North Carolina released a much-anticipated...

...Request for Proposals (RFP) for its revamped Medicaid managed care program. The state expects to move about 70% of its 2,164,945 Medicaid and CHIP eligibles into managed care plans in late 2019. Aetna Inc., Anthem, Inc. and Centene Corp. are already said to be interested, according to a report in AIS's Radar on Medicare Advantage. Contract awards are set to be announced in February 2019.

Anthem, Walmart Announced MA Partnership

From Health Plan Weekly

On Aug. 20, Anthem, Inc. announced an arrangement with Walmart Inc. to increase Medicare Advantage (MA) members' access to over-the-counter (OTC) medicines and health services and products. It’s a move an expert at KPMG describes as "a natural" fit that may signal a return to using partnerships to introduce new products, rather than full-fledged M&A.

Under the Anthem/Walmart program, starting in January 2019, Anthem's MA enrollees will be able to use "OTC plan allowances" to buy OTC medications and health-related items such as pain relievers and first aid supplies at one of Walmart’s 4,700 stores or through its website.

This latest collaboration further emphasizes Anthem's commitment to MA, a program in which the insurer has more than 1 million members, Leerink analyst Ana Gupte, Ph.D., said in an Aug. 20 note. She notes that Anthem's Walmart partnership "stopped short of retail clinics and is also complementary to Anthem’s retail platform, CareMore for Seniors, and complex populations and strengthens Anthem's retail branding, clinical care delivery and distribution in MA."

For major retailers with very large geographic footprints, "there's always been a natural collaboration with the Blues," says Ashraf Shehata, a principal in KPMG's health care life sciences advisory practice.

According to Shehata, the bottom-line question is how to take a long-standing relationship to create new market opportunities. "We've become accustomed to large mergers with large organizations in health care," he says. "This kind of announcement is more along the lines of how health care traditionally was done — through partnerships."

Pharma enters into the equation, too. "The other thing I like about the news is many organizations on the retail side are building generic preferred formularies," Shehata says. "But retailers need to go beyond that with specialty pharmacy [and] be able to leverage retail and health insurance footprints, [which] is happening in these MA partnerships."

Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.

Resolving Family Conflicts

Dealing with Alzheimer's can bring out many strong emotions. As the disease progresses, caregiving issues can often ignite or magnify family conflicts. The tips below can help families cope with the situation together.

Tips for families

• Listen to each family member with respect. Coping with a progressive illness, such as Alzheimer's, can be stressful — and not everyone reacts in the same way. Family members may have different opinions. Some relatives may deny what is happening; a long-distance relative may be resented for living far away; or there may be disagreement about financial and care decisions, especially at the end-of-life. These issues are complex and require ongoing discussions. Give everyone an opportunity to share their opinion and avoid blaming or attacking each other, as this will only cause more hurt.
• Discuss caregiving responsibilities. Talk through caregiving roles and responsibilities. Make a list of tasks and include how much time, money and effort may be involved to complete them. Divide tasks according to the family member’s preferences and abilities. Some family members may be hands-on caregivers, responding immediately to issues and organizing resources. Others may be more comfortable with being told to complete specific tasks. Consider setting up an online care calendar to coordinate helpers. 
• Continue to talk. Keep the lines of communication open. Schedule regular meetings or conference calls to keep everyone involved up-to-date. Discuss how things are working, reassess the needs of the person with Alzheimer’s, and decide if any changes in responsibilities are needed. Plan for anticipated changes as the disease progresses.
• Cope with changes and loss together. As Alzheimer's progresses and cognitive abilities change, it is normal to experience feelings of loss. Caregivers and family members may want to seek support from others who are dealing with similar situations. Attend a support group in your area or join our ALZConnected online community.
• Seek outside help. If tensions and disagreements are ongoing, you may want to seek help from a trusted third party, such as a spiritual leader, mediator or counselor. Sometimes, an outside perspective can help everyone take a step back and work through the difficult issues. The Alzheimer's Association Helpline (800.272.3900) is staffed with care consultants who can help any time — day or night.

https://alz.org/help-support/resources/resolving-family-conflicts?WT.mc_id=enews2018_08_31&utm_source=enews-aff-172&utm_medium=email&utm_campaign=enews-2018-08-31

