Physician Expectations and Primary Care Shortages: Evidence from the Affordab...Gerrit Lensink
This paper is the first installment in my undergraduate thesis on physician expectations and their effect on primary care shortages in the United States. Over following semesters I will be strengthening my research with econometric models and further analysis. Updates will follow as completed.
Achieving Universal Coverage through Comprehensive Health Reform: The Vermont...soder145
Presentation by Ronald Deprez at the AcademyHealth Annual Research Meeting adjunct State Health Research and Policy Interest Group meeting panel, "Early Results from the State Health Access Reform Evaluation (SHARE) Program," Chicago, IL, June 27 2009.
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
Physician Expectations and Primary Care Shortages: Evidence from the Affordab...Gerrit Lensink
This paper is the first installment in my undergraduate thesis on physician expectations and their effect on primary care shortages in the United States. Over following semesters I will be strengthening my research with econometric models and further analysis. Updates will follow as completed.
Achieving Universal Coverage through Comprehensive Health Reform: The Vermont...soder145
Presentation by Ronald Deprez at the AcademyHealth Annual Research Meeting adjunct State Health Research and Policy Interest Group meeting panel, "Early Results from the State Health Access Reform Evaluation (SHARE) Program," Chicago, IL, June 27 2009.
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
Did you have time to read the 1,990 page healthcare bill that was recently passed through Congress? Have you since wondered about the impact that massive bill will have on the average American, health insurance providers, business owners and YOU? If yes, then join the Young Professionals of Chicago as we host a panel of diverse health care professionals that will be discussing current healthcare reform and taking questions on the impact of the United States' new healthcare policy. The distinguished panelists will also provide some insight and clarity into what this massive bill means for individuals like you. There will also be an opportunity for open networking with other young professionals before and after the discussion.
Obamacare - The Patient Protection and Affordable Care Act - ACAAndrew F. Bennett
This short presentation will help bring you up to speed on the Affordable Healthcare act, eligibility requirements to buy in the online marketplace, and coverage that will be available.
Did you have time to read the 1,990 page healthcare bill that was recently passed through Congress? Have you since wondered about the impact that massive bill will have on the average American, health insurance providers, business owners and YOU? If yes, then join the Young Professionals of Chicago as we host a panel of diverse health care professionals that will be discussing current healthcare reform and taking questions on the impact of the United States' new healthcare policy. The distinguished panelists will also provide some insight and clarity into what this massive bill means for individuals like you. There will also be an opportunity for open networking with other young professionals before and after the discussion.
Obamacare - The Patient Protection and Affordable Care Act - ACAAndrew F. Bennett
This short presentation will help bring you up to speed on the Affordable Healthcare act, eligibility requirements to buy in the online marketplace, and coverage that will be available.
Whats easy to see is easy to miss. Shravan has complied a presentation from his expereinces as a employability skills Facilitator , Career Analyst and Executive Coach which will guide you to your dream job....
Reputation management in six (sort of) easy stepsmickeylonchar
It's not who YOU say you are, it's who GOOGLE says you are. What can you do to help yourself show up as your best self on Google and the other search engines? Here are some suggestions.
Virginia AFP's lobbyist Hunter Jamerson's presentation from the 2013 SLC on the unique Medicaid reform approach being followed in the state of Virginia.
Presentation delivered by Cheryl Phillips, MD, President and Chief Executive Officer, SNP Alliance, Inc. at the marcus evans Long-Term Care & Senior Living CXO Summit 2019 held in Orlando, FL.
“Dual eligibles” are low-income individuals who qualify for both Medicare and Medicaid. This DataBrief describes the pathways through which dual eligibles access assistance with Medicare premiums and cost-sharing.
States may provide Medicaid benefits either by directly reimbursing providers or by paying private health insurance plans or provider groups (called managed care organizations, or MCOs) to provide services to enrollees. This presentation examines the extent to which Medicaid benefits are delivered through MCOs and the reasons for recent growth in enrollment in and spending for managed care. CBO found that although the overwhelming majority of Medicaid beneficiaries are enrolled in MCOs, payments to MCOs account for less than half of all Medicaid spending. As for the increase in the use of managed care programs to provide Medicaid benefits, the agency found that it is largely attributable to MCOs’ expanding the types of beneficiaries, geographic areas, and range of services that they cover.
