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Tag: Medicaid

Medicaid MCO Quality Tabulations – NCQA Rating Year 2018-2019

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…
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Medicaid MCO Savings on Prescription Drug Costs – Therapeutic Class Level Comparisons

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…
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Disproportionate Share Hospital (DSH) Payment Trends in Medicaid Expansion vs. Non-Expansion States

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…
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Medicaid MCO Profitability, 2016-2017

Our July 2018 edition conveys summary data regarding the Medicaid MCO industry’s overall financial performance during CY2016 and CY2017.
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Georgia Medicaid MCO Profile Report, 2016-2017

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.
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Hepatitis C Medication Market Share

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…
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Getting Out of the Stairwell in Quality Measurement and Improvement

The December edition addresses some aspects of how quality data are reported and are used in performance-based payment structures.
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Use of Capitation Contracting in Medicaid: State-by-State Overview as of 2016

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…
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