Managing Medicaid Patients with Physical and Behavioral Health Dual Diagnoses through Advanced Analytics

By Claire Thayer, March 28, 2012

MCOL’s Healthcare Web Summit announces a complimentary webinar event, co-sponsored by Elsevier/MEDai: Managing Medicaid Patients with Physical and Behavioral Health Dual Diagnoses through Advanced Analytics, scheduled for Tuesday, May 1st, 2012 at 1PM Eastern.  This webinar will provide a high-level briefing on how using a combination of analytical tools can be used to improve clinical and financial outcomes in state Medicaid programs, particularly for high-cost, high-risk Medicaid beneficiaries with dual medical and behavioral diagnoses.

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Fail to Prepare, Prepare to Fail

By Lindsay Resnick, March 27, 2012

For health plans looking at the period leading up to the Affordable Care Act’s 2014 big launch, it’s a critical time. We’re about to see the most jarring market reforms ever. Even with the uncertainty of the Supreme Court decision and 2012 election, can Plan’s really afford to sit on the sidelines and watch valuable time tick away? The retailization of healthcare is coming, and preparation is key.

Which of reform’s changes are going to stick…which will fade away? How will existing competitors react…which new ones will appear in your markets? Can you move from a B2B to B2C marketing culture?

Tough questions need to be asked (and answered) about legacy core competencies in tomorrow’s reformed marketplace. In other words, sustainability of your health plan’s value chain—the series of individual activities within your enterprise that when linked together, combine to add comparative value to a final products or services.

It’s time for a serious look at four critical areas of focus.  Here are some questions to spark internal debate and begin an ACA transformation assessment:

  1. Brand Position What’s your unique selling proposition in a reformed marketplace likely to see increased competition and disintermediation the individual and small group markets by Exchanges?
  2. Customer Segmentation Are you quantifying and profiling new customer segments that you’ll be serving in 2014: previously uninsured, pre-ex time-bombs, newly subsidized, abandon employees, Medicare boomers, etc. to be sure you have the right product mix?
  3. Customer Acquisition Are marketing’s multi-channel lead generation tactics (e.g., traditional direct response, digital, social media, mobile) being optimized across all distribution outlets (e.g., field agents, telesales, online, mobile, retail)?
  4. User Experience Is your health plan delivering a personalized customer experience driven by retention metrics and built around superior member engagement using a managed touchpoint discipline?

Retail healthcare, product standardization and price transparency levels the playing field. Health plans need to refresh their toolkit of customer acquisition and retention tactics. It means protecting and expanding relationships with their existing customer base across product-lines and market segments. And, to grow market share it means strengthening direct-to-consumer marketing tactics and bolstering sales distribution to facilitate (and influence) customer choice.

For a free copy of the Solutions Brief, "Healthcare Reform Readiness: A Transformation Toolkit", click here:


The 3rd Annual Contracting Web Summit

By Claire Thayer, March 23, 2012

MCOL’s Healthcare Web Summit announces The 3rd Annual Contracting Web Summit, scheduled for Thursday, May 10th, 2012 at 1PM Eastern.  The Third Annual Health Plan Contracting Web Summit will address value based contracting, bundled payments, readmissions financial incentives and more. Join us for the live 90 minute webinar and also access pre-recorded sessions featuring national experts providing key insights, trends, strategic recommendations, actionable intelligence and more on these critical topics.

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Celebrating an Anniversary Under Threat of Divorce

By Clive Riddle, March 23rd , 2012

The Affordable Care Act turned two today. If we consider this a birthday, some would say the Act is entering its terrible twos, but DHHS and other are referring to this as an anniversary, which in this context is bittersweet as the Act now sits under a Supreme Court cloud starting next week, with plenty of partisan positioning from both sides. Will the Anniversary result in Divorce, Annulment, Trial Separation, a Second Honeymoon or settle in a routine marriage with ups and downs?

