The medical home model for delivering health care is getting tested for people with mental health problems. Missouri has been a pacesetter. By using a cost-based prospective payment system for health home patients, Missouri Medicaid shifted providers’ emphasis from periodic acute care-to-care management with a focus on preventing high-cost exacerbations.
CMS chief Seema Verma wants to reshape the entitlement program that covers about 62 million people. Verma endorses “community engagement”—work or community service— as a condition for “able-bodied” people to get Medicaid coverage and accused the Obama administration of the “soft bigotry of low expectations” for opposing such a requirement.
Opioids remain the go-to products because they target the mu opioid receptor, which has been shown to be the most effective pathway to reduce pain. The holy grail for drug developers is an agent that stifles pain without producing the euphoria and addiction of opioids.
Blame for the epidemic has focused on drugmakers, drug wholesalers, and physicians who prescribed opioids too liberally. This fall, fingers pointed at health insurers. Investigative reporting showed that coverage policies that restricted access to less addictive medications might have helped fueled the epidemic.
Whether in a red or blue state, the state commissioner jobs do require decent working relationships with insurance companies, particularly in precarious times as insurers threaten to leave some areas with no ACA coverage because of poor market conditions or dithering in Washington, D.C.
A year ago you probably couldn’t find a Las Vegas bookmaker willing to give odds that the ACA would still be the law of the land in 2018. Turns out that repealing Obamacare and crafting a replacement acceptable to various factions of the GOP is not so easy.
Federal and state officials have moved this year to impose some preparedness requirements on providers that will have an effect in 2018 and years beyond. For instance, CMS’ finalized emergency preparedness rules for health care providers that serve Medicare and Medicaid patients went into effect last month.
The Democratic governor and the Republican legislature have moved to shore up the individual market, but Minnesotans are leaving it in droves. About 167,000 residents bought individual coverage this year, compared with 270,000 in 2016. Premium hikes have been caused, in part, by the consolidation of providers.