'We Have to Be Willing to Change'

BUFFALO, N.Y. – Maureen Brown has recently found herself asking the same question – “Why did you do that?” – when conversing with co-workers.

“All of us have to take ownership of what we do,” said Brown, director of purchasing at Baker Victory Services (BVS) in Lackawanna. “Are we doing the right thing, and for the right reason?”

Brown and 13 other professionals from BVS, Community Services for the Developmentally Disabled (CSDD) in Buffalo and People Inc. in Williamsville are taking a fresh look at service delivery through a different lens: the Lean methodology of decreasing waste.

4 Years of Managed Care in Kentucky

FRANKFORT, Ky. — Kentucky’s Medicaid Managed Care system has experienced profound growing pains since its implementation four years ago, but Cabinet for Health and Family Services officials assured a legislative panel Thursday that the state is taking steps to resolve disputes between medical providers and managed care organizations.Providers like Sen. Danny Carroll, chief executive officer of Easter Seals West Kentucky, which provides care for disabled adults and youths, have complained of delayed or denied Medicaid payments and a morass of bureaucratic hurdles to clear for each MCO.

Iowa Official Fears 'Disaster' with Move to Medicaid Managed Care

Iowa Senate President Pam Jochum said Thursday she's worried that vulnerable Iowans face a "disaster" as the state implements a cost-saving plan to hire a private business to manage the Medicaid health insurance program.
Jochum, a Dubuque Democrat who has an adult daughter with severe developmental disabilities, said her family has the financial resources to care for her daughter if necessary. But she feels obligated to speak on behalf of other Iowa families who don't have enough money to care for their loved ones if Medicaid services aren't available.

Managed Care Pilot Meets Resistance

California’s initial efforts to move almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance.

Many beneficiaries have received stacks of paperwork they don’t understand. Some have been mistakenly shifted to the new insurance coverage or are unaware they were enrolled. And a third of those targeted for enrollment through Nov. 1 opted out, indicating they will stick with their traditional coverage.

Agencies Challenge New Hampshire's Transition to Medicaid Reform

NASHUA – Clients, parents and employees of Gateways Community Services packed a showdown meeting at Harbor Homes last week on the state’s plans to impose cost efficiencies on a state Medicaid system considered to be hemorrhaging money.

Medicaid officials told the Governor’s Commission on Managed Care that more than 100,000 Medicaid subscribers on Dec. 1 smoothly switched into care management for their visits to hospitals, clinics, doctors and other medical providers.

New Hampshire is the 48th state in the nation to offer managed care under Medicaid and state budget writers are relying on the reform to save $16 million in state spending over the next 22 months

Florida Governor Presses Feds on Medicaid

TALLAHASSEE -- After emerging from a meeting with U.S. Health and Human Services Secretary Kathleen Sebelius, Gov. Rick Scott said Monday he asked for the federal government to “expedite” approval of Florida’s controversial proposals to shift most Medicaid beneficiaries into managed-care plans.
But Scott offered few details about their discussion on another major issue — how, or if, the state will carry out key parts of the federal Affordable Care Act.

Officials Quell KanCare Confusion

When Kansas Medicaid recipients received their KanCare enrollment packets last fall, they were given a simple directive – check the three insurance companies that will be taking over the state’s Medicaid program to be sure your primary care provider and other health providers are covered, then choose a plan accordingly.
But while KanCare went into effect on Tuesday, the same problem remained for more than 3,700 Miami County residents enrolled in Medicaid. When looking up the list of Kansas providers, there’s a gap in the “O” section where Olathe Health Systems should be listed – but isn’t. Since the company owns the county’s only hospital, Miami County Medical Center, as well as family care clinics in Paola, Osawatomie and Louisburg, the absence of the health group from the three plans’ lists of providers is worrisome for the county’s Medicaid recipients.

Editorial: Entitlement Changes, Misplaced Fear

The next time you hear someone say that Mitt Romney wants to “end Medicare as we know it,” consider what New Hampshire has done with Medicaid.
Last week, the federal government gave New Hampshire the final OK to switch to what is being called Medicaid managed care. The state has hired three companies to manage the coverage provided to the state’s Medicaid recipients. (Medicare is the subsidized government insurance program for seniors; Medicaid is for low-income and disabled individuals.)
With Washington’s approval last week, New Hampshire officially has ended Medicaid as we know it. The new managed care plan will end the state Medicaid program’s old fee-for-service model (in which patients go to the doctor and Medicaid pays for services individually) with a managed care plan in which the three contracted companies work with patients to more effectively spend health care dollars and provide better care.

500 Practices Selected for Primary Care Demo

WASHINGTON --  More than 2,000 physicians and health professionals will care for Medicare, Medicaid and private plan beneficiaries under the same new payment model aimed at coordinating care and keeping patients healthy to avoid costly admissions for inpatient care.

Roughly 500 physician practices in seven regions spread out over eight states successfully applied to participate in the Centers for Medicare & Medicaid Services-led comprehensive primary care initiative. Doctors will receive as much as $40 per high-risk patient per month to support care coordination and wellness programs. Practices that keep health spending below expenditure targets will share in the savings, but those that do not meet expectations might be asked to leave the project.