The Menges Group puts out these great analyses and insights each month. And is kind enough to let us repost them for the MM audience. Check out themengesgroup.com to learn more about the work they do.
Our November Edition of the 5 Slide Series focuses on the 2018 election results and conveys some of the potential implications of these results regarding Medicaid expansion.
Mid-Term Election Results and Medicaid Expansion Dynamics — November 2018
Alison Croke is President and CEO of Wood River Health Services. Check out her LinkedIn profile HERE.
I currently serve as the President & CEO of a federally qualified health center in Rhode Island. We provide medical, dental, behavioral health, case management and other support services to our patients, regardless of insurance status or ability to pay. We have many Medicaid patients, but we also have patients who are uninsured or underinsured.
I have been in the Medicaid industry for 20 years.
I grew up attending an all girl Catholic college preparatory academy run by the Sisters of Mercy. The mercy mission instilled a passion for social justice, the importance of giving back to your community, and the value of women’s leadership. I enjoy mentoring young women who are interested in health care administration, and I’m lucky to work at an organization whose mission is to improve their local community.
My other passion would be for all New England sports teams, with the Patriots at the top of the list.
I don’t have one particular item on my bucket list -and I have no desire to jump out of an airplane. I would love to travel more and see some of the beautiful cities in Europe like Prague. And if I happen to meet Queen Elizabeth somewhere along the way, that would be great. Also, would love to attend certain sporting events once- a Super Bowl, the Kentucky Derby, etc.
I love to play with my dogs and take them running. I also enjoy watching Patriots games.
Queen Elizabeth I is fascinating to me. She led her country through a historical period where intolerance was commonplace and was able to demonstrate that tolerance and acceptance was the better path. She allowed England to flourish and become a place where authors and playwrights could thrive, and also position the country for the future position as a super power and global leader. Without her bravery and determination, we would not have classics like Shakespeare and Marlowe.
This is a tough one. It’s hard for me to resist anything chocolate. But I also sometimes splurge on movie theater popcorn with butter. I always feel guilty after though.
When I worked for RI Medicaid, we built many new managed care programs that expanded access to care for members. I worked on a team that created the RIte Smiles program – a dental managed care program for kids. By contracting with a managed care plan, the state was able to not only raise rates for providers, but improve the quality of dental care kids received, and create a much larger network of dentists that would treat children on Medicaid.
I do not regret any of the career choices I’ve made in the last 20 years, as they have led me to where I am today. I am sure that as a young professional just out of graduate school I made some naive mistakes and misjudgments. I have many people to thank for mentoring me through those early years and being very honest with their feedback. Without their help, I would never have made it! I have learned to be much more humble in my professional interactions. Most people do not care what your title is -they care that you are committed to your work and follow through on your word.
Now that the Congress does not consist of one majority party, I believe the efforts to repeal and replace the ACA will not receive much traction. However, state budgets, especially in our state, continue to be stretched by health care expenditures, often making Medicaid programs a target for budget cuts. I would consider the aging population, the opioid crisis, and better access to mental health treatment are the top 3 issues in the coming months.
Jeff Leston is the President of Castlestone Advisors. Check out his LinkedIn profile HERE.
We are in the fraud prevention, health identity protection and oversight segment. We developed tools that use the existing payment (credit/debit) networks to deliver real-time encounter information to health plans right from the point of care. Inexpensive and very effective.
I’ve been in and around health insurance and health IT world for over 30 years, and about the last 10 in Medicaid. In the early ‘90s I created the first use of artificial intelligence for health insurance fraud detection at a Blue Cross plan. Like what Castlestone does, the technology we used was born in the credit card industry.
Professionally and personally related, I hate to get ripped off. Finding hundreds of thousands of dollars of fraud in a co-op I lived in in New York was part of the inspiration for starting Castlestone. My personal passions are music and ice hockey. I’m lucky because I have a great musician and a hockey player growing up in the house. I also love to follow investments, particularly in technology companies.
Other than certain professional goals, I want to teach 8th grade algebra. I remember being scared out of my wits on my first day of algebra when the teacher just started throwing formulae up on the board. I decided I could do it better and show students where it applies in the real world and explain it as a language of numbers. I also want to go to a Stanley Cup Finals game when the Pittsburgh Penguins are playing.
My wife and I have 15-year old twins, Adam and Joanna, and we are very involved in their activities. Joanna is a dedicated musician and performer. Adam is a hockey player, which takes us a lot of time. I’m also the President of the high school’s hockey club, which I enjoy. The most satisfying thing is watching them, and their friends mature and grow skillful in their pursuits.
I like to read about people who really changed the world, the way we think, and how society operates. They were the rebels and often shunned in their own time, until history caught up with them. Galileo, Charles Darwin, Dr. Martin Luther King, and Sigmund Freud all changed how we perceived the world around us, often against powerful societal and religious forces. Isaac Newton wanted to explain the elliptical orbits of the planets, so he invented calculus. Ernest Rutherford figured out the structure of the atom with none of the instruments available to scientists today. Marie Curie took it a step further to explain radioactivity. People didn’t know what to make of Jimi Hendrix when they first heard him. He still sounds great and original today.
