3 Ways Proposed CMS Rule Could Cut Costs, Increase Transparency in Medicaid Prescription Drug Pricing

Monday, February 6th, 2012
This post was written by Cheryl Miller

In an attempt to pare down the nearly $16 billion Medicaid spent on prescription drugs in 2009, CMS is proposing three cost-cutting measures, one of which includes increasing rebates paid by drug manufacturers that participate in Medicaid. All of the measures are intended to increase transparency for states and taxpayers as well. The comment period for the proposed rule will close on April 2nd. CMS plans to issue a final rule in 2013.

Cutting healthcare costs is the NQF’s goal also; they are targeting diabetes, CV disease and primary care costs with four new resource use measures which have been approved for endorsement. This is the NQF’s first effort at endorsing measures that evaluate how resources are used in care delivery.

Aetna has launched a national PCMH program that will reward primary care physicians on a quarterly basis for selected care coordinated tasks, as long as the PCPs meet eligibility requirements. Connecticut and New Jersey are the first states to host this program. Aetna is the latest private payor to revamp the medical home funding model; you can read more about the others in our featured blog in this issue.

Hospitals are doing something right: according to the latest study from Press Ganey hospitals’ overall patient satisfaction scores have improved since July 2011, when the value-based purchasing period began. The new VBP criteria will affect hospitals’ performance-based Medicare payments.

P.S. By the time this newsletter publishes Monday, let’s hope the Giants did something right Sunday night and won the Super Bowl. Go Giants!

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