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

The $350 billion Medicare-Medicaid dual eligible market is an extraordinary new business opportunity for health insurers, as well as a way for state Medicaid programs to generate significant budget savings and improve access and quality of care for frail seniors and persons with severe disabilities.  A dozen states are now looking...
As a natural outcome of program incentives, physicians and other health care providers are motivated to deliver more services as a means to increase Medicare fee-for-service (FFS) payments. Chronic overtreatment, and the resulting overpayment, has led Medicare into its current financial crisis. Medicare’s private insurance plans, Medicare Advantage (MA) plans,...
The Agency for Healthcare Research and Quality (AHRQ) is hosting a free webinar on Using Health Information Technology for Chronic Disease Management.  Webinar is set for Tuesday, June 21, 2011, at 11:30 am EST. During the 90-minute conference, participants can watch and listen as presenters share their experiences, lessons learned, and insights into the potential of...
MedPAC released its Medicare Data Book for 2010, with a wide range of useful information on Medicare spending, utilization, beneficiaries, providers, health plans, drug plans, access, and quality. The format is reader-friendly charts and tables with bulleted summaries. Specifically, the latest MedPAC Data Book includes information on: Medicare spending, including Medicare...
The federal health reform legislation - Patient Protection and Affordable Care Act (PPACA) - includes an ambitious list of changes to long-term care (LTC) services for seniors and the disabled. Most include a massive infusion of federal funding to help state Medicaid programs provide more LTC through home and...
The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) created the Medicaid and CHIP Payment and Access Commission (MACPAC) to advise Congress on a wide range of Medicaid and CHIP issues. MACPAC will start operating in early 2010. MACPAC Membership and Staff: Modeled closely after the long standing and highly...
Medicare beneficiaries in Special Needs Plans (SNPs) have higher Part D prescription drug utilization and costs than enrollees in other Medicare Advantage Prescription Drug Plans (MA-PDs) do. This is no surprise since, by design, Special Needs Plans serve higher-risk Medicare patients, including many dual eligibles. However, despite higher drug...
The next President and Congress will face many fiscal and policy challenges from the $436 billion Medicare program. Following my earlier quick primers on Medicaid policy making and Medicare and Medicaid waivers, here is a similar briefing on the primary vehicles of Medicare policy making. As a federal health program...
Many of my clients ask me how Medicaid policy is made, particularly for coverage, reimbursement, and managed care and other delivery systems. The $360 billion Medicaid program is highly complex and there are many nuances and exceptions, but here is a high-level primer on the basics. Given the Medicaid program's...
Federal waivers are powerful tools to demonstrate Medicare or Medicaid reforms, including new payment methods, benefit packages, and delivery systems. The business and policy opportunities are considerable. Here's a quick primer. Demonstration Waivers: Historically, federal policymakers have understood the need to test new ideas in the complex Medicare and Medicaid programs....

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