beneficiaries have appropriate access to needed...

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