Republican lawmakers' quest to expand a Medicaid privatization program statewide was dealt a blow this week after federal health officials said the state could not impose $10 monthly premiums on Medicaid beneficiaries. The Centers for Medicare and Medicaid Services also denied the state's proposal to charge $100 co-pays for any non-emergency ER visits, according to a letter sent Thursday. Federal health officials said the fees violated several statutes designed to protect nearly 3 million of state's most vulnerable. Lawmakers passed the bills last year trying to rein in the Medicaid budget of more than $20 billion a year and increase accountability for providers.
Each day, executives and analysts at Centene Corp. peer into a digital dashboard, hunting for spikes in health care usage—and costs. Their proprietary database, known internally as Centelligence, helps them predict the likelihood that a patient will, for instance, develop diabetes or asthma. And they can drill into individual patients' records to pinpoint causes. Like bond traders poring over rates and yields, Centene's prognosticators dissect health data to play the spread between what state governments will pay Centene for Medicaid management—and what costs Centene can shave for a specific subpopulation's health care.
The Leapfrog Group has named the nation's top hospitals for 2011, and the list shines a spotlight on how health IT can help improve patient care—even preventing medical errors that can lead to adverse drug reactions and deaths. Leapfrog bases its annual ranking on a survey of hospitals' processes, quality of care, and patient safety. Its evaluation includes "stringent IT requirements," said Leah Binder, Leapfrog CEO.
When President Nixon wanted to overhaul the health care system to provide universal coverage, his administration turned to Stuart Altman. Ten years later, when Congress created a commission to improve the Medicare payment system, Altman led the effort. And, in the early '90s, when newly elected Bill Clinton assembled a team to guide his health care policies, Altman was among the first chosen. There may be no single person with a longer or deeper history in the health care overhaul efforts of the past 40 years than Altman, a professor of national health policy at Brandeis University in Waltham.
The case of a man who was stuck with a $14,419 bill that he calls inflated and unreasonable after three days of care in a Charlotte hospital is going to be heard by the North Carolina Supreme Court. The case, scheduled to be heard by the state's high court on Monday, is upsetting officials at the state's major medical centers. Robert Talford argues that there should be a trial to determine whether the cost of medications was reasonable. He says the hospital, which he declined to identify, charged 24 times more for the medication than what a local pharmacy would charge.
Eight executives from 15 Lower Hudson Valley hospitals received more than $1 million in salary, bonuses, benefits and other pay in 2010 at a time when the state struggled to control health-care costs. A Journal News analysis of tax records shows they included CEOs and top physicians who earned five times more than a cap ordered last month by Gov. Andrew Cuomo for nonprofit organizations, a move to restrict the amount of state money they can use on executive compensation to $199,000 a year.