Managed Care

Also in the news for July 17, 2014 . . .

Strokes declined 25% among seniors ... All nations should ensure long-term care for seniors, declaration to UN states ... Lawsuit: Shift to managed care denies home health services ... House bill would halt home health payment cuts

Managed care will completely replace today's healthcare payment system by 2025, former White House adviser says

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Healthcare providers should expect that they will be paid exclusively through managed care systems by 2025, a former White House adviser said Tuesday.

Federal government needs to boost Medicaid managed care oversight, GAO says

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The government's oversight of Medicaid managed care organizations is not strong, even though these entities cover about 50 million people and are growing rapidly, according to a recently released report from a watchdog agency.

Also in the news for June 3, 2014 . . .

Social involvement is No. 1 influence on nursing home residents' daytime sleep ... OIG casts doubt on managed care tax ... In potential Alzheimer's breakthrough, scientists use light to erase, restore rats' memories

Long-term care was the strongest healthcare sector for mergers and acquisitions last year, analysis shows

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Long-term care was the only healthcare sector to experience an increase in mergers and acquisitions last year, according to a new analysis from business intelligence firm Irving Levin Associates Inc.

Managed care experts wanted

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Skilled nursing facilities could take major hits to their bottom lines unless a coordinator is on top of managed care contracts, a prominent healthcare consultant said last month at the American College of Health Care Administrators annual meeting in Las Vegas.

Is 'person-centered care coordinator' the next must-have staff member?

Is 'person-centered care coordinator' the next must-have staff member?

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Long-term care operators take note: You soon could fail residents, anger family members, increase survey deficiencies, drop Nursing Home Compare stars and lose money unless you hire a Coordinator of Coordinators.

Bill would create 'advanced aide' positions in nursing homes to improve transitions, dementia care

Bill would create 'advanced aide' positions in nursing homes to improve transitions, dementia care

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Advanced certified nursing assistants — with specialized skills in care transitions, dementia and other areas — could become important staff leaders in long-term care facilities through newly proposed federal legislation. The "Improving Care for Vulnerable Older Citizens through Workforce Advancement Act of 2014" was introduced Thursday by Rep. Matt Cartwright (D-PA) and Sen. Bob Casey (D-PA).

Skilled nursing facilities could lose big money if they don't hire a managed care coordinator, expert says

Skilled nursing facilities could lose big money if they don't hire a managed care coordinator, expert says

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Skilled nursing facilities stand to lose substantial sums of money as they increasingly do business with managed care plans, unless a coordinator is on top of exclusions and other contract elements, a prominent healthcare consultant told an audience Monday at the American College of Health Care Administrators annual meeting.

Feds recover $10 million in incorrect Medicaid payouts

Feds recover $10 million in incorrect Medicaid payouts

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Federal investigators recovered more than $10 million in incorrect Medicaid payments made to nursing homes in 2013, an annual review shows.

Privately managed Medicaid threatens long-term care quality and options, New York Times article states

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People with complex needs could find themselves squeezed out of the most appropriate long-term care settings as Medicaid beneficiaries become enrolled in programs from private sector companies, The New York Times reported in a lengthy Page 1 examination of the subject Friday.

Profile: Boldly improving quality

Profile: Boldly improving quality

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As a child, Adrienne Mims, M.D., MPH, thought about being a lawyer. But when her beloved grandmother died of cervical cancer when she was in high school, she redirected her attention to a career in healthcare.

CBO analyzes Medicaid caps to curb federal healthcare spending

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The federal government could reduce its Medicaid contributions to states as a deficit reduction measure, but the move likely would achieve savings only by putting seniors at risk, according to the Congressional Budget Office.

Long-term care financing reform - progress is possible

Long-term care financing reform - progress is possible

When the federal Commission on Long-term Care issued its report last month, there was a sense of déjà vu all over again. Sixteen years ago, in New York State, we were staff person and task force member, respectively, for New York's Task Force on Long-term care Financing. Despite the passage of time, there were some interesting similarities between the federal Commission and the New York State Task Force -- these included the compressed time frame for deliberations and the issuance of dissenting reports.