Here’s some key accomplishments that White House touts, in their six page white paper regarding the Act at the two year mark: Affordable Care Act: The New Health Care Law at Two Years:

  • A one-time $250 Medicare rebate check to seniors who hit the “donut hole” coverage gap in 2010, and a 50 percent discount on brand-name drugs in the donut hole in 2011.
  • Insurance companies can no longer deny coverage to children because of a pre-existing condition.
  • In 2014, discriminating against anyone with a pre-existing condition will be prohibited.
  • No more lifetime dollar limits on coverage
  • Insurance companies prohibited from rescinding coverage because of an unintentional mistake on an application.
  • Starting this fall, health plans provide consumers standardized Summary of Benefits and Coverage forms
  • Health insurance companies now have to meet the 80/20 Medical Loss Ratio rule.
  • Insurance companies must publicly justify any rate increase of 10 percent or more.
  • Tax credits for small businesses, in 2011 affecting an estimated two million workers from an estimated 360,000 small employers who will receive the credit in 2011.
  • Early Retiree Reinsurance Program (ERRP) has provided $5 billion in reinsurance payments to employers to benefits for retired workers not yet eligible for Medicare.
  • 2.5 million young adults who were uninsured have gained coverage by being able to stay on their parent’s health plan,
  • 54 million additional Americans now receive coverage through their private health insurance plan for many preventive services without cost sharing such as copays or deductibles.
  • More than 32.5 million seniors have already received one or more free preventive services, including the new Annual Wellness Visit and like mammograms and other cancer screening tests for free
  • More than 50,000 Americans with pre-existing conditions have gained coverage through the new temporary Pre-Existing Condition Insurance Plan.
  • Advancement of Medicare Accountable Care Organizations  with Thirty-two “Pioneer” ACOs already up and running
  • Thirty-three States have  received at total of nearly $670 million in Health Insurance Exchange Establishment Grants.
  • The Act creates a new type of non-profit health insurer, called a Consumer Operated and Oriented Plan (CO-OP),  run by their members, with seven non-profits intending to offer coverage in eight states h awarded more than $638 million in loans to get up and running.

So what are others saying about the state and fate of the Act on this second anniversary?

Bloomberg BusinessWeek notes huge numbers of the population are enjoying the benefits included in the Act, even as they are caught up in the politics of it, and quotes Paul Keckley, executive director of the Deloitte Center for Health Solutions: "The coverage improvements are very popular. I think all of that will stay regardless of the individual mandate.”

The Center for Studying Health System Change  released a new study: The Great Recession Accelerated Long-Term Decline of Employer Health Coverage and found that “between 2007 and 2010, the share of U.S. children and working-age adults with employer-sponsored health insurance dropped 10 percentage points from 63.6 percent to 53.5 percent.” They conclude that “while there has been vigorous debate about the effects of national health reform on employer-sponsored insurance, the study findings  indicate that the debate often misses a key point—employer-sponsored insurance likely will continue to erode with or without health reform, especially for lower-income families and those employed by small firms.”

The Wall Street Journal reports in an article Untangling Unknowns in Health-Care Law, that as guidance continues to be developed, and the details continue to unfold, we really don’t know enough today about the Act as we think we do. They summarize: “Two years after Congress passed President Barack Obama's health-care legislation, despite all the assertions about what it will or won't do, no one really knows how it's going to work. The U.S. has rarely attempted anything of this scale before.”

Kaiser Health News comments on the possibility that the Supreme Court might strike down the Individual Mandate while keeping the other components of the Act intact, in their article The New Jersey Experience: Do Insurance Reforms Unravel Without An Individual Mandate  in which they state that” or some clues, the justices could examine what happened in New Jersey, a state that tried to reform its insurance markets without a mandate -- and failed pretty miserably”

The Wall Street Journal also informs us the health plans are making their contingency plans, in their article Insurers Set Plans in Case Mandate Is Quashed.

And, The New York Times notes that politicalization of the issue in their article ”Publicity Push as Health Law’s Court Date Nears”, reporting that “Republicans on Capitol Hill have put together a highly coordinated two-week renewed assault on the health care law, seizing on the legislation’s second anniversary and the next week’s oral arguments before the Supreme Court concerning its constitutionality. “


Health Plan Readmission Strategies: Contracting and Care Management Approaches

By Claire Thayer March 17, 2012

MCOL’s Healthcare Web Summit announces Health Plan Readmission Strategies: Contracting and Care Management Approaches, scheduled for Wednesday, May 9th, 2012 at 1PM Eastern.  Health plan readmissions management encompasses a variety of approaches that often incorporate new provider payment structures, data tracking, education and engagement. Some initiatives are designed for specific care delivery settings, while others are system-wide programs. Please join Drs. Joe Gifford and Robert Herr from Regence, and Dr. Brian Wolf from BCBSRI as they provide a Medical Director's perspective on aspects of their organization's current approaches to drive accountability by reducing unnecessary readmissions.

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