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

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...
Under the new employer mandate imposed by the Affordable Care Act (ACA), employers will pay about $130 billion in penalties over the next 10 years.  The ACA employer mandate is highly complex and employers have many factors to consider. The employer mandate – called “shared responsibility” in federal law and...
Employer-sponsored insurance (ESI) has been central to the U.S. health care system. The Affordable Care Act (ACA) adds many requirements and imposes many costs on employers that could change how - and if - they offer employee health care coverage.  But estimating the effect of changes to ESI is...
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...
Love it or hate it, the Affordable Care Act is unprecedented in size, scope, complexity, and uncertainty.  To project its impact, numerous policy, economic, competitive, and behavioral factors must be considered and assumptions made.  From an analytical perspective, the ACA is a simultaneous, non-linear equation from hell. A number of...
What's the impact on patient care, particularly prescription drug utilization, as Medicaid beneficiaries move from fee-for-service to Medicaid health plans?  This year, state Medicaid programs will spend over $22.1 billion on pharmacy benefits. This will grow to about $50 billion by 2020, according the CMS actuaries. Nearly half of Medicaid prescriptions...
The Affordable Care Act (ACA) created a trade-off for providers, particularly hospitals: On the one hand, Medicare fee-for-service hospital payments will be cut by $260 billion over 10 years. Some people newly eligible for Medicaid will switch from private insurance, which pays much higher provider rates than Medicaid does....
Some states have expressed interest in using premium assistance to expand Medicaid eligibility under the Affordable Care Act (ACA).  Instead of serving the new ACA Medicaid expansion population through the Medicaid delivery system (through Medicaid health plans or Medicaid fee-for-service, depending on the state), the new enrollees would be...
The qualified health plan contracting process in Health Insurance Exchanges present many opportunities and challenges for states and the Centers for Medicare and Medicaid Services (CMS).  Success in implementing the Exchanges - one of the Affordable Care Act's most complex and ambitious features - will require comprehensive, well-structured strategies,...
Primary care is shifting to payment based on providing higher quality, lower cost health care. New payment models - such as patient-centered medical homes (PCMH) - replace or supplement traditional fee-for-service payments with per-member per-month payments, and emphasize coordinated care, quality measurement, and accountability. Some models offer cost-sharing, as...

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