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

Multi-payor medical home initiatives have many benefits. They can bring Medicare, Medicaid, and private health plans together to promote care coordination, better health outcomes, and lower costs. But they have one potential flaw: Allowing payors to coordinate payment policies could trip federal (or state) anti-trust protections to prevent price-fixing and...
Risk adjustment is a key mechanism to ensuring appropriate payments for Medicare Advantage plans, Medicare Part D drug plans, and Medicaid health plans.  Since health plans vary in their mix of healthy and sick enrollees, risk adjustment modifies premium payments to better reflect the projected costs of members served and...
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...
Price transparency - or making price information publicly available - is an idea that has gained steam recently as one more way to reduce health costs and improve quality. So far, that has taken the form of online tools to help private health plan enrollees choose providers. But states...
Medicare-Medicaid dual eligibles are often talked about as a single type of patient. They have significant levels of disability and chronic disease, and account for a disproportionately large spending in both Medicare and Medicaid budgets. But dual eligibles are a diverse group. A few recent studies into health spending on dual...
Debate about whether consumers will pay more for insurance under health reform has become political, with conservative organizations saying Obamacare will increase premiums and liberals saying it won't, at least not when you take into account taxpayer-funded subsidies for health coverage. In a new study, RAND Corporation joins the latter group....
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...
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...
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....
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...

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