Medicaid Archives - Recon Strategy

An opinionated take on NEJM highlights for October 2016

Marc Herant November 2, 2016

Continued progress in multiple myeloma About 25,000 patients are diagnosed with multiple myeloma yearly in the US. Despite being initially treatable, typically this disease is ultimately lethal. Following a highly successful phase 1-2 study a monoclonal antibody against a marker of myeloma cells (daratumumab, Janssen) underwent phase 3 studies in combinations with established mainstays of therapy (the proteasome inhibitor bortezomib and the immune modulator lenalinomide) in a patient population several years out from their initial diagnosis. Results were stellar, with the inclusion of daratumumab decreasing the disease progression rate by

Clear Health Alliance: Debut of the for-profit HIV/AIDS special needs plan

James Matheson July 16, 2012

Summary HIV Special Needs Plans (SNPs) offer extra layers of services specialized for the HIV/AIDS patient and can generate attractive savings particularly in reduced in-patient costs A new partnership in Miami-Dade is creating a for-profit model in what has historically been a space pursued by mission-oriented non-profits Recent Florida legislation mandating HIV positive Medicaid members join an HMO specialized in HIV/AIDS sharply expands the potential market for SNPs and was likely critical for the for-profit venture In contact to the condition-specific provider ACO, SNPs are likely better suited for addressing

Six strategic choices made by CMS in the final ACO rules

Tory Wolff November 1, 2011

1. The final ACO rules largely maintain the demanding economic parameters for mature ACOs (Track 2) found in the originally proposed version (relative, for example, to the original PGP demonstration project): Potential for both downside and upside reward. Maximum shareable savings of 60% (less than in the original PGP demo); and the rewards are limited to an upper bound of total costs. In this regard, the ACO contract payoff locks a lot like your classic “collar” financial option (see graphic below). The starting cost benchmark based on the ACO’s actual

Partners’ acquisition of Neighborhood Health Plan: reinforcing the role of community health centers in the care continuum

Tory Wolff August 18, 2011

Much of the public speculation (for example here and here) regarding the acquisition of a local high quality safety net health plan — is it about locking in Medicaid volume? or about doing a “good deed” before regulators make decisions about Partners market influence? – is not very persuasive. Partners is already under intense scrutiny — a program of pushing Medicaid volume to its own facilities would contradict its public promises, exacerbate regulator suspicion and not be very profitable anyway. And if regulators believed Partners has the market power to

Medicaid going mainstream: thoughts on the IBC / BCBSM / AmeriHealth deal

Tory Wolff August 10, 2011

Historically Blues have shied away from Medicaid. Two thirds of plans do not serve any Medicaid and those that do often have disproportionately small shares. No real surprise: Medicaid specialist plans can fluidly move in and out of markets depending on the rates and redeploy their capabilities wherever are the best returns. Blues on the other hand, are prime “hold-up” targets because they are largely stuck in their assigned states. They can only respond to an offer of low rates with a threat of dismantling their Medicaid operations entirely (and

Primary care capacity and the looming Medicaid surge: Medicaid-focused providers must be part of the answer

Tory Wolff March 21, 2011

Summary A new study from Center for Studying Health System Change suggests that new Medicaid eligibles under reform will have trouble getting access because most primary care are not accepting new Medicaid patients. Our view: The study does not take into account the role of focus in Medicaid which makes a big difference: Providers earning more than 25% of revenues from Medicaid are much more willing to take on all or most new patients. In fact, among the providers most likely to care for Medicaid eligibles, the willingness to accept

Tag: Medicaid

Recon takes an analytical look behind select developments in healthcare

An opinionated take on NEJM highlights for October 2016

Clear Health Alliance: Debut of the for-profit HIV/AIDS special needs plan

Six strategic choices made by CMS in the final ACO rules

Partners’ acquisition of Neighborhood Health Plan: reinforcing the role of community health centers in the care continuum

Medicaid going mainstream: thoughts on the IBC / BCBSM / AmeriHealth deal

Primary care capacity and the looming Medicaid surge: Medicaid-focused providers must be part of the answer

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