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.
5-Slide Series
The November 2017 edition looks state-by-state at the degree to which its 2016 Medicaid expenditures were capitated. Nationally, capitation payments represented 48.9% of FFY2016 Medicaid expenditures. This figure was 27% as of 2010. It is highly likely that we have now crossed a threshold where the majority of Medicaid expenditures occur via capitation payments.
5-Slide Series
The October 2017 edition summarizes an analysis of Medicaid MCO financial performance of Medicaid MCOs in each state, showing the degree to which the health plans are collectively experiencing gains or losses. During 2015 and 2016, about two-thirds of states with MCO capitation programs landed in what we would consider an optimal place – with the health plans collectively earning a positive margin on their Medicaid business but with that margin not exceeding 5%.
5-Slide Series
The September edition provides suggestions for making Medicaid managed care optimally effective.
5-Slide Series
The August edition tabulates information from the Medicaid MCO financial statements we collect and compile, showing the overall profitability among plans whose revenue is primarily (and often entirely) obtained through serving Medicaid populations.
5-Slide Series
The June edition raises concerns with how Medicaid policymaking is currently being approached and debated. We identify specific areas where excess costs exist in the program and where considerable savings can be achieved without diminishing Medicaid’s current coverage levels.
