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

States might find it useful to have a database replete with health care service claims data to identify Medicaid fraud, evaluate disease trends, establish cost and utilization rates, and share price information with consumers. Typically such comprehensive data is difficult to gather because it comes from various public and...
Medicare Advantage plans now serve over 27 percent of all Medicare beneficiaries, according to the Kaiser Family Foundation's annual update on the Medicare Part C program. In 2012, Medicare Advantage plans serve 13.1 million beneficiaries, a jump of over one million - 10 percent - compared to last year. Medicare Advantage Plan Enrollment...
Special Needs Plans are a type of Medicare Advantage plan that is allowed to selectively market and enroll Medicare beneficiaries with special needs.  Special Needs Plans (SNPs) offer the opportunity to improve care for Medicare beneficiaries with special needs, primarily through improved coordination and continuity of care.  SNPs must also...
Medicare Part D prescription drug plan formularies in 2012 covered 96 percent of the drugs most used by people eligible for both full Medicare benefits and Medicaid - full benefit dual eligibles - according to the Department of Health and Human Services Office of Inspector General (OIG). That figure is...
Medicare reimbursement methods are highly complex and constantly changing.  Here are a series of concise briefings on Medicare payment policy for healthcare providers, Medicare Advantage plans, and Medicare Part D drug plans. These primers on Medicare payment basics are courtesy of the outstanding staff at the Medicare Payment Advisory Commission...
The nation’s 9 million Medicare-Medicaid dual eligibles - low-income frail seniors and persons of all ages with severe disabilities - now use about $350 billion in healthcare annually.  States and CMS are rolling out models to integrate Medicare and Medicaid financing and care delivery for dual eligibles.  These reforms are of...
Through the years, the Centers for Medicare and Medicaid Services (CMS) has changed its payment adjustment method for Medicare Advantage (MA) plans. These adjustments are made based on a calculated risk score per beneficiary, which should be consistent among individuals in similar demographics and with a comparable health status. Following policymaker concerns...
Several Medicare reform proposals have concentrated on realigning financial incentives within Medicare’s provider payment and delivery system to improve program cost-effectiveness and quality, a key health policy challenge. There have been calls to modernize Medicare’s fee-for-service (FFS) benefit design and address other beneficiary incentive issues as a means of...
The Congressional Budget Office’s issue brief, Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment, provides details on the outcome of 10 major Medicare demonstrations following independent researcher evaluation. Demonstrations were conducted during a 20-year span within two categories. Demonstrations were aimed at improving health care...
Because preventative care can reduce expenditures and improve health outcomes, the GAO conducted a study examining actual preventative service use in relation to the U.S. Preventative Services Task Force (USPSTF) and Advisory Committee on Immunization Practices (ACIP) by Medicare fee-for-service (FFS) beneficiaries. This study also examined whether or not the...

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