MCO Procurements: Medicaid Agency Best Practices and Not-So-Best Practices
This edition discusses – with some input from the Health Policy Cows – some do’s and don’ts for states in implementing Medicaid MCO procurements.
Tag: Policy
Prescription Drug Spending in State Medicaid Programs, Employee Health Plans, and State Prisons
This month’s edition investigates prescription drug spending in all 50 states across three major state health care payers: Medicaid, state employee health plans, and in state prisons. By comparing these expenditures to total health care spending and overall spending in…
Removing the Medicare Advantage Program’s Key Disadvantages & Guidance From the Health Policy Cows
The health policy cows are back for April’s report, which presents data and opinions regarding the need to pilot-test implementing managed care in the Medicare arena in a similar manner as typically occurs in Medicaid -- mandatory enrollment of beneficiaries…
Assessment of Medicaid MCO Preferred Drug Policy Options in Louisiana
Over 90 percent of Louisiana’s Medicaid prescriptions are paid for by MCOs. The Louisiana Association of Health Plans engaged us to assess the impacts of a potential policy change to take the preferred drug list (PDL) content responsibility away from…
Assessment of Medicaid Reform Options Prepared for Alaska Legislative Budget and Audit Committee
The Legislative Budget and Audit Committee of Alaska sought information and analyses with regard to other states’ experiences with Medicaid reform and expansion initiatives. This report describes opportunities for Medicaid savings and to reduce pharmacy costs. As well as recommendations…
Health Policy Sacred Cows: Research Findings from the Mainstream Cow Community
This August issue of the Five Slide Series challenges some “sacred cows” in health policy. The format is a bit unusual – we hope you enjoy reading it and that the content is useful.
Comparison of Medicaid Pharmacy Costs and Usage in Carve-In Versus Carve-Out States
This study examined 35 states and DC that used the Managed Care Organization (MCO) model in their Medicaid program and either included (carved-in) or excluded (carved-out) pharmacy benefits from coverage. The report found that carve-in states outperform carve-out states by…
Modernizing Medicare through Piloting Mandatory Enrollment in Care Coordination Programs
This edition of our Five Slide Series is Medicare-focused, policy-oriented, and qualitative and opinionated in nature. We report on the achievements the Medicaid program has made in the mandatory enrollment MCO model, and convey our thoughts on testing a similar…
Eliminating Excess Costs and Redeploying Savings
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…
State Policies Regarding Medicaid MCO Preferred Drug Lists
The Association for Community Affiliated Plans (ACAP) enlisted The Menges Group to prepare a report on the ways in which state Medicaid agencies have opted to regulate Medicaid MCO PDL content. Most states afford MCOs wide latitude in establishing their…