Word: medicaid
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...persuaded to prescribe expensive new drugs, even though older drugs or generics would be just as effective. A Harvard model projects that every dollar spent on better information would yield $2 in drug savings. That's a big deal to cash-strapped states that pay a large chunk of Medicaid patients' drug costs. Thus SCORxE - South Carolina Offering Prescribing Excellence - a joint program between the state's Medicaid program and the South Carolina College of Pharmacy, which trains its pharmacist-reps to visit doctors' offices armed with unbiased studies...
...objective is to standardize methods for validating genetic tests and guaranteeing accuracy and quality, says Mari Baker, CEO of California-based Navigenics. For now, all clinical labs, including those that conduct genetic tests, are regulated by the Centers for Medicare and Medicaid Services, which, under the federal Clinical Laboratory Improvement Amendments (CLIA), governs lab-personnel qualifications, quality-control procedures and proficiency testing. But critics argue that the law needs to be updated to include standards for genetic-testing labs. CLIA requires independent evaluations of labs' test-performance proficiency, for example, but genetic-testing labs are exempt from this rule, according...
...reform, many insurers have turned to pay-for-performance programs to try to improve quality of care, and cut costs along the way. Early efforts have shown positive signs. In the first three years of an ongoing pay-for-performance demonstration project led by the Centers for Medicare and Medicaid, more than 250 participating hospitals were assessed in five clinical areas. The hospitals performing in the top quintile received bonuses of an unspecified amount. In findings released in January, researchers following the project concluded that quality scores in the five measured clinical areas had improved on average 17%, and costs...
...Urban Institute on April 29 warned that each percentage-point rise in unemployment would result in an additional 1.1 million people losing health insurance; add that to the 47 million Americans who are currently uninsured. Virtually all of those newly uninsured will be forced to enroll in Medicaid or the State Children's Health Insurance Program, the government's primary low-income health plans. To support the growing registry, these health plans will need $3.4 billion in additional funding, at least $1.4 billion of which will have to come from state legislatures. But the extra money will be difficult...
Many health plans, including some state Medicaid programs, delay prescriptions of antipsychotic drugs used to treat schizophrenia until doctors have submitted a form indicating that other therapies have failed or that the drugs are medically necessary...