Blogs

As if the worsening diabetes epidemic were not enough to worry about, this chronic condition also increases risk for complications like heart disease, stroke, and kidney failure. This is a major challenge for health plans managing the care of a growing population of Medicaid members, who tend to overutilize emergency rooms for routine or non-urgent care.

While preventive and disease management programs are helping improve outcomes for people with diabetes and other chronic conditions, more must be done beyond just phone outreach to adequately engage Medicaid members. For instance, the single mother with young children and no car doesn’t need a call to remind her of an A1C test; she needs help resolving socioeconomic barriers like lack of transportation or child care.

Next year is a big year for Medicare Advantage plans. In 2015, they will not receive bonuses unless they have a 4-star rating or above. Many health plans are feeling under pressure right now, and may even feel a little disgruntled, as their businesses could really take a hit next year if they fall even slightly below 4.

One way to view this challenge that may take the edge off the pain is that the CMS Five Star Quality Rating System for Medicare Advantage Plans is not just about being able to stay or earn a spot in the Medicare Advantage program. Taking steps to improve ratings can help Medicare Advantage plans and other health plans hoping to enter the program achieve the Triple Aim and move them even closer to getting the business results they really want.

Meetings

4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015

Our other journal

P&T Journal for September 2014

FEATURES

HEALTH CARE & LAW

Legal Risk Management Opportunities, Pharmacy Practice, and P&T Committees

Hospitals Struggle With ACA Challenges

Drug–Gene Interactions: Inherent Variability in Drug Maintenance Dose Requirements

Schizophrenia: Overview and Treatment Options

PIPELINE PLUS

Schizophrenia Therapy Options Increasing

DEPARTMENTS

MEDICATION ERRORS

Too Many Abandon the “Second Victims” of Medical Errors

PRESCRIPTION: WASHINGTON

New Controversy for 340B: OPA Rebuffs Ruling by Court

New Drugs/Drug News/New Medical Devices

Pharmaceutical Approval Update

DRUG FORECAST

Loxapine Inhalation Powder (Adasuve)


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