Heard around the table: Provider execs listening to the right people

Heard around the table: Provider execs listening to the right people

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Captains of the long-term care profession get to their lofty positions by using their intellect and superior vision skills, as a gathering of minds recently re-emphasized.

Data mandated for dual eligibles outlined as states move to managed care

Data mandated for dual eligibles outlined as states move to managed care

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Dual eligible managed care plans involved in an upcoming Centers for Medicare & Medicaid Services demonstration project will need to submit data in a variety of areas, the agency explained in a draft statement last week.

Managed care: Panacea, death knell or something in between?

Managed care: Panacea, death knell or something in between?

In a nutshell, troubled long-term care operators seem to be encountering this scenario with managed care companies: initial romance, followed by heightened accountability and reduced payments.

Gift cards for patients don't violate anti-kickback statute, OIG says

A facility that has proposed to offer grocery store gift cards in return for health screenings or clinical services will be sanctioned, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has announced.

Managed care plans to play a bigger role in Medicaid: Exec

Managed care plans to play a bigger role in Medicaid: Exec

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States are expected to shift an increasing number of Medicaid enrollees from fee-for-service plans into managed care, nearly doubling its size in the sector over the next two years, a prominent healthcare exec said late last week.

Managed care holds opportunities for SNF, experts say

Managed care holds opportunities for SNF, experts say

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As states expand enrollment in managed care plans, operators should focus on quality improvement, according to panelists at a National Investment Center for the Seniors Housing and Care Industry session.

Integrated care coordination for dual eligibles lowers readmission rates in case study

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Dual eligibles in an Arizona integrated coordinated care plan had a 21% lower hospital readmission rate than their counterparts in Medicare fee-for-service programs, a new analysis reveals.

Officials: Number of accountable care organizations more than doubles to 154

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There currently are 154 accountable care organizations in operation, according to federal officials. They announced today that 89 brand new ACOs began service July 1.

Why managed care is good for long-term care

Why managed care is good for long-term care

Managed long-term care can provide a solution to many challenges facing providers. Coordinating patients' care, working with family members, and focusing on the right type of treatment can lead to lower costs and better outcomes.

Lawmaker urges more oversight of Medicaid managed care

Lawmaker urges more oversight of Medicaid managed care

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Medicaid managed care contracting should come under increased federal and state scrutiny, a prominent senator said Wednesday.

Pharmacist underpayments results in adverse events, citations, investigation finds

Pharmacist underpayments results in adverse events, citations, investigation finds

Nursing homes that provide below-average consultant pharmacist salaries may be getting what they pay for, a state investigation suggests.

Report: States propose managed care plans for dual eligibles

All of the 15 states selected by the Centers for Medicare & Medicaid Services to develop better plans for dual eligibles have proposed managed care models.

States should re-evaluate Medicaid managed care plans, report says

States should re-evaluate Medicaid managed care plans, report says

States will have to consider changes to their Medicaid managed care plans in order to accommodate the bigger, more diverse population expected to apply for Medicaid benefits, according to a new report.

Florida's Medicaid HMO program could lead to 'granny dumping'

A lesser known provision of Florida's newly adopted Medicaid reform law includes an incentive for health plans that can reduce the number of seniors in nursing homes, according to Florida elder law attorney Ellen Morris.

Florida passes Medicaid HMO plan with special nursing home provisions

The Florida Legislature has approved a bill to move three million Medicaid enrollees into a managed care program, making it one of the biggest states to do so.

Rheumatoid arthritis treatments for seniors called 'unacceptable'

More than one-third of 93,000 Medicare managed care enrollees who received care for rheumatoid arthritis in recent years did not receive recommended drugs, according to researchers. In addition, the quality of drug treatments varied among geographic areas, socio-economic groups and health plans. Study results appeared in Wednesday's issue of the Journal of the American Medical Association.

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