Unbiased Analysis of Today's Healthcare Issues
A number of people talk about Medicaid “best price”…but what is it really? StatNews provides a concise overview: The Medicaid best price law, enacted in 1990, requires drug manufacturers to charge the Medicaid program the lowest or “best” price they negotiate with any other buyer and send a rebate check to every state Medicaid department so…
That is what is proposed by Dana Goldman in his article in The Hill. He uses the case of Louisiana’s approach to pay for treatments for the hepatitis C virus (HCV) to make the point. The [Louisiana] Department of Health is working on a new strategy to expand access—one that involves a licensing deal. The state…
When you buy a typical product, the vendor does its best to make the purchasing process as easy as possible. There is a reason for this, clearly; they want your business. State and federal governments, however, have no such incentive. In fact, oftentimes reducing the number of people using government services saves money. Thus, it…
A new paper by Sharma et al. (2017) finds that Medicaid patients living in states with lower Medicaid reimbursement have more challenges accessing primary care services. We found that states with higher Medicaid fees had higher probabilities of appointment offers and shorter wait times for Medicaid patients, and lower probabilities of appointment offers and longer…
In general the answer is yes, but often with some difficulty. AJMC recaps the findings from a the CDC Morbidity and Mortality Weekly Report (MMWR) Quick Stats section from July 21, 2017. 88.9% of primary care physicians said they are accepting new patients, based on 2015 data from the National Electronic Health Records Survey. However,…
In short, the reason is that Medicaid reimbursement rates for providers is too low. Saurabh Jha, however, explains the point a bit more artistically in his Health Care Blog piece. Medicaid pays a cardiologist, with years of training, $25-40 for a consultation to manage a complex patient with multiple comorbidities, on polypharmacy, where the cardiologist…
One of the primary changes in the healthcare system directed by the Affordable Care Act was providing funding for states to expand Medicaid. Many states did so; many others did not. Some states expanded Medicaid but put additional hurdles in front of beneficiaries to receive this coverage at no cost. Consider the case of the State of Iowa.…
The answer may be yes. One of the big inpediments to value-based pricing of pharmaceuticals was that any discount given to any single organization based on outcomes needed to be reflected in the Medicaid price. Since outcomes are subject to random noise, there will inevitably be health plans that end up getting a low price due to worse than expected…
How will Medicaid expansions affect patient access to pharamceuticals? This question is particularly relevant for patients with serious mental illness. The answer is complicated by the increasing presence of Medicaid managed care plans. Increasingly, states have turned to contracts with Medicaid managed care plans in order to better control costs and reduce budgetary uncertainty. However, in…
Does Medicaid use pay-for-performance (P4P) for providers? If so, how does it work? And does it affect quality and cost? These are the questions of interest to Rosenthal et al. (2015) in their study of P4P programs in Alabama, Minnesota, and Pennsylvania. Although all three focus on physicians, the Alabama program is a “medical home ”…