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

Health care quality and patient safety have become increasingly important in recent years, particularly as part of efforts to prevent wasteful spending, hospital readmissions, and medical errors. Accountable Care Organizations (ACO), health information technology (HIT), electronic health records (EHR), and new health plan reporting requirements are among the many...
The 2012 Supreme Court got a lot of attention for its decision to uphold most of the Affordable Care Act (ACA) health reform law in NFIB v. Sebelius. But this year’s court docket will be no dud. There will be a number of interesting and important cases for pharma...
Medicare Part D, the Medicare drug benefit, served roughly 31 million seniors last year. Medicare Part D is more similar to Medicare Advantage than to traditional Medicare in that enrollees can choose among several private health plans for drug coverage. The lists of which drugs Part D plans cover -...
Special Needs Plans (SNP) are part of the Medicare Advantage program and were created by the Medicare Modernization Act of 2003 (MMA). There are three types of SNPs, each intended to provide coordinated care for Medicare beneficiaries that meet specific criteria. Institutional SNPs (I-SNP) serve beneficiaries who, for 90 days...
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...
Medicare will spend $598.4 billion on health care services for seniors and the disabled in 2013 and about $635 billion in 2014.  Medicare expenditures will top $1 trillion in 2021, according to CMS actuarial projections. Medicare spending patterns and payment policies are highly complex and change constantly. The Affordable Care...
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...
Overuse and abuse of opioid drugs, particularly prescription pain killers, is a serious, costly problem, with a host of challenges for purchasers, payors, patients, physicians, pharmacists, regulators, public health, and drug manufacturers.  For 20 years, overuse of opioid drugs has steadily increased, as have inpatient hospitalizations for opioid overdoses.  Together, Medicaid and...
For the 2.4 million Americans with an opioid use disorder, the over 10 million who abuse prescription opioids, and the nearly one million heroin users, access to medication-assisted treatment (MAT) is critically important, according to the National Institute on Drug Abuse (NIDA) and Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines....

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