Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

Managed Long Term Services and Supports (MLTSS) programs provide long-term care primarily to aging adults and people with disabilities. This care is provided not via the fee-for-service model but through managed care organizations. These contractors deliver benefits, which include community, home, and institution-based services, and receive payment through Medicaid....
Undocumented immigrants may be able to receive federally subsidized health insurance coverage under waiver authority built into the Affordable Care Act (ACA).  The ACA allows States to request waivers of certain major provisions of Obamacare, including a waiver of the ACA requirement limiting federal premium and cost sharing subsidies...
To control rising health care costs and improve outcomes, health care purchasers - Medicare, state Medicaid programs, and large employers - and health plans are eager to entirely replace traditional, inefficient, volume-based fee-for-service (FFS) physician and hospital reimbursement with value-based payment models.  Value-based payment comes in various flavors but...
High hospital emergency room use by Medicaid enrollees is a perennial concern. What do we know about Medicaid emergency department visits? Are they medically necessary? What drives Medicaid emergency department visits? Is Medicaid ER utilization increasing under the Affordable Care Act? The Medicaid and CHIP Payment and Access Commission (MACPAC)...
The practice of medicine in the age of generic pharmaceuticals is built upon the premise that these chemically identical medications have the same therapeutic effect as the brand-name ones. But do they? Generic: The Unbranding of Modern Medicine by Jeremy A. Greene, MD, PhD, of John Hopkins University is...
Overuse and abuse of opioid drugs, particularly prescription pain killers, is a serious, costly problem, with a host of challenges for purchasers, payors, patients, physicians, pharmacists, regulators, public health, and drug manufacturers.  For 20 years, overuse of opioid drugs has steadily increased, as have inpatient hospitalizations for opioid overdoses.  Together, Medicaid and...
States across the US are engaged in ambitious and critically important initiatives to reform health care payment and care delivery.  Partnering with other major health care purchasers and payors, including employers and commercial health plans, State Medicaid agencies seek to improve health outcomes and decrease per capita health spending.  This...
Throughout the new Health Insurance Exchanges, health plan offerings vary in premiums, cost sharing, and provider networks. As the Affordable Care Act’s radically new regulatory and financing framework plays out in the insurance market and with consumer and employer decisions, we can expect considerable change and variability from 2014...
For health plans, the Affordable Care Act dramatically increases complexity and uncertainty in the health insurance market.  One thing is clear - Obamacare turns traditional risk management practices of health plans upside down. Predicting and adapting to the financial and operational dynamics of ACA is a daunting challenge for health plans,...
In the U.S., we usually hear about health care in Europe as an example of what the American health system is not. Universal health coverage, state-run provider networks, and rationing are the two differences that come up most often. But the U.S. and Europe share many health care policy challenges:...

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