The Health Plan Management Navigator
Dear ME-P Readers
Please find attached below the Mid April 2010 Edition of Plan Management Navigator.
In this month’s edition, we estimate the strength of cost drivers for claims processing in Medicare and Medicaid plans. We quantify the relationships of claims processing to simple algebraic expressions and operational metrics within the Claim and Encounter Capture and Adjudication function.
Assessment
Also included in this analysis is an update on our progress on our various benchmarking universes. Participation is up this year, we think due to public policy changes and economic weakness. Please let us know if you are interested in joining our Medicare, Medicaid or TPA universes.
Erin Sawchuk
Sherlock Company
P.O. Box 413
Gwynedd, PA 19436
215-628-2289 – Phone
Conclusion
Link: Navigator Mid April 2010
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Filed under: Alerts Sign-Up, Health Economics, Health Insurance, Healthcare Finance | Tagged: Douglas B. Sherlock CFA, Erin Sawchuk, Health Economics, health plans, Medicaid, medicare, Plan Management Navigator, Sherlock Company |















Mandatory Medicare – Mandatory Medicaid
Here is a scary essay by Daniel Palestrant MD on the events playing out in the state of Massachusetts.
It appears as though a bill currently under review by the state legislature will make participation in the state and federal Medicare and Medicaid programs a condition of medical licensure, effectively making physicians employees of the state.
http://www.thehealthcareblog.com/the_health_care_blog/2010/04/more-madness-in-massachusetts.html#comments
Fist Massachusetts … then the next 49. Just say “hello” to nationalized healthcare!
Beau
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Forced Medicare and Medicaid for Physicians
The care that physicians provide for Medicaid – and some Medicare – patients is essentially volunteer work or charity care, given the extremely low [and declining] reimbursement rates. If legislation is passed to mandate participation, dependence on government – and Democrats – will continue to grow.
The care then ceases to be charity [self-fulfillment] and commences to be physician servitude [drudgery]. And, a once noble profession is emasculated.
Dr. David Edward Marcinko; MBA
[Editor-in-Chief]
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Medicare Will Save Money Under Healthcare Reform According to the CMS
Provisions under the four-month-old health reform law that hit the provider and payer communities the most are expected to save Medicare $7.8 billion through 2011 and $418 billion over the next decade, according to a report released by the CMS.
The report focuses primarily on the scores of measures aimed at changing how care is delivered and paid for, and which made up the spine of the massive legislative package passed this year. Programs meant to reduce the number of hospital re-admissions, reshape how hospitals and doctors are reimbursed and those that target fraud and abuse are expected to reduce Medicare spending by tens of billions of dollars.
Source: Matthew DoBias, Modern Healthcare [8/2/10]
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Mystery After The Health Care Ruling
[Which States Will Refuse Medicaid Expansion?]
The Supreme Court ruling allows states to decline the Medicaid expansion included in the Affordable Care Act without losing federal money for their existing Medicaid programs.
http://www.propublica.org/article/mystery-after-the-health-care-ruling-which-states-will-refuse-medicaid-expa
But, if the 26 states that challenged the law opt out, an estimated 8.5 million people would not be covered by Medicaid.
Marcellus
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