ICER’s 2022 “Barriers to Fair Access Assessment” Protocol
How does ICER plan to determine whether health plans offer fair access to pharmaceuticals? I summarized their approach last year as outlined in their white […]
Managed Care
How can physicians earn a ‘gold card’?
Prior authorization is a pain. A paper by Howell et al. (2021) found that the total cost of various utilization management schemes is $93.3 billion […]
Montana Hires a Medicaid Director With a Managed-Care Past
Montana, one of only about a dozen states with a fully government-run Medicaid program, has hired a new Medicaid director who oversaw managed-care programs in […]
Preferred Pharmacies in Medicare Part D
Medicare Part D plans have begun using preferred pharmacy networks in order to steer their beneficiaries to lower cost pharmacies. A key question is, does […]
How can payers create favorable risk selection?
Many countries allow private plans to administer health insurance benefits but with restrictions on premiums and with the potential for risk adjusted government payments based […]
Narrow networks: love ’em or hate ’em?
Are narrow networks a good thing or a bad thing? The first thing you need to know is what is a “narrow network”. Narrow networks […]
Record Fines Might Mean California Is Finally Serious About Improving Medi-Cal
Is California getting tougher on health plans that participate in Medi-Cal, the state’s insurance program for low-income residents? A few weeks ago, state regulators imposed […]
Mapping Medicaid Managed Care Models & Delivery System and Payment Reform
Delivery system and payment reform are dynamic and ever-evolving policy areas of state Medicaid programs; virtually every state has initiatives underway. This interactive is designed […]
Medicaid and Racial Health Equity
The COVID-19 pandemic has highlighted and exacerbated longstanding racial and ethnic disparities in health and health care. In the past year, the federal government and […]
10 Things to Know About Medicaid Managed Care
This brief describes 10 themes related to the use of comprehensive, risk-based managed care in the Medicaid program and highlights significant data and trends. Understanding […]
Georgia Bill Aims to Limit Profits of Medicaid Managed-Care Companies
ATLANTA — Georgia lawmakers will consider a bill that could force the state’s Medicaid managed-care insurers to repay millions of dollars if their spending on […]
State Delivery System and Payment Strategies Aimed at Improving Outcomes and Lowering Costs in Medicaid
State Medicaid programs are using managed care and an array of other service delivery and payment system reforms, financial incentives, and managed care contracting requirements […]
State Policies Expanding Access to Behavioral Health Care in Medicaid
On KFF’s 21st annual Medicaid budget survey, all responding states reported at least one initiative to expand behavioral health care in Medicaid, including crisis service […]
How often do health plans use “provider requirements”?
Specialty drugs have delivered significant improvements to patient health, but oftentimes they pay be expensive. To try to insure that these treatments are used appropriately, […]
States Respond to COVID-19 Challenges but Also Take Advantage of New Opportunities to Address Long-Standing Issues: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2021 and 2022
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. The findings are drawn from the 21st annual […]
California’s Reboot of Troubled Medi-Cal Puts Pressure on Health Plans
When Denise Williams’ baby boy was 2 months old, she became alarmed by a rattling sound in his lungs and took him to the emergency […]
Medicaid Authorities and Options to Address Social Determinants of Health (SDOH)
Extensive research and the pandemic have elevated the importance of addressing social determinants of health (SDOH) to improve health and reduce longstanding disparities in health […]
How ICER will conduct it’s “Barriers to Fair Access” Assessment
Last fall, ICER published a white paper titled “Cornerstones of ‘Fair’ Drug Coverage: Appropriate Cost-Sharing and Utilization Management Policies for Pharmaceuticals.” To paraphrase, ICER’s goal […]
Bagging it
How do you get your prescription drugs? For most people, it involves going to your local pharmacy and picking up your pills. But what if […]
Potential Implications of Policy Changes in Medicaid Drug Purchasing
This brief examines how leading federal and state policy options related to changes in Medicaid Drug Rebate Program (MDRP), drug pricing, and payment and management […]
Health Insurer Financial Performance in 2020
This analysis examines insurers’ financial data across markets through the end of 2020. It finds that average margins remained relatively high compared to recent years, […]
Meet Circulo, the insurtech firm on a mission to disrupt Medicaid managed care
A new startup has entered the highly competitive insurtech market — with $50 million in new funds. Circulo, co-founded by Olive CEO Sean Lane, is […]
Health Insurer Financial Performance Through September 2020
In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average […]
Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic
This data note looks at state Medicaid managed care enrollment data through September 2020 to assess the impact of the COVID-19 pandemic and economic crisis […]
CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes
On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November […]
CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes
On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November […]
The problem with prior authorization
Prior authorization is a requirement that health plans require physicians to obtain plan approval in order to prescribe a patient a given medication. Prior authorizations […]
Data Note: Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic
This data note looks at state Medicaid managed care enrollment data from March 2019 and March 2020 as well as managed care enrollment data obtained […]
