* In case anyone is still wondering why some of us were so upset about the state’s rush to shove thousands of foster kids into Medicaid managed care, here’s Stephanie Goldberg at Crain’s…
Illinois is funneling more people into the Medicaid managed care plan with the highest turnover and lowest scores on state quality measures.
The Illinois Department of Healthcare & Family Services sends 35 percent of new Medicaid enrollees who didn’t request a particular plan to NextLevel Health. That ties CountyCare for the highest percentage assigned to any of the state’s Medicaid managed care providers.
NextLevel gets all those new customers despite poor quality grades and high rates of defection among its current members. The plan finished last in the state’s latest quality survey, which rated NextLevel “low” or “lowest” in five of six performance metrics. Meanwhile, NextLevel lost customers at twice the rate that patients left the program overall.
Go read the rest.
A new study found waste accounts for roughly one-quarter of all U.S. healthcare spending, an estimate that’s in the same ballpark as its predecessors.
The cost of waste in the U.S. healthcare system ranges from $760 billion to $935 billion annually, according to a JAMA review of 54 peer-reviewed studies, government reports and other information, released Monday. The study found one-quarter of that could be cut using interventions found to reduce waste. […]
The current study divided waste into six previously identified categories. Administrative complexity accounted for the most waste, at $265.6 billion annually. Below that was waste due to pricing failure, which costs $230.7 billion to $240.5 billion annually. Failure of care delivery accounts for $102.4 billion to $165.7 billion annually. Overtreatment or low-value care results in $75.7 billion to $101.2 billion in waste annually. Waste related to fraud and abuse costs between $58.5 billion and $83.9 billion annually. Finally, failure of care coordination generates $27.2 billion to $78.2 billion in waste annually.
The study also estimated potential annual savings from measures shown to cut waste. In aggregate, those interventions could save $191 billion to $282 billion annually, or about 25% of the total cost of waste.