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3 posts from April 2013

04/18/2013

Joan Alker Discusses What's Known About the Quality of Care Provided by For-Profit Medicaid Managed Care Plans (April 18, 2013)

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It's estimated the Affordable Care Act will add another 16-17 million lives to the 60 million Americans already receiving Medicaid.  Of these current 60 million Medicaid enrollees, two-thirds receive their health care via managed care companies and over half of Medicaid managed care enrollees are in for profit plans.  Concerning the quality of care for profit plans deliver, a 2011 study published by the Commonwealth Fund found for profit Medicaid plans did significantly worse than non profit plans at ensuring members receive preventive care and managing members chronic disease.  Also too, for profit plans had comparatively higer administration costs than non profit plans.

Ms. Alker begins this 24-minute interview discussing reasons for ever-growing Medicaid managed care plan enrollment and the issue of access to, or provider participation in, Medicaid and in Medicaid managed care plans.  She assesses the state of quality data collection and explains why data is generally lacking, spotty and/or not uniformly collected.  She makes comment on for profit  interest in expanding to cover additional Medicaid sub-populations, what relevant ACA reforms promise, the challenges and opportunities for reducing costs since the Medicaid program as already an efficient payer, findings from her recent study of a five-county managed care demonstration in Florida and lastly provides comment on the recent decision in Arkansas to use federal Medicaid subsidies to purchase insurance in 2014 via their state exchange for citizens otherwise eligible for Medicaid under the ACA's expanded coverage provision.             

Ms. Joan Alker is the Co-Executive Director at the Center for Children and Families (CCF) and for the past ten years a Research Associate Professor at the Georgetown University Health Policy Institute.  Her work focuses on health coverage for low-income children and families, with an emphasis on Medicaid, the Children’s Health Insurance PJoan-Alker-cropped[1]rogram (CHIP) and the Affordable Care Act (ACA).  She has authored numerous reports and studies on a range of issues including Medicaid waivers, child and family coverage, premium assistance and is the principal investigator of a multi-year study on Florida’s Medicaid program.  Ms. Alker holds a Master of Philosophy in politics from St. Antony’s College, Oxford University and a Bachelor of Arts with honors in political science from Bryn Mawr College.

04/10/2013

Dr. Burt Edelstein Discussess Tooth Decay, the Most Chronic Infectious Disease Among Children (April 10, 2013)

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Tooth decay affects US children more than any other chronic infectious disease.  It is five times more common than asthma and almost entirely preventable.  Between 41% and 55% of children age 2 to 11 suffer tooth decay and upwards of 34% of this decay is untreated.  Disparities in dental health, the CDC has termed, "profound."  This is explained in part by fact that one-third of the population (over 100 million Americans) lack dental health insurance.  That means uninsured children are 2.5 times less likely to receive dental care than insured children.  All this matters because oral health is an integral part of both overall physical (systemic) health as well as nutritional health.

Dr. Edelstein begins this 31-minute podcast assessing children's oral and dental health status including how and why oral health effects overall health status and the relationship between obesity and oral health.  He discusses the level of adequacy of dental care financing or coverage and the subsequent adequacy of (and barriers to) access to dental services particularly under Medicaid.  How relevant provisions of the Affordable Care Act may change care delivery approaches are discussed, the relevant work anticipated by MACPAC and the work of the Children's Dental Health Project.         

Dr. Edelstein is a Board Certified pediatric dentist and the 1997 founder of the Children’s Dental Health Project.  Dr. Edelstein practiced pediatric dentistry in Connecticut while teaching at both Harvard and UCONN for 21 years.  He is currently Professor of Dentistry and Health Policy at Columbia University where he Mail[1]chairs the Department of Social and Behavioral Sciences at the College of Dental Medicine.  Edelstein has authored over 100 publications on topics related to pediatric oral health, dental education and health policy.  He presently serves as a Commissioner of the Congressional Medicaid and CHIP Payment and Access Commission (MACPAC).  He is a graduate of Harpur College, SUNY Buffalo School of Dentistry, the Harvard School of Public Health, and the Boston Children's Hospital pediatric dentistry residency program.

04/03/2013

Dr. Brian Isetts Discusses Ways to Improve Medication Therapy (April 3, 2013)

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Over 80 percent of Americans take at least one medication, nearly 30 percent take five or more. That translates to more than 3.5 billion prescriptions written every year making drugs the third highest health care delivery cost after hospital and physician services - amounting to over $250 billion annually. While the benefits of medication therapy are or can be substantial medication errors are among the most common medical error. According to the IOM an estimated 450,000 preventable adverse drug events (ADEs) occur each year in hospitals and another 800,000 preventable ADEs occur in long term care facilities – though these numbers are believed to be under estimates. According to the CDC fatalities from medication errors in 2010 accounted for 35,000 deaths, or more deaths than caused by auto accidents. Medication harm is so pronounced per the Dartmouth Institute for Health Policy there is nearly a 1:1 ratio of drug spending to spending on unintended mediation harm.

Dr. Isetts begins this 20-minute podcast by noting the importance of rethinking or reframing the problem of medication harm by emphasizing the utility developing a true medication use system, i.e., medication therapy management (MTM) and imbedding MTM into all health care delivery settings.  He emphasizes the importance of understanding first why patients do not appropriately follow their medication regimes.  He discusses the pluses and minuses of physician computer order entry systems.  He defines MTM as primarly insuring patients understand the intended uses for their medications, identifying each patient's goals of therapy and insuring patients understand all relevant drug safety issues.   Dr. Issets describes the work that's been done to improve the Medicare drug benefit by aligning it with Medicare hospital and physician care delivery and what can and is being done to reduce drug-related fatalities.                 

Dr. Brian Isetts is Professor of Pharmaceutical Care and Health Systems at the University of Minnesota.  For the past two years he has been a Health Policy Fellow at the Centers for Medicare and Medicaid Cop_content_359568[1]Services (CMS) working to improve medication adherence.  Dr. Isetts' field of expertise concerns studying the outcomes of medication therapy management services (MTMS) provided within the practice of pharmaceutical care.  Beyond CMS, Dr. Isetts has worked with the American Medical Association, et al. to ensure MTMS by pharmacists.  He was graduated with a BS from the University of Wisconsin School of Pharmacy and with a Ph.D. from the University of Minnesota College of Pharmacy.