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Cost-containment programs targeting high-need, high-cost Medicaid populations now have more information to work with. Researchers from the Hamilton, NJ-based Center for Health Care Strategies analyzed prescription drug use in addition to diagnostic claims in the October 2009 report, "The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions." Here are key findings resulting from the addition of pharmacy data to the analysis:
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How effectively does the Medicaid Statistical Infor- mation System (MSIS), the only nationwide Medicaid eligibility and claims information source, detect fraud, waste, and abuse? Not very, according to a new report which found the MSIS failed to capture data elements that can assist in fraud, waste, and abuse detection.
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After last year's round of budget cuts, Washington Medicaid seemingly exhausted all opportunities to achieve savings through purchasing initiatives.
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On the one hand, expenditures for Medicaid Buy-In participants, who pay monthly premiums, more than doubled from $887 million to $1.9 billion between 2002 and 2005, as did program enrollment. On the other hand, this group was found to be less expensive than other adult disabled Medicaid enrollees, with lower average Medicaid expenditures.
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In fiscal year 2008, Alabama's Program Integrity Division's Pharmacy Audit unit reviewed 143 medical providers and 629 pharmacies to assure proper claim payment and recovery of identified overpayments.
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Medicaid programs may never have had as much reason to redouble their utilization review efforts, in order to be sure funds are not being spent inappropriately, as they do right now.
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There is no question that decreasing inappropriate use of the emergency department for Medicaid patients can save significant costs, but getting results is a daunting challenge.
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Washington's Chronic Care Management Project targets the most medically expensive, high-risk Medicaid clients in its long-term care system. It has lowered mortality and improved the health of clients with chronic conditions such as diabetes, heart disease, and musculoskeletal diseases.