Care Coordination in the News

Strategies for States to Reduce Medicaid Fraud
States have implemented a variety of strategies to reduce Medicaid fraud. California conducts the “Medi-Cal Payment Error Study” annually to identify patterns of fraud; Florida  performs random, unannounced site visits for all kinds of providers, both before contracting with them and after; and New Jersey's “Operation X”  initiative tries to prevent individuals who have previously engaged in unethical or fraudulent practices from collecting Medicaid in the first place.
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Prices for Routine Procedures Vary Greatly Across States
The Department of Health and Human Services has released the prices of 100 common Medicare services for thousands of hospitals finding large disparities in cost. Those without health insurance pay greatly higher costs for care while there are less expensive options are often available nearby. Nearly everyone who seeks health care ends up paying inflated prices in one form or another as these stark disparities in price create inefficiencies in the market.
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Washington State Senator Randi Becker along with Representatives Shelly Short and Tami Green sponsored a health care quality measure that was signed into law by Governor Christine Gregoire this week (April 30, 2013).
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Medicare Should Move to Accountable Care Organizations
It would be beneficial for Medicare to develop accountable care-like organizations where providers receive a globally capitated payment for their patients and must meet quality measures for full payment. The initial benchmark for capitated payments would be based on current beneficiary spending and quality measures according to the plan from the Engelberg Center for Health Care Reform at the Brookings Institution.
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Statewide Clinical Outreach Program for the Elderly Helps Reduce Avoidable Psychiatric Visits
The Statewide Clinical Outreach Program for the Elderly trains nursing home workers to look for ways to improve a troubled patient’s environment to curb anti-social behavior. This also helps prevents nursing home residents unnecessarily ending up in psychiatric care due to under-staffed nursing homes believing dementia-related problems are a psych emergency.
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