These slides are health policy focused, looking at areas where significant cost savings can/should occur, and identifying at a high level ways that these savings can best be redirected to improve overall health. Some of these concepts are relevant to current Sovaldi discussions, although the “value pricing” issue has much broader reach.
This month’s edition provides data on the costs of Medicaid-covered adults and a conceptual framework for estimating the Medicaid expansion population’s emerging PMPM costs.
The April 2014 edition of our five slide series focuses on historical Medicaid expenditure growth. The size of annual Medicaid cost increases do not seem to be driven by fluctuations in the economy or by which party holds the presidency. However, a correlation exists between the degree to which state governments are collectively under Democrat political control and relatively high percentage increases in Medicaid program costs. On a PMPM basis, data indicate an annual average cost increase from 2003-2010 very close to 5.0% for each of three major eligibility groups – children, adults (non-disabled, non-duals), and blind disabled (non-duals).
This month’s 5-Slide Series examines CMS’ MSIS database to tabulate Medicaid costs across 18 service categories between 2007 and 2010. Capitation as a portion of total Medicaid expenditures increased 6.0 percentage points from 2007-2010. Additionally, capitation spending increased 57% from 2007 ($59 billion) to 2010 ($92 billion).
This edition of the 5-Slide Series examines CY 2010 national Medicaid expenditures in the institutional setting. Nursing Homes, ICF/MR, and Mental Health Facilities collectively represented about one-fifth of national Medicaid expenditures. Dual eligibles accounted for 88% of nationwide Medicaid nursing home spending and 37% of all FY2010 Medicaid spending.
This edition of our 5-slide series examines Medicaid per capita costs for individuals with disabilities and provides recommendations for how to manage this population. 22.1% of nationwide spending for disabled non-duals was paid via capitation during 2010 (versus 50.2% for TANF). The disabled subgroup has many attributes that are more conducive to use of care coordination than TANF, including a high prevalence of chronic conditions and relatively stable and lasting Medicaid eligibility. The ideal approach adopts an individually tailored “whole person” focus that can address multiple health conditions and flexibly accommodate differing life circumstances.