Author: Howard Green

DISCORD AT HHS VERMA AZAR

16 Dec DISCORD AT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES

Government healthcare reforms along with reducing prescription drug prices have been at the top of President Donald Trump’s agenda. A feud between the top health officials at HHS is delaying the administration’s healthcare initiatives. Over the past year, tensions have been building between HHS Secretary Alex...

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Michigan Rx Carve Out Syrtis Solutions Medicaid

25 Nov MICHIGAN MEDICAID PBM RX CARVE OUT

To reduce costs in its Medicaid Health Plan (MHP), Michigan is carving out pharmacy benefit managers (PBMs) and transitioning to a fee for service (FFS) model for the delivery of prescription drugs. In October, Michigan’s Department of Health and Human Services (MDHHS) announced that outpatient...

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Medicaid Third Party Liability GAO CMS Syrtis Solutions ProTPL TPL OHI

20 Sep Medicaid Third Party Liability Report From GAO

Identifying third party liability continues to be a challenge under the coordination of benefits for Medicaid plans. By law, plans are payers of last resort so whenever beneficiaries have other active coverage (OHI), those third parties should pay first. Currently, Medicaid plans are required to...

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Rx Carve Out Syrtis Solutions Medicaid California

11 Sep CONCERNS OVER CA’s Rx CARVE OUT

California’s Governor, Gavin Newsom, signed an executive order at the beginning of the year to move all pharmacy services for Medi-Cal from managed care to a FFS model. The consolidated purchasing power would leverage the state’s population size to negotiate drug prices with pharmaceutical...

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Medicaid Improper Payments Syrtis Solutions DHHS

29 Aug MEDICAID IMPROPER PAYMENTS IN FY 2018

DHHS has released its annual Agency Financial Report for FY 2018. The report provides an overview of improper payments in the Medicaid program, root causes for the payments, and corrective actions. In line with the agency's goal of reforming, strengthening, and modernizing the nation’s healthcare...

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DHCS FFS Syrtis Solutions Prescription Drug Costs Medicaid

20 Aug DHCS SEEKS FFS Rx BENEFIT MANAGEMENT

In January, California’s newly elected Governor, Governor Gavin Newsom signed an executive order to drastically reform health care in the state. Executive Order N-01-19 introduced a number of actions and budget proposals to reduce the cost of prescription drugs and health care. One measure, in...

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Medicaid Managed Care Saves Plans Money

30 Jul COST AVOIDANCE TECHNOLOGY SOLUTIONS FOR MEDICAID

In addition to rising health care costs and increased spending from the program’s expansion, Medicaid is losing billions of dollars a year from improper payments. Protecting the integrity of the Medicaid program has become a top priority for the Centers for Medicare and Medicaid Services...

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