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Monthly Archives: March 2012

Health Reform: Toolkit on State Implementation, Outreach, Education, and Enrollment

As part of the Health Reform Toolkit Series, the Blue Cross Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation, and the Commonwealth Health Insurance Connector Authority have published Effective Education, Outreach, and Enrollment Approaches for Populations Newly Eligible for Health Coverage. The series offers resources for health reform stakeholders to assist other states in planning and implementing...

HHS Reports That Only 14 Percent of Patient Harm Events Experienced by Medicare Beneficiaries Are Captured

A study conducted by the HHS Office of Inspector General, Hospital Incident Reporting Systems Do Not Capture Most Patient Harm, analyzed the ways in which hospitals use incident reporting systems and incident reports to determine how accurately this reflected actual patient harm occurring within hospitals. The study also aimed to determine the extent of review by accreditors when assessing...

Medicare Secondary Payer: Options for Improving Medicare Payment Recoveries from Individual, Non-Group Health Plans

The Centers for Medicare and Medicaid Services (CMS), charged with protecting Medicare’s fiscal integrity, works to recover payments made by Medicare that are the responsibility of non-group health plans. While CMS has not always been aware of all such situations in the past, 2007 legislation introduced mandatory non-group health plan reporting requirements, which should increase CMS awareness. Reports made...

Lack of Price Transparency Could Limit Hospitals’ Ability to Secure Favorable Pricing for Implantable Medical Devices

Policymakers expressed concern about the lack in price transparency for implantable medical devices (IMD), with confidentiality clauses in purchasing agreements frequently restricting the release of third-party prices. Because this lack of transparency could drive up hospital cost and Medicare spending, GAO examined trends in IMD Medicare spending and utilization, information on IMD pricing for hospitals, and IMD market factors...

Health Opportunity Accounts: Results of Medicaid Health Opportunity Accounts Demonstration Program

Following a five-year demonstration, a new report examines the Health Opportunity Accounts Demonstration Program created by the Deficit Reduction Act (DRA).  The law allowed up to 10 states to test the use of Health Opportunity Accounts as an alternative health benefit design in Medicaid. Participating states were allowed to establish Health Opportunity Accounts (HOA) funded by state and federal government and offered...

National Health Reform: HSC Reports on Premium Subsidies and Exchanges for the Uninsured

A new report examines individual eligibility for federal premium subsidies in Health Insurance Exchanges when employer-sponsored or public coverage is not available to them.  Both federal premium subsidies and state or federally-run Health Insurance Exchanges are features starting in 2014 under the Affordable Care Act (ACA). While most individuals will be required to have or buy health insurance coverage – and individuals earning...

Medicare Advantage and Preventative Services: GAO Finds Preventative Care Services and Clinical Recommendations Could Be Better Aligned

Because preventative care can reduce expenditures and improve health outcomes, the GAO conducted a study examining actual preventative service use in relation to the U.S. Preventative Services Task Force (USPSTF) and Advisory Committee on Immunization Practices (ACIP) by Medicare fee-for-service (FFS) beneficiaries. This study also examined whether or not the Welcome to Medicare (WTM) exam effected preventative service use, the...

Information Technology in State Government: Top IT Actions to Save States Money and Boost Efficiency

Governors and state policymakers are looking at methods for making better use of information technology (IT).  State IT assessments aim to rectify four primary challenges: Disconnected hardware and software systems that hinder data share and cause redundancies. Outdated or restrictive IT procurement requirements. A focus on IT for program implementation as opposed to value and impact assessment. Increasing demand for public, web-based access...

Medicare-Medicaid Dual Eligibles Market for Health Plans: Briefing by Kip Piper for Wall Street Analysts at Citi Global Healthcare Conference

The $350 billion Medicare-Medicaid dual eligible market is an extraordinary new business opportunity for health insurers, as well as a way for state Medicaid programs to generate significant budget savings and improve access and quality of care for frail seniors and persons with severe disabilities.  A dozen states are now looking at integrating Medicare and Medicaid health care for the nation’s...

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