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Access to Care in a Medicaid Managed Care World
Each state might look a little different, but Medicaid in all states is moving toward some kind of managed care, stated Matt Salo. And a newly proposed rule from CMS regulating access, enrollment, financing and more is an attempt to get everyone on the same page. But some people are concerned that this rule will stifle innovation in the states, Salo said.
People are appropriately distrustful, though, according to Margaret E. O’Kane, MHA, because it’s a new way of doing things and the success of managed care depends on a “vigorous accountability agenda.”
“There’s going to be a lot of pushback from people that are used to working only in fee-for-service and in a different situation,” she said.
Access to care for Medicaid has been a longstanding issue, Austin Frakt, PhD, said, and it remains a complex one because there are a variety of ways to measure access. The new regulations were concerning, in a way, because he found them vague, and that they put a lot of the burden back on states to put a plan in place for standards to measure access to care without specifying what it should look like.
The National Committee for Quality Assurance will be monitoring the situation, O’Kane said, especially since the industry has been in a period of very broad networks, and now the discussion is about narrow networks.
“It’s kind of a new day for us,” she said.
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
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Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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What We’re Reading: FDA Approves UTI Antibiotic; Ozempic, Wegovy Price Investigation; US Births Fall
April 25th 2024The FDA recently approved an antibiotic for the treatment of urinary tract infections (UTIs) in women; a Senate committee recently launched an investigation into the prices of Novo Nordisk’s diabetes and weight loss drugs; US births fell last year, resuming a national slide after a previous increase during the pandemic.
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HOPE-CAT Can Identify Maternal Cardiovascular Risk 2 Months Earlier Than Doctors, Study Says
April 25th 2024In a retrospective study, the machine learning tool was able to screen for potential risks of cardiovascular disease nearly 60 days before the patient's medical record showed any signs of a related condition or before they were officially diagnosed or treated for it.
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