But an expert on Medicaid waivers note to Kaiser Health News that the Big Sky State probably won’t get exactly what it wants.
“A waiver proposal never comes out the way that it went in,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “All of these waiver negotiations require some flexibility on both sides.”
Cambridge Management Group is (quietly) celebrating its 30th anniversary this month. Since 1985, our firm, composed of senior professionals with many years of business and clinical experience from across America — has been privileged to help organizations adapt to healthcare-sector-wide changes while addressing individual organizations’ often unique challenges.
The sector has seen vast changes since 1985! Consider the arrival of various forms of managed care, the rise of big hospital chains and the surge in hospital employment of once-independent physicians. Then there are the stunning new technologies that can turn patients into amateur doctors and new government insurance programs aimed at expanding coverage while controlling costs. The Affordable Care Act has, of course, accelerated the sector’s transformation in the past several years.
During the past three decades, CMG has expanded from consulting at hospitals to also work for a wide range of other healthcare organizations, such as Federally Qualified Health Centers and statewide Medicaid programs as “population health’’ becomes a mantra.
Whatever the challenges along the way, we’re always energized by our mission, as summarized in our motto “Cooperating for Better Care’’. To us at CMG, healthcare remains the most exciting – and, arguably, the most important — place to work. We’re grateful to have had the opportunity to do so for three decades, and look forward to continuing for years to come.
Cambridge Management Group is (quietly) celebrating its 30th anniversary this month. Since 1985, our firm, composed of senior professionals with many years of business and clinical experience from across America — has been privileged to help organizations adapt to healthcare-sector-wide changes while addressing individual organizations’ often unique challenges.
The sector has seen vast changes since 1985! Consider the arrival of various forms of managed care, the rise of big hospital chains and the surge in hospital employment of once-independent physicians. Then there are the stunning new technologies that can turn patients into amateur doctors and new government insurance programs aimed at expanding coverage while controlling costs. The Affordable Care Act has, of course, accelerated the sector’s transformation in the past several years.
During the past three decades, CMG has expanded from consulting at hospitals to also work for a wide range of other healthcare organizations, such as Federally Qualified Health Centers and statewide Medicaid programs as “population health’’ becomes a mantra.
Whatever the challenges along the way, we’re always energized by our mission, as summarized in our motto “Cooperating for Better Care’’. To us at CMG, healthcare remains the most exciting – and, arguably, the most important — place to work. We’re grateful to have had the opportunity to do so for three decades, and look forward to continuing for years to come.
The deal would make Aetna a major player in the surging Medicare Advantage business and would bolster Aetna’s presence in Medicaid and in Tricare coverage for military personnel and their families. But everyone in the healthcare sector would be affected, directly or indirectly, including Federally Qualified Health Centers.
Modern Healthcare noted that Aetna’s announcement came a day after the Medicaid coverage provider Centene said it would buy fellow insurer Health Net to help Centene expand in the California Medicaid market, the nation’s biggest, and give it a Medicare presence in several other western states.
As private-sector-employer-based insurance has shrunken, the big insurers are expanding into public programs at an ever faster clip.
The Medicaid “private option” pioneered by Arkansas is speading. More states, most recently Montana, are expanding Medicaid with this model. Now, Arkansas is considering the future of its program. The “private option” is attactive to Red State governors who oppose the Affordable Care Act.
One idea, writes Rachel Dolan in a HealthAffairs blog entry, is to use “1332 waivers” to expand the private option, “where Medicaid provides premium support for certain enrollees to purchase commercial insurance on the marketplace, to cover all or most of current enrollees. Right now the program is limited to the Medicaid ‘expansion’ population: adults without children. The main selling point for the ‘private option for all’ approach appears to be its palatability to red state governors, a way to expand insurance coverage where they otherwise might not.”
“In any case, adding a population of high needs individuals from traditional Medicaid—rather than healthier expansion beneficiaries as Arkansas did—might offset some or all of marketplace cost savings, but that will depend on the state and the particular insurance market. The key is that commercial coverage for high needs/disabled people will be expensive and could increase what states are on hook for in Medicaid dollars.”
“{I}t’s hard to see how states will see a good deal in any way other than politically in expanding the Medicaid private option to the wider program population.”
Gynecologists ordered fewer preventive services for women who were insured by Medicaid than for those with private coverage, a recent study found.
The study by researchers at the Urban Institute examined how office-based primary care practices provided five recommended preventive services over a five-year period. The services were clinical breast exams, pelvic exams, mammograms, Pap tests and depression screening.
The study used data from the National Ambulatory Medical Care Survey, a federal health database of services provided by physicians in office-based settings. It looked at 12,444 visits to primary-care practitioners by privately insured women and 1,519 visits by women who were covered by Medicaid between 2006 and 2010. That difference reflects that the share of women who are privately insured is seven times larger than those on Medicaid, the researchers said. Pregnancy-related visits and visits to clinics were excluded from the analysis.
Overall, 26 percent of the visits by women with Medicaid included at least one of the five services, compared with 31 percent of the visits by privately insured women.
As for specific preventive services, the study found “strong evidence” that visits by Medicaid patients were less likely include a clinical breast exam or a Pap test, says Stacey McMorrow, a senior research associate at the Urban Institute’s Health Policy Center and the study’s lead author. The differences for depression screening weren’t statistically significant, and once patient characteristics such as age, race and home address were taken into account weren’t significant for mammograms or pelvic exams either.
For example, 20.5 percent of visits by privately insured women included a clinical breast exam, and 16.5 percent of visits included a Pap test. But the percentage of Medicaid-insured visits that included those services was only 12 percent and 9.5 percent, respectively. (The differences narrowed but remained statistically significant when adjusted for patient characteristics.)
The Medicaid-insured women were not necessarily receiving lower quality care, according to the study. They may have been receiving additional care at a community health clinic or from a nurse practitioner, for example, but the study only examined physician services provided in office-based practices.
In addition, privately insured women may have been receiving services more frequently than recommended. For example, current guidelines generally recommend a Pap test to screen for cervical cancer every three years. But if a patient asks for a Pap test every year the doctor may provide it, McMorrow says.
In addition, private insurers generally pay providers better than does Medicaid, sometimes significantly better, she says: “Where providers are getting reimbursed better, they’re going to provide services more frequently.”
Yes, many physicians are very, very busy, but the ignorance of the law that affects them so much is, well, amazing.
That survey, conducted this year by the Kaiser Family Foundation (KFF) and the Commonwealth Fund, reported that 48 percent of primary-care physicians didn’t know enough about the ACA to understand how it was affecting their practices.
One ACA provision raised Medicare rates for office visits and preventive care by 10 percent from 2011 through the end of 2015. Yet 49 percent of physicians surveyed didn’t know this!
The law also increased Medicaid rates for office visits and vaccine administration to Medicare levels in 2013 and 2014 for primary-care physicians.
The survey found that 47 percent of primary care physicians didn’t know about the Medicaid payment bump. This is an important oversight: Of those who did know about the bonus, 22 percent said it moved them to see more Medicaid patients.
Clearly, the government and professional organizations need to do a lot more educating of physicians about the Affordable Care Act.
As part of this, she says, the administration plans to push further on a patient-centered approach.
“Our vision is paying providers for what works, and incentivizes quality over quantity.”
She also emphasized the importance that the administration puts on enlisting states that do not currently accept federal funds for for the Affordable Care Act’s Medicaid expansion. With the recent Supreme Court ruling on ACA subsidies, it seems likely that all or most of the states now refusing to expand Medicaid will do so within the next year or so.
