National Association of Community Health Centers – To address the widespread lack of access to basic health care, Community Health Centers serve 20 million people at more than 8,000 sites located throughout all 50 states and U.S. territories.
Further reading
Meaningful Use – Meaningful Use is the way in which EHR technologies must be implemented and utilized for a provider to be eligible for the EHR Incentive Programs and to qualify for incentive payments.
Further reading
https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives
Memorandum of Agreement – A signed agreement between two or more parties to establish specified policies or activities.
Further reading
Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2u5LKtU
For optimist readers- http://bit.ly/2u2PRXL (a poppy bit for your vacation trip)
SHAMELESS PLUG FOR OUR NEW ONLINE TRAINING COURSE: Check it out. We released it after years in the making. Here’s the video ad for it- http://bit.ly/2twQCeF
I WILL BE AT MHPA 2017, WILL YOU? Chairing a Medicaid Director’s panel. Would love to see you there. You can check it out here – http://bit.ly/2twCi5L
DETAILS OF THE SENATE BILL THAT WILL KILL EVERYONE 4 TIMES OVER AND ALSO INCREASES CLIMATE CHANGE AND ALSO EVERY OTHER BAD THING WE CAN TACK ON TO THIS BILL THAT STOPS THE SPENDING ORGY WE HAVE ALL ENJOYED FOR DECADES, UNINTERRUPTED (BUT WE LOOKED NOBLE DOING IT, AND ALWAYS CLAIMED MORAL SUPERIORITY, SO WE’RE TOTES GOOD, RIGHT?) – Long headline, short link to good analysis on the timeline for the BCRA funding changes: http://bit.ly/2u1CDKM Here is another one that compares the House and Senate bills in case you are into that sort of thing: http://bit.ly/2twMXxs
YEAH, BUT HOW DID WE GET HERE? As part of the frenzy to show what all problems Medicaid can solve, DJs have put the “Caid can solve the opioid crisis” EP back into the rotation. My suspicion is if you look at a chart oxycontin, et al volume over the last 20 years and slapped a category for payer on it that Medicaid funded the current opioid crisis. Am I crazy to think this? Write in and do tell.
IT’S THE BIG ONE, ELIZABETH! Please tell me you get the reference. Assuming you do, I am suddenly struck by the richness of what we all share via pop culture. Anyways… OR Caid has studies out now showing a 17% drop in cardiac arrests after expansion. Once patients got an insurance card in their pockets, they delayed care less and had that chest pain checked out.
MCOS IN ILLINOIS: MAY NEED TO WRITE THIS ONE OFF ON YOUR TAXES- IL State Attorney Stratton told a judge this week that the state simply does not have the cash to pay its Medicaid costs (as was asked by a recent Medicaid member lawsuit in response to the state not paying providers and MCOs). The lawsuit asked IL to pony up $500M more a month to get caught up. Stratton says the state may be able to come up with $150M a month for the pay-your-freaking-tab effort. Fortunately, healthcare superheroes from CA and NV flew in and paid for it out of their own pocket (they had a ton left over once their single-payer bills failed last week). Just kidding, we all know Bernie wrote the check.
SHOW ME STATE WANTS TO UN-SHOW EXPANSION- MO reps voted to freeze Medicaid enrollment in the expansion group to try and help deal with their budget crisis. All analysts expect this to trigger a fight with the Good Guvn’r Kasich.
CENTENE GOES ON PROBATION IN THE CORNHUSKER STATE- Seems the state is unhappy with the plan’s troubles getting behavioral health and home health providers paid.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Rabbi Zalmen Sorotzkin of Lakewood, NJ was popped this week for leading a $1M fraud bilking Medicaid and other benefit programs. Cheryl Mcgrath of Guysville, OH plead guilty this week to using her home health care company steal $2M from Medicaid via false claims, including for dead people or people in nursing homes at the time she claimed to be providing home health services. Anthony Handal and his fiancé Sandra Mora of Orlando, FL billed Medicaid for $160k of intensive family case management services they never provided. They would conduct an initial meeting with the Medicaid-enrolled families to get their member numbers, then never do anything else to help them (but billing FL Medicaid for 3 sessions a week for the family). Collins Anyanwu-Miller of Bridgeport, CT was arraigned this week for stealing $390k from Medicaid by falsifying home care claims. Mr. Anyanwu-Miller even managed to get paid for home care services that occurred while he vacationed in Europe. Mrs. Mcgrath- you win! (Taxpayers, you lose! Total tab this week: $3.6M).
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (when the rain stops) and keep running the race (you know who you are).
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FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: an tAthair chuir an Mac a shábháil ar fud an domhain
Medicaid Management Information System – The MMIS is an integrated group of procedures and computer processing operations (subsystems) developed at the general design level to meet principal objectives. For Title XIX purposes, “systems mechanization” and “mechanized claims processing and information retrieval systems” is identified in section 1903(a)(3) of the Act and defined in regulation at 42 CFR 433.111. The objectives of this system and its enhancements include the Title XIX program control and administrative costs; service to recipients, providers and inquiries; operations of claims control and computer capabilities; and management reporting for planning and control.
Further reading
https://www.medicaid.gov/medicaid/data-and-systems/mmis/modules/index.html
We talked with innovative Medicaid vendors, Lucia Buffaloe w/ CBIZ, Susan Moore w/ Managed Healthcare and Steven Konsin, Jr. w/ Syrtis Solutions.