Presentation by Alice Burns, an analyst in CBO’s Budget Analysis Division, and by Ben Layton and Lyle Nelson, both of CBO’s Health, Retirement, and Long-Term Analysis Division, at AcademyHealth’s Annual Research Meeting.
Shaking Up the Delivery of Traditional Mental Health Services. Several primary health care organizations (PHCOs) have established a central referral point or “one stop shop” to help primary care practices connect their patients to community-based mental health and/or substance abuse services
Advancing Health Equity through State Implementation of Health ReformNASHP HealthPolicy
The Affordable Care Act (ACA) provides opportunities for states to make lasting
and comprehensive systems change in their approaches to achieving health equity
for their most vulnerable populations. Through provisions in areas such as coverage
and access, prevention, care coordination, population health, and quality and efficiency,
the Act offers state policymakers a broad range of policy levers for improving health care
and the health status of their racial and ethnic minority populations.
With support from the Aetna Foundation, the National Academy for State Heath Policy is hosting a
webinar to highlight the opportunities presented by health care reform to advance state health equity
agendas. In addition to featuring national health equity experts and information on how states are
using the ACA to achieve health equity, this webinar will announce the NASHP State Health Equity
Learning Collaborative, an initiative to help state policymakers maintain momentum towards achieving
health equity while implementing federal health care reform.
Affordability and Lessons Learned from State CHIP Programs by Leigha BasiniNASHP HealthPolicy
States are responsible for on the ground implementation of the Affordable Care Act (ACA), including expanding coverage options through Exchanges, Medicaid and other health insurance programs. This webinar considers different ways policymakers define affordability and draws on lessons from the Children's Health Insurance Program (CHIP), which can serve as a model for states as they implement affordability provisions in ACA. It also looks at the impact on families when coverage is not affordable and considerations for families in purchasing decisions.
Putting Affordability into Context--Policy Considerations by Genevieve Kenney...NASHP HealthPolicy
States are responsible for on the ground implementation of the Affordable Care Act (ACA), including expanding coverage options through Exchanges, Medicaid and other health insurance programs. This webinar considers different ways policymakers define affordability and draws on lessons from the Children's Health Insurance Program (CHIP), which can serve as a model for states as they implement affordability provisions in ACA. It also looks at the impact on families when coverage is not affordable and considerations for families in purchasing decisions.
Relationships with State Officials Building and Keeping them KaramokoNASHP HealthPolicy
Moriba A. Karamoko, Director of the Louisiana Consumer Healthcare Coalition discusses how build and maintain relationships with state officials in reference to health care systems.
Rebecca Mendoza, Director of Maternal and Child Health in Virginia presents on eligibilty, enrollment and engaging stakeholders. Partnerships include Virginia Health Care Foundation, the Robert Wood Johnson Foundation, and NASHP's Maximizing Enrollment Program.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Integrating Care for Dual Eligibles: Capitated Managed Care Options
1. Integrating Care for Dual Eligibles: Capitated Managed Care Options Prepared by James M. Verdier Mathematica Policy Research, Inc. for the National Academy for State Health Policy 23rd Annual State Health Policy Conference New Orleans, LA October 5, 2010
2. Introduction and Overview Background on dual eligibles Fewer than ten states currently include dual eligibles in capitated managed care organizations (MCOs) that cover a significant portion of their Medicare and Medicaid benefits Several more states are developing programs to do so, with an emphasis on covering long-term supports and services (nursing facility and home- and community-based services [HCBS]) States generally rely on Medicare dual eligible Special Needs Plans (SNPs) for these programs, but there also may be a niche for institutional SNPs PACE was an option in 29 states in 2009 (15,000 total enrollees) Managed long-term care (LTC) for duals presents major opportunities for states ― and major challenges 2
