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

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...
States that expand Medicaid and establish Health Insurance Exchanges - both part of the Affordable Care Act (ACA) - should start planning early, should take advantage of time-limited federal funding to improve enrollment systems, and should emphasize online enrollment methods, says a brief from the Robert Wood Johnson Foundation’s Maximizing...
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...
In the Medicaid managed care market, health plans that specialize in Medicaid are more likely to be profitable.  Health plans that also offer commercial and Medicare products tend to operate at a loss for their Medicaid line of business. An interesting new study by Mike McCue, DBA, at Virginia Commonwealth...
Pharmaceutical manufacturers face an economic transformation as payors look more toward value-based – as opposed to transactional, unit-based – models for drug reimbursement.  This value-based revenue model presents enormous implications for the future of pharma and biotech, impacting everything from innovation, clinical trials, pricing, and marketing. The Health Research Institute at PwC surveyed...
States deciding whether to create a Basic Health Program (BHP) are worried it could undercut their health insurance exchanges, create a new entitlement program, and could carry financial risks if federal funds don’t cover the costs, according to a series of briefings on state progress in implementing the Affordable...
Under the Affordable Care Act, Health Insurance Exchanges, whether state or federally operated, must manage several core functions starting in 2014.  The functions include pre-screening for Medicaid or CHIP coverage, federal subsidy eligibility determination, consumer assistance, management and oversight of qualified health plans (QHPs), financial management, and enrollment of individuals or small...
New federal guidance outlines what States must do to demonstrate they are ready to operate a Health Insurance Exchange (HIX) or share HIX functions with the Centers for Medicare and Medicaid Services (CMS).  While CMS guidance on HIX implementation and operation remains very general and many questions remain, the new guidance...
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...

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