In The Spotlight: Insights Into The Medicare, Medicaid & Duals Programs

Read these popular highlights from the AHIP Coverage blog:


Must-See Sessions at the National Conference on Medicaid
Medicaid is the largest federal health program in the country, serving more than 70 million individuals. Next month, policymakers, administration officials, health plan leaders, and industry thought leaders will gather at AHIP’s National Conference on Medicaid (Oct. 26-27 in Washington, D.C.) to discuss the program’s successes, challenges, and regulatory changes.


The Future of Senior Care is Here
As we age, we face increasingly complex health issues that impact our quality of life while stretching our individual, family and societal resources. And the challenge is growing all the time. From 2000 to 2050, the senior population is projected to grow by 135 percent, according to the International Journal of Epidemiology. The population aged 85 and over – the group most likely to need health and long-term care services – is projected to increase by 350 percent.


Value: What’s Right for Patients
Earlier this month I was part of a panel discussion on the health system’s transition to value-based health care. What I hope attendees took away from the panel discussion is that value-based care is the right thing to do for the health care system and for patients. But as often is the case with doing the right thing, it won’t be an easy road.


How Geisinger is ‘Reading’ Patient DNA and Pioneering Precision Medicine
With electronic health records going back 20 years and a system-wide biobank dating back almost 10 years, the Geisinger Health System in Pennsylvania began laying the framework for the new field of precision medicine long before the Obama Administration announced its national Precision Medicine Initiative.


Medicare Advantage Savings Spread Far and Wide
Tailored care coordination, disease management programs, comprehensive benefits, market competition – these are all part of what makes Medicare Advantage the foundation for care delivery innovations across the health system. By increasing provider efficiency in the delivery of clinical care, the innovative, cost effective practices implemented by Medicare Advantage plans are reducing spending in the fee-for-service Medicare program.


How Group Health is Embracing Preventative Care
When Group Health started 70 years ago in Washington state, our founders wanted to offer health care coverage focused on preventative care to increase affordability and expand access. We are a member-governed, nonprofit health care system that coordinates care and coverage.


Harvard Pilgrim Health Care Foundation’s Mobile Market Initiative
Harvard Pilgrim Health Care has long recognized that a person’s health is not constrained to how and when they access health care – and in fact, that access to preventative measures, such as nutritious food helps to prevent and manage many chronic diseases in the long term.


New Data Brief Finds Physician Shortages Lead to Network Adequacy Challenge
States are facing a shortage of physicians in primary care, psychiatry, obstetrics and gynecology, and general surgery, according to a new AHIP data brief. This analysis looked at the ratio of these physicians to the population and found several U.S. states currently have physician supply rates that fall well below the national average.


Financial Security in Retirement: Q&A with Bankers Life President
Baby boomers are expected to live longer than previous generations. They’re also facing more complex retirement challenges and opportunities than previous generations. As Boomers are preparing to exit the workforce, there are things they can do today to be financially prepared, according to Scott Goldberg (pictured), president of Bankers Life, which offers a variety of products, like Medicare Supplement and Life Insurance. He recently spoke with AHIP about how Boomers can find peace of mind about their financial security.


New Poll: Medicaid Beneficiaries Overwhelmingly Satisfied With Their Coverage
A new Morning Consult poll commissioned by America’s Health Insurance Plans (AHIP) shows that the great majority of Medicaid beneficiaries are satisfied with the access to care and benefits that the Medicaid program provides. With the continued growth of the program, the poll captures the importance of Medicaid coverage for enrollees across the country. The poll is based on responses from a representative national survey of nearly 2,000 adult Medicaid beneficiaries.


Finding or Choosing a Provider: What You Need to Know About Health Plan Provider Directories
Health plans publish provider directories that include comprehensive listings of the physicians and other clinicians, facilities (e.g., hospitals), and pharmacies that participate in their networks. These directories, which are typically posted online and in a searchable format, are a valuable resource for individuals and their families.


Plan-Provider Partnerships Improve Health Care Cost and Quality
Blue Shield of California is no stranger to using accountable care models to reduce health care costs and deliver effective, evidence-based, personalized patient care.

After launching its first ACO in 2010, the health plan now has more than 36 ACOs in California, serving more than 340,000 members. These ACOs are partnerships between the health plan, hospitals, and doctors that break down silos, build trust, optimize costs, and improve health outcomes for patients.


Medicare Advantage Plans Deliver Quality and Cost Savings Through High-Value Hospital Networks
Over 17 million Americans have chosen a Medicare Advantage plan because of the higher-quality care and additional benefits these plans provide. An important factor behind the comprehensive, cost-effective care that is fundamental to Medicare Advantage is high-value provider networks.