CMS provides new flexibility to increase prescription drug choices and strengthen negotiation for Medicare enrollees

CMS NEWS FOR IMMEDIATE RELEASE August 29, 2018 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries CMS provides new flexibility to increase prescription drug choices and strengthen negotiation for Medicare enrollees The Centers for Medicare & Medicaid Services (CMS) issued a memo today to Medicare Part D plans, which cover prescription drugs that beneficiaries pick up at a pharmacy, offering plans new tools and flexibility to expand choices and lower drug prices for patients.  Currently, if a Part D plan includes a particular drug on its formulary, the plan must cover that drug for every FDA-approved indication, or patient condition, even if the plan would otherwise instead cover a different drug for a particular indication. The requirement to cover drugs in this manner can discourage Part D plans from including more drugs on their formularies and limit their power to negotiate discounts. Today’s memo explains that starting in 2020, plans will have new flexibility to tailor their formularies so that different drugs can be included for different indications.  This policy, known as “indication-based formulary design,” is used in the private sector and will enable Part D plans to negotiate lower prices for patients.  Targeted formulary coverage based on indication will also provide Part D beneficiaries with more drug choices and will empower beneficiaries to select a plan that is designed to meet their unique health needs. “This action delivers on President Trump’s drug pricing blueprint by offering Medicare plans new tools to negotiate lower drug prices and offer patients better choices,” said HHS Secretary Alex Azar. “This is a significant step in modernizing the successful Medicare Part D program by giving plans the tools that serve patients well in the private sector.” “President Trump and Secretary Azar are working to get the best deal for American patients,” said CMS Administrator Seema Verma. “By allowing Medicare’s prescription drug plans to cover the best drug for each patient condition, plans will have more negotiating power with drug companies, which will result in lower prices for Medicare beneficiaries.” Today’s policy is expected to increase both the number of drugs available on a given plan’s formulary and the diversity of plan formularies available.  Part D plan sponsors and prescription drug manufacturers begin negotiations in the fall of 2018 for formulary placement in Contract Year 2020, so CMS is making this announcement today to ensure that beneficiaries will see the benefits of this policy in 2020. The memo emphasizes that if a Part D plan limits formulary coverage of a drug to certain indications, the plan must ensure that there are other therapeutically similar drugs on formulary for the drug’s non-covered indications.  To help ensure that Medicare enrollees understand their coverage, the agency will update the online tools that beneficiaries use when selecting a Part D plan, so that beneficiaries will see that a plan’s coverage for a drug varies by indication before they make a choice in 2019 for their 2020 plan. CMS will also require plans that implement this tool to explain what it will mean for beneficiaries in the plan’s Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents.  In addition, the agency will update the 2020 Medicare & You handbook to include information on this new flexibility.  CMS looks forward to working with patients and other stakeholders to ensure the successful implementation of this policy. To view a fact sheet on today’s announcement, please visit: https://www.cms.gov/newsroom/fact-sheets/indication-based-formulary-design-beginning-contract-year-cy-2020 To view a copy of the memo that was sent to Medicare Part D plan sponsors, please visit: hhttps://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/HPMS/Downloads/HPMS-Memos/Weekly/SysHPMS-Memo-2018-Aug-29th.pdf ### Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

Why CBO won't estimate cost of Bernie Sanders's 'Medicare for all' bill

BY PETER SULLIVAN - 08/29/18 

 A recent study concluding that Sen. Bernie Sanders's (I-Vt.) “Medicare for all” bill would cost $32 trillion has set off a furious debate over the cost of the plan.

But there's one estimate that would make an even bigger splash: the score from the nonpartisan Congressional Budget Office (CBO).

However, it does not appear that CBO is working on a spending estimate, despite a request from Sen. John Barrasso (R-Wyo.), who asked for a cost analysis in September in order to highlight the steep costs for Medicare for all, also known as single-payer.

Barrasso told The Hill last week that he doesn’t recall receiving a response from the CBO, suggesting that his request was not accepted.

The CBO declined to comment, but former directors said the fact that passing single-payer legislation is not a priority for the Republican-controlled Congress means the CBO is unlikely to devote time to scoring the bill.

