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Rebates please

Medicare & Reimbursement Advisor Weekly, June 10, 2009

Private health insurance leaders are pushing Congress to allow insurers to benefit from the Medicaid Drug Rebate Program, which lets states pay less for drugs in their Medicaid program. J. Mario Molina, MD, chair and CEO of Molina Healthcare, which covers more than 1.3 million Medicaid patients in 11 states, said roughly half of Medicaid beneficiaries are covered under managed care plans, which shows the rebate’s importance to insurers and states. To read the full story, click here: http://healthplans.hcpro.com/content/233981/topic/WS_HLM2_HEP/Private-Insurers-Give-Us-the-Medicaid-Drug-Rebate-Too.html.

Profit centers

What if today’s hospitals were managed as a collection of profit centers, instead of cost centers? Healthcare thought leader Rick Jackson believes costs and revenues are misleading metrics in measuring the success of a service line. This white paper challenges executives to transform their hospital’s financial model in order to remain healthy staples of their communities. For the full story, click here: www.healthleadersmedia.com/forms/Jackson-05182009/.

Account Team Tip

Let your account teams know that healthcare team meetings in the hospital setting are powerful interventions that are held far too infrequently, says Karen Zander, RN, a case management instructor. Clinicians will often reflect with wonder on how they were so surprised by a family’s change of mind or why they didn’t realize sooner that a fellow clinician had an important piece of information that no one else knew. Documentation, at its best, is only part of the story. The real story is the up-to-the-minute information that is actually integrated at a team meeting. Case managers and social workers should know the indicators and take initiative to organize and conduct team meetings, Zander says. If done right, there is an opportunity for an account manager to play a resource role and position your programs and brands as a solution, not a pitch. Common indicators for team meetings without the patient and family are:

• Referrals from complex care rounds
• Confusion about the diagnosis and treatment plan
• Preparationfor meeting with patient and/or family
• Disagreement about the appropriate level of care needed currently or in the future

Indicators for team meeting with the patient and family:

• Initiation of special treatment protocols
• Important decisions are needed, such as surgery or end-of-life care
• Setting limits with patients and/or families about behaviors

For the full story, click here: http://www.hcpro.com/CAS-232452-2278/CMW-Tip-of-the-Week-Know-when-to-set-up-a-care-team-meeting.html.

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