Risk Adjustment Data Validation (RADV) Audits: What You Need to Know
Payments to Medicare Advantage plans are adjusted based on health risk of enrollees. The goal of risk adjustment is to ensure beneficiaries, including those with chronic conditions, are enrolled in plans that are appropriately reimbursed to meet their individual health needs.


Creating Better Health by Connecting Communities
To impact population health, we must move beyond the walls of a doctor’s office and directly into communities. Humana is acting as a catalyst in several communities, sharing data we’ve collected that identifies prevalent health conditions and barriers to health. We are convening local stakeholders, collaborating to improve health and measuring progress toward a bold goal of improving the health of the communities we serve 20 percent by 2020.


Empowering Consumers To Live Their Best Lives
The Medicaid program is a critical safety net for beneficiaries, and Medicaid health plans address beneficiaries’ needs beyond health care to improve their economic stability and social well-being. That’s why our team at CareSource is helping our members transition toward greater independence and job security through our Life Services program.


Lessons Learned Bringing Care to the Under-Served
Chuck is a 58-year-old Tufts Health Plan member who has multiple chronic physical and mental health conditions, including diabetes, congestive heart failure, kidney disease, and depression. On top of his urgent medical needs, he is chronically homeless. Recently he found himself in an emergency room yet again, this time in Florida, far from his last known address in Massachusetts. He ultimately returned to Massachusetts, and with the help of his care team, began looking for subsidized housing so he could focus on his health.


How Medicaid Managed Care Addresses Barriers to Care
Millions of Americans depend on the Medicaid program, and it’s through the work of Medicaid health plans that beneficiaries across the country benefit from coordinated, high-quality care.

Oftentimes this work goes beyond medical care and treatments.


Why States Depend on Medicaid Managed Care
Roughly 70 percent of Medicaid patients receive benefits from a managed care plan, a percentage that continues to grow. Across the country, states are increasingly turning to Medicaid health plans to provide better quality care and greater value to beneficiaries and their families.


Setting the Story Straight on Medicare Advantage
A recent Kaiser Family Foundation article suggests differences in coverage between private Medicare options, including Medicare Advantage, and traditional Medicare may “disadvantage” seniors enrolled in fee-for-service Medicare. Yet the article fails to acknowledge how the traditional fee-for-service program continues to undermine the care seniors need.


What You Need to Know About Health Plans and the Medicaid Program
Medicaid  health plans are uniquely positioned to assist in strengthening the Medicaid program for millions of beneficiaries across the country. A new issue brief from AHIP helps explain the Medicaid program works and how health plans work with states to deliver care for Medicaid beneficiaries.


How WellCare Meets the Needs of Medicaid Patients: Q&A With CEO Ken Burdick
Next week, WellCare CEO Ken Burdick will present on a panel at AHIP’s National Health Policy Conference in Washington, D.C. The session will focus on managing complex health conditions among diverse populations through public programs, such as Medicaid and Medicare Advantage, and also features Molina Healthcare CEO Dr. J. Mario Molina, AmeriHealth Caritas CEO Paul Tufano, and Healthfirst CEO Pat Wang. Burdick shared some of his insights with AHIP Coverage ahead of the event.


Report: Protect Medicare Advantage’s Ability to Care for Patients With Complex Health Needs
Changes to the Medicare Advantage risk adjustment model undermine health plans’ efforts to care for beneficiaries managing multiple chronic conditions, concludes a new report from Avalere Health. This will have real consequences for the millions of seniors and individuals with disabilities who rely on the Medicare Advantage program.


A Bundled Payments Success Story for Patients, Providers, and Plans
While helping consumers choose the right coverage, health plans are working to make coverage as affordable as possible by driving health care delivery reforms. The bundled payment model is one such health plan innovation that is successfully promoting affordability and quality for patients, health care providers, and health insurance plans.


How Hospital-Physician Consolidation is Driving up Health Costs
More hospitals are acquiring physician practices or hiring physicians as hospital employees, according to a report recently released by the Government Accountability Office. The number of hospitals swallowing up physician practices almost doubled from 96,000 to 182,000 between 2007 and 2013, and the number of hospitals directly employing physicians grew from 1,400 to 1,700.


Finding Innovation in Medicaid Managed Care
Today, Medicaid serves nearly 70 million Americans, which is roughly 20 percent of the U.S. population. While Medicaid is a necessity for its beneficiaries, it has also become a proving ground for health care innovation.


New Issue Brief: Medicaid Managed Care Delivers Stronger Outcomes, Better Value
When it comes to serving the more than 35 million low-income individuals who rely on Medicaid managed care, health plans continue to receive high marks for improving beneficiaries’ care, according to a new AHIP report.