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A small but committed number of state Medicaid programs are setting out to enhance their primary care case management programs (PCCM) that link beneficiaries to primary care providers (PCPs) and pay providers for a core set of care management activities.
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Oklahoma's Medicaid director, Lynn Mitchell, MD, says as of January 2009, the state's primary care case management (PCCM) program, called SoonerCare Choice, in which 423,000 Oklahomans participate, had "further embraced the patient-centered medical home principle, and we did that as a request from our providers. We feel that this will take even a further benefit to our members."
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When Michael P. Starkowski, commissioner of Connecti- cut's Department of Social Services, gave a recent presentation, a woman in a wheelchair approached him during a coffee break. She asked whether he had anything to do with Money Follows the Person (MFP), a Medicaid initiative that helps people transition from institutions to community living.
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Over the past 12 months, Ohio Medicaid has seen a 9% increase in enrollment, totaling 168,000 additional individuals on the program. Interestingly, though, 80% of that growth has been in the Healthy Families program, which covers parents, pregnant women, and children at low income levels.
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The American Industrial Hygiene Association (AIHA) has issued a position statement on H1N1 pandemic influenza A that endorses and reiterates the key findings of an Institute of Medicine panel that recommended N95 respirators for health care workers. Key points stressed by AIHA include:
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After last year's round of budget cuts, Washington Medicaid seemingly exhausted all opportunities to achieve savings through purchasing initiatives.
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Washington's Chronic Care Management Project targets the most medically expensive, high-risk Medicaid clients in its long-term care system. It has lowered mortality and improved the health of clients with chronic conditions such as diabetes, heart disease, and musculoskeletal diseases.
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There is no question that decreasing inappropriate use of the emergency department for Medicaid patients can save significant costs, but getting results is a daunting challenge.
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Medicaid programs may never have had as much reason to redouble their utilization review efforts, in order to be sure funds are not being spent inappropriately, as they do right now.
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In fiscal year 2008, Alabama's Program Integrity Division's Pharmacy Audit unit reviewed 143 medical providers and 629 pharmacies to assure proper claim payment and recovery of identified overpayments.