We talked with innovative Medicaid vendors, Regina Shapiro w/ Data Wing, Michael Cousins w/ Forecast Healthand and Dr. Ernie Fletcher with Mobile Telemedical.
Medicaid Who’s Who: Lauralie Rubel – State President, WellCare of Nebraska, Inc.
Q: In which segment of the industry are you currently involved? What is your current position and with what organization? How many years have you been in the Medicaid industry?
A: I currently serve as the state plan president for WellCare Health Plans under Nebraska’s Heritage Health program. Integrated managed care is new to Nebraska. Heritage Health integrates medical, pharmacy and behavioral healthcare benefits into a single comprehensive and coordinated system for Nebraska’s Medicaid and CHIP clients.
My managed care career began in 1996 as a provider relations representative for a provider-owned TennCare MCO. Since that time, I’ve held a variety of roles in network contracting, operations, provider relations, new market development, mergers and acquisitions, associate training and government relations.
Q: What is your focus/passion? (industry related or not):
A: Navigation of the healthcare delivery system is complex for even the savviest consumer. I am devoted to the simplification of care coordination and to shifting financial incentives from volume of service provided to value of care received.
A key to success in any role is the ability to apply life lessons and personal experience to the job at hand. As the oldest daughter of a mother with serious and persistent mental illness, I spent many hours during my teens and twenties trying to help coordinate her care among various providers of physical, behavioral, institutional and pharmacy services. Today I am the wife of a disabled Navy veteran whose Type II diabetes has resulted in several difficult health conditions including a kidney transplant and a below knee amputation.
In both circumstances, I’ve been the primary advocate and care coordinator for my family. Managing their medications, their appointments, transmission of medical records, confirming benefits and out-of-pocket expenses… sometimes my husband says that he doesn’t know what he would do without me.
Translating these complexities into my professional career, it’s readily apparent that we have millions of persons with Medicaid coverage who face similar challenges every day. Who can they count on to help them? The answer – when done well – is managed care.
Q: What is the top item on your bucket list?
A: The top item on my personal bucket list is to write a book (or two). As the primary caregiver for a husband with diabetes, much of the clinical jargon required me to research the disease process so I could be a useful advocate. I’d like to write a book for non-clinicians who are caring for a diabetic. I hope that what I have learned over the years will help others understand what it all means and what to expect. For my second book, I want to write something that isn’t health care related, is completely fictional and totally hilarious.
Q: What do you enjoy doing most with your personal time?
A: Writing; taking day trips with the family; spiritual development; and anything related to being in or near a body of water.
Q: Who is your favorite historical figure and why?
A: Gosh this was hard – there are so many people I’ve studied and admired. A few years ago, though, I had occasion to research several hymn writers and I was profoundly moved by the story of Fanny Crosby. Blinded as a small child due to corneal infection, Fanny’s visual impairment never deterred her faith or her love of writing poetry and hymns. She achieved national recognition as a poet in the early 1850s and she delivered recitations to Congress and to President James K. Polk. While Fanny is most well-known for her prolific hymn writing, her generosity and mission work in some of New York City’s most impoverished communities set her apart as one of my personal heroes.
Q: What is your favorite junk food?
A: Diet coke and a quart of fresh boiled peanuts, preferably from a roadside vat manned by authentic boiled peanut experts.
Q: Of what accomplishment are you most proud?
A: While I can’t take credit for their many successes, I’ve been privileged to hire and train some of WellCare’s top performers, particularly in provider- and member-facing positions in our markets. A servant’s mindset can be hard to detect during a job interview, but I’m very proud to say I had a hand in building a committed workforce of genuine “people” people – many of whom have gone on to become servant leaders themselves.
Q: For what one thing do you wish you could get a mulligan?
A: I’ve learned over the last twenty-plus years that most anti-managed Medicaid and Medicare sentiment comes from a committed, well-intentioned desire to protect the rights of individuals dependent on these programs. There have been times over the years where I took feedback too personally and did not pause to listen – really listen – and then address the matter at hand with an objective, solution-oriented response. This has been one of my greatest personal and professional life lessons.
Q: What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?
A:
Quality – the concept of “quality” must extend beyond HEDIS metrics and into service delivery and good communication. Whether we’re referencing prompt claims payment, or effective member and provider education, or timely transportation to appointments… the assurance of quality service delivery to our members, providers and government clients will be a key determinant in a managed Medicaid program’s success.
Transparency – One of the things I admire most about Nebraska’s Heritage Health program is the commitment to transparency. The state agency and by extension the MCOs have an inherent obligation for responsible stewardship of public resources. Transparent communication of capitation payments, encounter data reconciliation, care management outcomes, MCO performance metrics and program integrity findings will improve public awareness of the return on investment in managed Medicaid.
Migrant Health Center – Provides health care services to migrant and seasonal farm workers and their families.
Further reading
https://bphc.hrsa.gov/qualityimprovement/strategicpartnerships/nacmh/index.html
Maternal and Child Health Bureau – HRSA bureau that administers programs (including grants) which seek to improve the health of mothers, children, and families.
Further reading
https://mchb.hrsa.gov/about-maternal-and-child-health-bureau-mchb
