States Turning To Managed Care For Medicaid Long-Term Care
An excellent Modern Healthcare article on Medicaid long-term care. Twenty-four states contract with Medicaid managed care organizations to cover people who need long-term services and supports. This is a remarkable shift from decades ago when managed care covered largely only TANF welfare and related populations. States have turned to private delivery to save costs and reduce trends.
However, some states are actually rolling back long-term managed care. Indiana and Nebraska recently ended insurer contracts amid provider concerns.
#medicaid #longtermcare #managedcare
https://www.modernhealthcare.com/insurance/mh-medicaid-managed-care-long-term-services
State Initiatives To Reduce Healthcare Costs Growing
Another interesting Modern Healthcare article on state efforts to reduce healthcare costs. Eight states have established cost growth targets. Enforcement ranges from hard penalties down to performance improvement plans and reporting.
Some states are also looking to cap certain healthcare services and payer types.
So far, there have been mixed reviews on state initiatives. No states with a growth target in 2023 stayed below the threshold. But cost growth programs were associated with a 2% reduction in total medical expenditure growth from 2010 to 2020. The more teeth in the program, the more likely a state is to see results.
#healthcare #costs #growthcaps
https://www.modernhealthcare.com/providers/mh-states-hospital-price-caps-penalties-spending
Padding Healthcare Costs
And last, a great piece by Kaiser Health News on the growing problem of costs at hospital- or insurer-owned practices and facilities. It notes that all sorts of healthcare integration is occurring at a swift pace, with hospitals and some plans buying doctors’ practices, surgery and imaging centers, and pharmacies. Private equity firms are behind many of the deals. Doctors working for hospitals rather than in private practice has more than doubled. About 82% of doctors are employed by hospitals, other corporate entities (like insurers), or private equity firms.
The article covers the growing trends of patients being directed to a higher-priced location for procedures. This meaningfully adds to out-of-pocket costs for patients.
The government has taken a relatively hands-off approach on healthcare consolidation.
#consolidation #mergers #acquisitions #healthcare #antitrust
— Marc S. Ryan