3. Background on Dual Eligibles Nine million dual eligibles in 2005-2006 accounted for 46% of Medicaid and 24% of Medicare expenditures Enrollment shares were 18% (Medicaid) and 16% (Medicare) About 80 percent are “full duals” receiving full benefits from both programs Medicaid pays only Medicare premiums and cost sharing for “partial duals” Two-thirds are over age 65, and one-third are under 65 and disabled or chronically ill High levels of physical and cognitive impairments High nursing facility use, especially among over-65 duals Substantial behavioral health problems, low levels of education, and limited family and community ties, especially among under-65 duals For more details on duals, see Ch. 5 in MedPAC June 2010 Report to the Congress “Coordinating the care of dual-eligible beneficiaries” http://medpac.gov/documents/Jun10_EntireReport.pdf 3
4. Duals Enrolled in Medicaid and Medicare Managed Care Plans Approximately 12 percent of duals were enrolled in comprehensive capitated Medicaid managed care plans in 2009 Largest numbers were in CA (196,000), TN (187,000), AZ (94,000), TX (86,000), MN (50,000), NM (31,000), and OR (31,000) Source: statehealthfacts.org, “Total Dual Eligible Enrollment in Medicaid Managed Care, as of June 30, 2009.” Includes only enrollees in HIO and MCO plans. Approximately 5 percent of full duals were enrolled in Medicare Advantage (MA) managed care plans in 2005 Probably closer to 15 percent now with advent of SNPs and Part D in 2006 CMS has not published dataon enrollment by full duals in MA plans, so this is a rough estimate 4
5. States with Integrated Medicare and Medicaid Managed Care Programs AZ, CA, MA, MN, NM, NY, TX, WA, and WI Services covered, extent of integration, and geographic areas covered vary substantially Medicaid enrollment is voluntary except in AZ, CA, NM, and TX Medicare enrollment is always voluntary Most, but not all, have relied on SNPs to provide coverage PACE enrollment is concentrated in NY, CA, MA, PA, and CO (only states with more than 1,000 enrollees in 2009) See Center for Health Care Strategies (CHCS) “Dashboard” for details on program features http://www.chcs.org/usr_doc/ICP_State-by-State_Dashboard.pdf See also sources cited in “References” slide at the end for more state-by-state and background information 5
6. States with Programs in Development CO, MD, MI, PA, TN, and VA have considered using SNPs and related managed care approaches to integrate care for duals, but have no firm plans at this point (see CHCS “Dashboard” for additional details) NC is developing an integrated care program for duals that will be operated by local provider networks Builds onlong-standing Medicaid enhanced primary care case management program (Community Care of North Carolina) VT is developing a program in which the state would function as the managed care entity 6
7. Massachusetts Experience With SNPS Senior Care Options (SCO) program has provided integrated care for duals age 65 and over since 2004 Started as a CMS demo; participating health plans became SNPs in 2006 Four SNPs (Commonwealth Care Alliance, Senior Whole Health, Evercare, and NaviCare [Fallon]) SCO plans cover all Medicare and Medicaid services, including LTC Both Medicaid and Medicare enrollment is voluntary, but SCO enrollees must get both Medicaid and Medicare services from the SCO plan 11 percent of 120,000 over-65 full duals in MA are enrolled in SCO plans Despite years of experience and positive results, enrollment remains low and coordination between Medicaid and Medicare remains difficult State is considering both SNPs and other options for under-65 disabled dual population 7
8. New Mexico Experience With SNPs New Mexico Coordination of Long-Term Services (CoLTS) program for dual eligibles is primarily a Medicaid managed long-term care program Medicaid enrollment in CoLTS is mandatory for duals and for most Medicaid-only beneficiaries needing LTC services Two SNPs (AMERIGROUP and Evercare) cover 38,000 CoLTS enrollees (including almost all full duals in NM) for Medicaid LTC services But only 1,600 duals also receive their Medicare benefits from these SNPs Others receive Medicare from other Medicare Advantage plans or fee-for-service Program planning began in late 2004, with implementation starting in August 2008 A major goal was to control and coordinate Medicaid personal care option services, where costs were growing rapidly Medicare-Medicaid integration has been limited because major MA plans in NM chose not to participate in CoLTS 8