My favorite historical figure above all is Roberto Clemente, whom I watched play for the Pittsburgh Pirates growing up. What he did on the field, off the field, his passion and pursuit of excellence at all times and his concern for the culture he came from should be a role model for a lot of people.
I have been addicted to pistachio nuts since I was a young boy. Also, a big fan of tortilla chips and a good hot salsa
So far, it is the US House passage of HR 6690, Fighting Fraud and Protecting Seniors Care Act of 2018. I’ll be even more proud when it passes the Senate. I’ve been an advocate, analyst and designer of smart-card anti-fraud solutions and data-oriented solutions for a long time.
I was once offered a position in New York with a very high-quality research and investment company as a technology analyst. I wish I hadn’t turned it down so quickly. I don’t know if I would have taken the position, but I didn’t give it the time and thought it deserved.
Managed Medicaid
Some states are moving ahead with Managed Medicaid, (North Carolina) while others are debating its value (Iowa) and a recent article by Chad Terhune of Bloomberg discusses the payments to Managed Medicaid and the limited oversight that accompanies those payments. Congress is stepping up its hearings on Managed Medicaid oversight and what CMS and the States should do about it.
Work Requirements /Eligibility and Expansion
Hardly a day goes by where there is not a news story about work requirements in various State waiver applications. Post-election, where some states approved expansion of Medicaid, Congress is or should be looking at oversight of expansion. The recent story of California enrolling 450,000 ineligible people onto their Medicaid program is not lost on Capitol Hill. Louisiana’s legislature voted down a bill to allow for income verification. That brings me to the third point:
Funding the Programs
We are at a point where we really don’t know whether Medicaid is a State program or a Federal Program. If Medicaid is a Federal Program – the Federal Taxpayer has funded 100% of expansion, now 90%- then increased Federal Standards and oversight are needed. Congress was making more noise about this with recent reports and hearing. If it is a State program, States will have to put in place better accountability and integrity measures in exchange for some level of Federal funding. Right now, we have neither. Medicaid is now the largest budget line item in many States, and even with 90% Federal Funding, it is beginning to crowd out programs in education and infrastructure, and taxes are increasing to meet the cost. The program ownership, funding and oversight will become a front and center issue.
Kili is the Chief Growth Officer at i2i Population Health. Check out her LinkedIn profile HERE.
A: Healthcare Technology, no that’s not an oxymoron.
A: My entire career, straight out of college. The actual count of years will remain a highly guarded secret.
A: Advising my husband on how to run his company. 🙂
A: I’d love to have a beer with Barack Obama and George W. Bush at a backyard bbq. Can you imagine the stories?
A: Drinking homemade tomato wine. It’s amazing. Big opportunity.
A: Genghis Khan. I’d ask him how to conquer healthcare.
A: Can I pick two? Pork rinds and pickled papaya. (If you knew where I was raised, that would make sense)
A: Out drinking Clay Farris at the last MHPA annual conference.
A: I’d be happy to redo the last 5 years of my life, BUT I’d redo it the exact same way. 🙂
The Menges Group puts out these great analyses and insights each month. And is kind enough to let us repost them for the MM audience. Check out themengesgroup.com to learn more about the work they do.
The August edition quantifies Medicaid DSH payments, showing the progression of DSH spending in each state from 2013-2017. The key takeaway is that Medicaid DSH has not dropped at all across the expansion states since 2013, even though this was intended to occur as one of the mechanisms to help offset the Federal costs of Medicaid expansion.
The September edition presents Medicaid data from our Pharmacy Practice, quantifying the differences in cost per prescription between the MCO and FFS settings in two selected high-volume therapeutic classes. In both drug classes (as occurs with Medicaid prescriptions overall), the MCO setting is achieving large percentage savings relative to FFS. However, the path taken to achieve these savings is quite different between the two drug classes shown.
October’s edition conveys some of our tabulations working with the recently published NCQA Medicaid health plan quality ratings for Rating Year 2018-2019. AmeriHealth Caritas and UnitedHealthcare are the two top-rated national chain organizations in terms of their average NCQA rating across the states they serve. Among the 13 Medicaid MCOs with a rating of 4.5 or above, the plans achieving this excellent quality score on the largest Medicaid membership base are Health Partners Plans in Pennsylvania, Neighborhood Health Plan of Rhode Island, and Priority Health in Michigan.
Medicaid DSH Spending Trends — August 2018
Medicaid MCO Rx Cost Savings at Therapeutic Class Level — September 2018
Medicaid MCO Quality Overview, NCQA Ratings for 2018-2019 — October 2018
A lot happens in Medicaid in 30 days.
We cover it all in 60 minutes with our distinguished panel this month – Jerry Dubberly, Ray Hanley, and Kip Piper.