Doug Elmendorf, a former CBO director, said the budget scorekeeper is required to provide estimates only for bills that have made it out of committee and that other measures it scores are usually the priority of a chairman or ranking member.

Elmendorf, who was CBO director from 2009 to 2015, noted that “it would take months” for the CBO to score a bill as complex as single-payer.

“You have to ask yourself, ‘Is there likely to be serious legislative action on it?’ And clearly the answer to that is no,” said Robert Reischauer, who was CBO director in the 1990s before becoming head of the Urban Institute.

CBO staff are busy working on more pressing legislation, Reischauer said. “The cost estimating units are usually operating at full or over capacity,” he said. “It isn’t like they can accept all requests.”

The release of the crucial spending analysis is therefore likely to wait until sometime when the measure is moving through Congress and appears to have a chance of passage.

Republicans have been pointing to Democratic calls for single-payer as a key rebuttal in this year’s midterm campaign, part of an effort to push back against Democratic attacks on GOP bills to repeal ObamaCare. A CBO score before the Nov. 6 elections would give Republicans a key analysis to point to on the campaign trail.

The releases of CBO estimates were defining moments in last year’s debate over Republican efforts to repeal ObamaCare, with the analyses showing that millions of people would lose coverage under the GOP-backed legislation.

A CBO score would likely prove pivotal again with Sanders’s single-payer plan, as opponents have criticized the trillions of dollars in new government spending that would be required.

Reischauer said that in this case, “opponents or people who want to embarrass advocates of the plan want it and nobody else does.”

The release of an outside study from the right-leaning Mercatus Center at George Mason University in late July gave a taste of the frenzy that would occur over the release of a CBO score of single-payer legislation.

Republicans seized on the Mercatus study’s finding that a single-payer, government-run health insurance system for all U.S. residents would cost the government an additional $32 trillion over 10 years.

Speaker Paul Ryan (R-Wis.) called the cost “absurd.” The Republican National Committee cited the study to say that Sanders’s plan would “bankrupt taxpayers.”

Barrasso pointed to the Mercatus study as fodder for the GOP in the absence of a CBO analysis.

“There have been a number of different reports out there, $32 trillion,” Barrasso said. “It looks like we have some pretty solid numbers on how expensive it is.”

But Sanders also touted the report, just a different aspect of it. He pointed to the finding that total U.S. spending on health care, as opposed to just the government’s share, would decrease by $2 trillion over 10 years under his legislation.

Elmendorf, highlighting the consequential decisions that go into any CBO score, said that the agency might not estimate the bill’s effects on total U.S. health-care spending, since its core mission is to examine spending by the government. Leaving that part of the analysis out would deprive Sanders of a key argument for his bill.

“I think they would do it if they had enough time,” Elmendorf said.

http://thehill.com/policy/healthcare/404004-why-cbo-wont-estimate-cost-of-bernie-sanderss-medicare-for-all-bill

KFF/Economist Survey: One in Five Americans Report Always or Often Feeling Lonely or Socially Isolated, Frequently With Physical, Mental, and Financial Consequences