9. Current SNP Marketplace SNPs in August 2010 335 dual eligible SNPs with 1,010,129 enrollees 153 chronic condition SNPs with 219,787 enrollees 74 institutional SNPs with 96,135 enrollees 562 total SNPs and 1,326,051 total enrollees Nearly 80 percent of enrollment is concentrated in 10 states and Puerto Rico PR, CA, FL, NY, TX, PA, AZ, GA/SC, MN, and AL Over 70 percent of enrollment is in 13 companies Over 90 percent of SNPs have fewer than 500 enrollees SOURCE: SNP Comprehensive Reports on CMS web site at: http://www.cms.gov/MCRAdvPartDEnrolData/SNP/list.asp#TopOfPage 9
10. Current SNP Marketplace(Cont.) SNP trends Total SNP plans and enrollees 2007: 477 plans, 1.1 million enrollees 2008: 762 plans, 1.3 million enrollees 2009: 699 plans, 1.4 million enrollees 2010: 562 plans, 1.3 million enrollees Plans are consolidating and enrollment growth is flattening SNPs are paid in the same way as other Medicare Advantage plans, but have more care management and performance reporting requirements For details, see: https://www.cms.gov/SpecialNeedsPlans/ MA reimbursement is scheduled to be reduced starting in 2012 Total SNP enrollment (1.3 million) is 12 percent of total MA enrollment of 11.1 million MA covers 24 percent of 47 million Medicare enrollees 10
11. Impact of Health Care Reform on SNPs SNP authority extended through 2013 P.L. 111-148, Section 3205 Dual eligible SNPs must have a contract with states by January 1, 2013 “to provide [Medicaid] benefits, or arrange for benefits to be provided”(MIPPA 2008, Sec. 164) May include long-term care services But states are not required to contract with SNPs Dual SNPs that are fully integrated, including capitated contracts for Medicaid LTC and other services, are eligible for a special “frailty adjustment” to their rates, beginning in 2011 (similar to PACE frailty adjustment) CMS is also required to consider additional payment adjustments in 2011 for chronic condition SNPs and others serving high-risk beneficiaries 11
12. Impact of Health Care Reform on SNPs (Cont.) Federal Coordinated Health Care Office established in CMS to improve coordination of care for dual eligibles P.L. 148, Section 2602 Goals are to more effectively integrate Medicare and Medicaid benefits for duals and improve coordination between the federal government and states Specific responsibilities include “Supporting state efforts to coordinate and align acute care and long-term care services for dual eligible individuals with other items and services furnished under the Medicare program” Center for Medicare and Medicaid Innovation (Sec. 3021) Models to be tested include “Allowing States to test and evaluate fully integrating care for dual eligible individuals in the State, including the management and oversight of all funds under the applicable titles with respect to such individuals” May be option for states with no or low managed care penetration 12
13. Contracting With SNPs – Considerations for States States that want to improve integration of care for duals should consider dual eligible SNPs if: SNPs or parent companies have experience with Medicaid and/or an established presence in the state (Medicaid managed care or Medicare Advantage) SNPs are prepared to take into account special needs and characteristics of the Medicaid program in that specific state SNPs have experience or strong interest in managing Medicaid long-term care supports and services States now cover few acute care services for duals in Medicaid (vision, dental, transportation, very limited Rx drugs, and Medicare premiums and cost sharing) As a result, states have little incentive to contract with SNPs just to cover Medicaid acute care services States have staff and other resources needed to negotiate contracts with SNPs and conduct procurements if necessary States will have a few other things on their plates in the next few years 13
