Health Care Delivery

Matt Salo, executive director of the National Association of Medicaid Directors, is emerging as one of the most important observers in how the expansion of the leading healthcare program for poor Americans is unfolding across the country. In December's issue of The American Journal of Accountable Care, he addresses how the fallout of the 2014 midterms will affect Medicaid in the near term.

After website glitches stole the spotlight during the first open enrollment period for the Affordable Care Act, CMS hired Accenture to fix HealthCare.gov. Now, the consulting firm has been awarded a 5-year, $563 million contract to continue working on the website.

Several states hit backlogs enrolling the flood of new Medicaid recipients under the Affordable Care Act (ACA), but New Jersey's experience appears to be in a category of its own: an effort to upgrade antiquated computer systems and fold in the ACA at the same time failed miserably, leaving an estimated 11,000 residents without coverage as 2014 ends.

The plaintiff, John Doe, alleges that not having access to a community pharmacist will limit his ability to gain counseling on potential drug interactions. United Healthcare settled a similar action earlier in 2014. Consumer groups have also alleged discrimination against HIV patients by insurers over drug access in Florida.

The main barrier to widespread use of telehealth isn't technology or consumer acceptance; it's figuring out how to pay for it. Authors writing for The American Journal of Managed Care and The American Journal of Accountable Care discuss why today's payment models for accountable care organizations are a better fit for telehealth, and why regulatory changes make sense.

Consumers remain very confused about their health insurance coverage, but the federal government is looking to provide a better understanding of benefits for consumers shopping for coverage.

A year ago, some Maine residents would have described the Affordable Care Act (ACA) as "hellish." Since then, a lot has changed. And a lot has stayed the same.

Using a provision of the Affordable Care Act, many state Medicaid agencies are trying to diminish use of medical services by super-utilizers by better managing their care. The goal is to not only reduce costs, but to achieve better health outcomes for these patients.

To provide a smooth transition in the first year of the auto-enrollment and renewal process, health plans are voluntarily providing flexibility with payment deadlines for consumers purchasing coverage through the federal Marketplace.

The Affordable Care Act and a federal parity law have already helped persons with mental illness get access to proper care. But a leading advocate, a medical director for Cigna, and a psychiatrist who has studied innovative care delivery models say more can be done to improve screening, to ensure the correct diagnosis, and to provide better access to services.

Marketplace health insurance premiums across the nation did not increase from 2014 to 2015. However, while the overall costs were flat, some states did see substantial average premium increases, which were offset by declines in other states.

The Obama administration's top Medicaid official, who negotiated tough terms with states seeking to expand the program under the health law, is stepping down.

CMS' Sean Cavanaugh announces in a blog post that 89 newcomers will participate in 2015. But ACOs remain a work in progress, with rule changes on the way and some discussion about whether these entities are assuming enough risk or dampening competition in certain markets.

The most important case since the Supreme Court upheld the constitutionality of the Affordable Care Act will determine the law's ability to function in states without their own exchanges.

Accountable care organizations (ACOs) are still a new creature in the world of managed care, and not all are alike. As the authors of a new comparative analysis in The American Journal of Managed Care outline, Medicare contracts dominate the ACO landscape, with only half of these entities having a contract with a private payer.

Although Virginia Gov Terry McAuliffe failed to pass a Medicaid expansion plan during his first year in office, the governor's health secretary has indicated that the fight will begin again.

More than 700 hospitals will be penalized in fiscal year 2015 as a result of poor scores in CMS' Hospital-Acquired Condition (HAC) Reduction Program.

The falling uninsured rate among all racial/ethnic groups under current Medicaid expansion decisions will narrow coverage differences between whites and all minority groups except for blacks, according to a report from the Urban Institute.

Over the long haul, Paul Gionfriddo expects that the Mental Health Parity Act will help rectify the situation where mental health professionals are paid so inadequately for the services, although in the short haul the effects are much more subtle.

Fresh off re-election, Governor Robert Bentley moved this week to name 6 groups to coordinate managed care in Medicaid, as part of a cost-saving strategy he launched in 2012. But the bigger news has been his reversal on expanding the program; as in other Southern states, hospitals have been pressing for the change to solve fiscal problems.

The employer and individual mandates, not Medicaid expansion and state-run exchanges, are what raised the ire of Republicans who gave opinions on the ACA in the most recent Kaiser poll.

States designing and testing healthcare payment and service delivery models to improve quality of care and lower costs will be receiving more than $665 million in funding from the government, according to HHS Secretary Sylvia M. Burwell.

How do ACOs reach the point of delivering both savings and better care? The recent online session of the ACO and Emerging Healthcare Delivery Coalition, sponsored by The American Journal of Managed Care, covered how ACOs evolve, how that process applies to oncology care, and how managed care can benefit from a better model for mental health delivery.

An attorney for the patient said this is the first lawsuit that alleges actual harm over inadequate networks, not just lack of access. California has had its share of growing pains through ACA expansion and its simultaneous expansion of managed care in its Medicaid program.

After a quieter open enrollment period, HHS officials give a final call for current customers to make changes to existing plans.

Tennessee became the latest Republican-led state to gain approval for a Medicaid expansion option when Gov Bill Haslam unveiled the Insure Tennessee plan Monday morning. There are just 20 states left that have not expanded Medicaid.

The 2014 elections are likely to have minor, but noticeable impacts on the future of the Medicaid program, both in terms of federal conversations on entitlement reform and in state approaches to the Medicaid expansion.

As Medicaid enrollment grows under the program's expansion, there are not enough providers to serve the increased amounts of enrollees, according to a new report from the Office of the Inspector General that measured the availability of specific providers in Medicaid managed care networks.

The study published in Health Affairs recommends standardization of benefit plans across states for children, especially those related to developmental abilities.