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

Billy Millwee, former Texas Medicaid director, recently published an excellent piece with insight into that state’s experience with quality-based payment reform. Health care payors, both private and public, are looking more and more to tie payment with outcomes. Millwee’s article is a thoughtful and thorough assessment of Texas Medicaid's...
Special Needs Plans (SNP) are part of the Medicare Advantage program and were created by the Medicare Modernization Act of 2003 (MMA). There are three types of SNPs, each intended to provide coordinated care for Medicare beneficiaries that meet specific criteria. Institutional SNPs (I-SNP) serve beneficiaries who, for 90 days...
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...
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...
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,...
Today, Medicaid spends nearly $500 billion a year on health care for about 71 million Americans.  Responsible for a quarter of state budgets, the highly complex program is poised to grow dramatically under the Affordable Care Act (ACA). The extraordinary fiscal, clinical, and administrative demands of Medicaid have left state...
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...
Much of the health information technology (HIT) today promotes patient communication to improve care and potentially lower costs. Some examples are interactive preventive health records (IPHR), e-prescribing, and electronic health records (EHR). Emerging telehealth technologies, however, take it a step further. Telehealth allows physicians and other providers not only to...
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...

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