Much of the story about rising health costs and spending has to do with relatively small groups of people with expensive health needs. For example, the Centers for Medicare and Medicaid Services (CMS) estimates Medicare beneficiaries with two or more chronic conditions accounted for 93 percent of Medicare spending...
Dual Eligibles and Medicare Cost Sharing: State Medicaid Payment of Medicare Premiums, Deductibles, and Co-PaymentsKip Piper -
State Medicaid programs will spend about $175 billion this year on health care for dual eligibles - low-income seniors and persons with disabilities who receive benefits from both Medicare and Medicaid. State spending on dual eligibles falls primarily in three areas: long term services and supports (nursing home, home...
Many new care models in both the public and private sector focus on people with chronic diseases, particularly conditions like diabetes, congestive heart failure, and hypertension. The Veterans Health Administration (VHA) Care Coordination/Home Telehealth (CCHT) pilot program serves veterans at risk of needing long term care for chronic conditions. Physician...
Kip Piper -
Medicare-Medicaid dual eligibles are often held up as a prime case for the need for better care management to reduce health costs and spending while improving quality. But doing so can be challenging. Most dual eligibles have multiple health conditions, whether a chronic disease, severe cognitive or physical disabilities,...
A painful fact about the U.S. health system is that roughly one third of health costs and spending are wasted. A study in the Journal of the American Medical Association (JAMA) found that wasted health spending could reach from about $500 billion to almost $1 trillion each year. And...
Kip Piper -
Here is a summary of the Medicare, Medicaid, and other health care related provisions of H.R. 8, the American Taxpayer Relief Act of 2012, as passed by House and Senate as part of the fiscal cliff negotiations. President Obama is expected to sign the law shortly. The Congressional Budget Office (CBO)...
Integrated Care for Medicare-Medicaid Dual Eligibles: CMS Grants for Implementation of State DemonstrationsKip Piper -
To support demonstrations to integrate Medicare and Medicaid for dual eligibles, the Centers for Medicare and Medicaid Services (CMS) offering state Medicaid agencies grants of up to $15 million each. The funds are for implementation of CMS approved designs to integrate care for Medicare-Medicaid enrollees. Most of the state...
Medicare and Medicaid spending will exceed $1 trillion in FY 2013. Together, the two programs now serve about 113 million Americans - over a third of the population. Policymakers in Washington and the states face a daunting challenge to containing costs in Medicare and Medicaid – both health programs are...
Kip Piper -
Enrollees in both Medicare and Medicaid, called dual eligibles, are the most expensive and vulnerable group of beneficiaries. More than 40 percent of dual eligibles have severe cognitive disabilities, are likely to have severe physical disabilities, and have higher rates of chronic disease, such as diabetes and Alzheimer’s. All...
Medicare Special Needs Plans for Dual Eligibles: Recommended Improvements to D-SNP Oversight by CMS and State Medicaid AgenciesKip Piper -
Special Needs Plans for dual eligibles (D-SNPs) account for a large and growing category of Medicare Advantage Special Needs Plans (SNPs), reaching 1.2 million or 83 percent of SNP enrollees in 2012. Medicare Advantage Special Needs Plans for dual eligibles, commonly an HMO, are often key players in new integrated Medicare-Medicaid health plan...
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