5-Slide Series
Our November Edition of the 5 Slide Series focuses on the 2018 election results and conveys some of the potential implications of these results regarding Medicaid expansion.
5-Slide Series
October’s edition conveys some of our tabulations working with the recently published NCQA Medicaid health plan quality ratings for Rating Year 2018-2019. AmeriHealth Caritas and UnitedHealthcare are the two top-rated national chain organizations in terms of their average NCQA rating across the states they serve. Among the 13 Medicaid MCOs with a rating of 4.5 or above, the plans achieving this excellent quality score on the largest Medicaid membership base are Health Partners Plans in Pennsylvania, Neighborhood Health Plan of Rhode Island, and Priority Health in Michigan.
5-Slide Series
The September edition presents Medicaid data from our Pharmacy Practice, quantifying the differences in cost per prescription between the MCO and FFS settings in two selected high-volume therapeutic classes. In both drug classes (as occurs with Medicaid prescriptions overall), the MCO setting is achieving large percentage savings relative to FFS. However, the path taken to achieve these savings is quite different between the two drug classes shown.
5-Slide Series
The August edition quantifies Medicaid DSH payments, showing the progression of DSH spending in each state from 2013-2017. The key takeaway is that Medicaid DSH has not dropped at all across the expansion states since 2013, even though this was intended to occur as one of the mechanisms to help offset the Federal costs of Medicaid expansion.
5-Slide Series
Our July 2018 edition conveys summary data regarding the Medicaid MCO industry’s overall financial performance during CY2016 and CY2017.
5-Slide Series
Our June 2018 edition summarizes the recent financial performance and quality performance for Georgia’s health plans, as an example of the information we often provide our clients using these datasets.
Publication
Legislation has been proposed in Louisiana to take the Medicaid preferred drug list (PDL) content responsibility away from the MCOs and shift it to a single state-determined PDL. The Menges Group assessed the impact of this policy option and estimated by transitioning to a PDL, Louisiana would experience a 13.5% increase in Medicaid pharmacy expenditures, with State Fund costs growing by $23 million in FFY2019 and $121 million across the five-year timeframe FFY2019-FFY2023. The non-financial programmatic dynamics of MCO latitude relative to a uniform Medicaid PDL are also discussed.
Publication
Currently, Louisiana includes (carves in) the pharmacy benefit in its capitated contracts with Medicaid MCOs. During FFY2017, Louisiana had the nation’s most favorable Medicaid generic dispensing rate at 90.9% and the nation’s 8th best (lowest) cost per prescription. The Menges Group analyzed the impact of legislation proposing a carve-out of the prescription drug benefit. Based on our analysis, transitioning the Medicaid prescription drug benefit back to fee-for-service would be costly for the Medicaid program and Louisiana’s taxpayers. We estimate that Louisiana would experience a State Fund cost increase of $69.3 million in FFY2019 and $395 million across the five-year timeframe FFY2019-FFY2023. Our report also discusses the programmatic advantages of preserving the pharmacy carve-in model.
5-Slide Series
The March 2018 edition of our 5 Slide Series tracks the national Medicaid market share and pre-rebate cost per prescription progression of curative Hepatitis C drugs from CY2014 through CY2017. The introduction of newer, lower cost-per-unit drugs has resulted in a significant shift in market share within this category of drugs. Additionally, we have quantified the considerable market share differences between MCO-paid and FFS-paid Medicaid prescriptions.
5-Slide Series
The December edition addresses some aspects of how quality data are reported and are used in performance-based payment structures.