14. Managed Long-Term Care Opportunities More than half of all nursing facility residents are dual eligibles 58% of Medicaid spending on duals is for LTC 40% institutional; 18% community Care is highly fragmented and poorly coordinated Medicare pays for short-term post-hospital SNF stays, Rx drugs, and physician services Medicaid pays for long-term NF care and alternative home- and community-based services (HCBS) Medicaid has little or no information on Medicare-provided services Incentives and resources for coordinated and cost-effective LTC for duals are not well aligned Costs of avoidable hospitalizations for dual eligibles fall on Medicare, so Medicaid has few incentives to invest in programs to reduce hospitalizations Nursing facilities benefit financially if dual eligible Medicaid residents are hospitalized and return after three days at higher Medicare SNF rate Medicaid has lost access to Rx drug information needed to manage and coordinate care, and is generally not informed about hospitalizations 14
15. Managed LTC Opportunities(Cont.) Dual eligible and institutional SNPs that cover Medicaid long-term services and supports could: Benefit financially from reduced Medicare-paid hospitalizations Use part of those savings to fund improved care in nursing facilities and in the community that could further reduce avoidable hospitalizations Manage Rx drugs in LTC settings more effectively and use information on Rx drug use to improve care management Increase availability of community-based Medicaid services and reduce unnecessary use of Medicaid nursing facility services, if Medicaid capitated rates provided appropriate incentives for community care Provide “one-stop shopping” for all Medicare and Medicaid acute and long-term care services for dual eligibles 15
16. Managed LTC Challenges Few SNPs and states have experience with managed LTC Medicaid LTC providers (nursing facilities and HCBS providers) generally oppose managed care Organized dual eligible beneficiaries may also be opposed The most organized and vocal beneficiaries may be managing their own care more effectively than SNPs could manage it for them Not necessarily representative of all dual eligible beneficiaries Return on investment for states is long-term and hard to measure and explain Institutional SNPs face special challenges Hard to build enrollment (nursing facilities must agree to contract with SNP, and then residents must choose the SNP) Enrollment is low and declining; heavily concentrated in Evercare SNPs For more details, see March 2010 Mathematica policy brief on coordinating care for dual eligibles in nursing facilities listed in “References” slide 16
17. Conclusions Dual eligibles in general have greater care needs and less ability to navigate the health care system than other Medicare and Medicaid beneficiaries The “system” they must navigate is highly complex and poorly coordinated Capitated managed care plans that include all Medicare and Medicaid benefits for dual eligibles can improve their care and reduce overall expenditures Substantial obstacles to expansion of managed care for duals currently exist Most legal and regulatory obstacles are on the Medicare side, but there are political obstacles on the Medicaid side in many states Voluntary enrollment in Medicare managed care limits enrollment Inability to share in Medicare savings limits state interest The new Federal Coordinated Health Care Office could help to reduce some of these obstacles 17
18. References Melanie Bella and Lindsay Palmer Barnette. “Options for Integrating Care for Dual Eligible Beneficiaries.” March 2010. Available at: http://www.chcs.org/usr_doc/Options_for_Integrating_Care_for_Duals.pdf Barbara Coulter Edwards, Susan Tucker, and Brenda Klutz. “Integrating Medicare and Medicaid: State Experience with Dual Eligible Medicare Advantage Special Needs Plans. “ 2009. Available at: http://assets.aarp.org/rgcenter/ppi/health-care/2009_14_maplans.pdf. Jessica Kasten, Paul Saucier, and Brian Burwell. “State Purchasing Strategies Drive State Contracts With Medicare Special Needs Plans.” September 2009. Available at: http://aspe.hhs.gov/daltcp/reports/2009/stpur.pdf. Paul Saucier, Jessica Kasten and Brian Burwell. “Medicaid Contracts with Medicare Special Needs Plans Reflect Diverse State Approaches to Dually Eligible Beneficiaries.” November 2009. Available at: http://aspe.hhs.gov/daltcp/reports/2009/SNPdual.pdf. James Verdier, Marsha Gold, and Sarah Davis. “Do We Know If Medicare Advantage Special Needs Plans Are Special?” January 2008. Available at: http://www.kff.org/medicare/upload/7729.pdf. James M. Verdier. “Coordinating and Improving Care for Dual Eligibles in Nursing Facilities: Current Obstacles and Pathways to Improvement.” March 2010. Available at: http://www.mathematica-mpr.com/publications/PDFs/health/nursing_facility_dualeligibles.pdf. 18