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

Controlling statewide costs in prisons was the rationale for privatizing the correctional healthcare delivery system across the nation, but there have been consequences.  The increased incarceration levels and shift from governmental to private criminal justice system medical care has resulted in an additional burden of care placed on hospitals...
The Affordable Care Act (ACA) is changing the health care landscape for everyone, including safety net hospitals. Just how this change will affect these key providers and what they must do to stay open are subjects of much debate.  In a multitude of ways, the ACA, new marketplace dynamics,...
Delivery of physical medical care and behavioral health services is too often uncoordinated, operating in silos with little or no communication between physicians and other providers providing a patient with primary, specialty, acute, and pharmacy services and behavioral health professionals proving that same patient with mental health care or...
Hospital readmissions are costly but largely preventable. Reducing inpatient readmissions are a top priority for Medicare, state Medicaid programs, and private health plans.  The opportunities to lower costs and improve patient outcomes are considerable.  Therefore, healthcare purchasers are realigning hospital payment methods to reward hospitals for fewer readmissions and...
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....
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)...
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...
Improving care integration for Medicare-Medicaid dual eligible beneficiaries is one of the many initiatives embedded in the Affordable Care Act (ACA). The health reform law created the Medicare-Medicaid Coordination Office at the Centers for Medicare and Medicaid Services (CMS), and provided funds for state demonstrations to integrate care for...

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