KFF/Economist Survey: One in Five Americans Report Always or Often Feeling Lonely or Socially Isolated, Frequently With Physical, Mental, and Financial Consequences One in five Americans (22%) say they always or often feel lonely or socially isolated, frequently with serious consequences, finds a new Kaiser Family Foundation/Economist three-country survey examining loneliness and social isolation. Americans who feel lonely or socially isolated often report negative impacts on their mental (58%) and physical (55%) health, their personal relationships (49%) and ability to do their job (33%). Some also say it has led them to think about harming themselves (31%) or committing a violent act (15%). The survey also finds that while most Americans (58%) view the increased use of technology as a major reason why people feel lonely and socially isolated, those who report feeling lonely or socially isolated are divided on the impact of social media in particular. About as many say using social media such as Facebook, Snapchat and Twitter has made their feelings of loneliness better (31%) and worse (27%). The survey takes a comprehensive look at the prevalence, causes and consequences of loneliness and social isolation in the United States, the United Kingdom and Japan at a time when aging societies and increasing use of technology is generating concerns about the effects of loneliness on health. Findings appear in The Economist’s Sept. 1 issue and in a separate KFF report that looks at people’s views and experiences with loneliness across the three countries. Reports of always or often feeling lonely or socially isolated are similar in the U.S. (22%) and U.K. (23%), compared to 9 percent in Japan. Other findings include: Loneliness appears to be closely tied to real life problems and circumstances, with at least six in 10 of those experiencing it across the three countries citing a specific cause, most often the death of a loved one. Those who feel lonely are much more likely to report a negative change in financial status, a change in living situation, a serious injury or illness personally, or loss of a job in the past two years than those who don’t report feeling lonely across the three countries. In the United States, those most likely to experience loneliness include people who report having a mental health condition (47% report loneliness) or a debilitating health condition (45%). That’s roughly three times the rates for those who don’t have such conditions. Similarly, Americans who are single, divorced, widowed or separated are more than twice as likely to report feeling lonely or socially isolated than those who are married or living with a partner (33% compared to 13%). The pattern is similar in the U.K. and Japan. Half of Americans (51%) say they’ve heard “a lot” or “some” about the problems of loneliness and social isolation – fewer than say the same in the United Kingdom (67%), where a minister for loneliness was appointed earlier this year. Across countries, large majorities of people say individuals and families should play a major role in helping to reduce loneliness and social isolation in society today. However, just about a quarter of Americans (27%) say the government should play a major role, less than half the shares who say the same in the U.K. and Japan. Most Americans (61%) also see a major role for churches and other religious institutions. The three-country survey is part of a polling partnership between KFF and The Economist. The poll was designed and analyzed by survey researchers at KFF in collaboration with The Economist. Each organization is solely responsible for the content it publishes based on the survey. The poll was conducted by telephone from April through June 2018 among random digit dial telephone (landline and cell phone) samples of adults in the U.S. (1,003), the U.K. (1,002) and Japan (1,000), including at least 200 adults in each country who report always or often feeling lonely or socially isolated. The margin of sampling error is plus or minus 3 percentage points for the U.S. results and plus or minus 4 percentage points for results for the U.K. and Japan. For results based on subgroups, the margin of sampling error may be higher. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.

Contacts: Craig Palosky | (202) 347-5270 | cpalosky@kff.org

kff.org | kaiserhealthnews.org Connect with us:

June 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

View in browser | Distributed by Center for Medicaid and CHIP Services (CMCS) Today the Centers for Medicare & Medicaid Services (CMS) released the June 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data. The full report is available on Medicaid.gov at https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html

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Stay connected with Medicaid.gov and CMS:

Outreach Strategies to Help Your Organization Reach Uninsured Families Living in Rural Communities

Outreach Strategies to Help Your Organization Reach  Uninsured Families Living in Rural Communities Children in rural communities are disproportionately uninsured compared to their counterparts in urban and suburban locations across the country, and for those who have coverage in rural communities, they are more likely to rely on Medicaid and the Children’s Health Insurance Program (CHIP). With nearly 60 million individuals currently living in rural areas, it’s more important than ever to engage with these communities. By working closely with local organizations, small businesses, and health providers, your organization can help eligible families gain access to coverage. The Connecting Kids to Coverage National Campaign’s recent webinar explored ways organizations can reach eligible families where they work, play, and pray and enroll children in Medicaid and CHIP. We also shared best practices and proven tips to make rural health outreach and enrollment efforts a success. Campaign in Action The CMS Office of Minority Health (OMH) works with local and federal partners to eliminate health disparities while improving the health of all minority populations through its health equity initiatives. Studies show that minority populations in rural areas tend to be younger and are less likely to report being in good health than their non-Hispanic white counterparts. Together with OMH, the Consortium for Medicaid & Children’s Health Operations launched a rural health strategy to improve access and quality of care specifically for rural Americans. By leveraging local and community partnerships, the Consortium empowers patients in rural communities to make independent decisions about their healthcare. The U.S. Department of Health & Human Services’ Office of the Assistant Secretary for Health (OASH) is focused on increasing the nation’s investment in health and science to advance health equity and improve the health of all people. OASH has 10 regional health offices across the nation that are managed by 10 different regional administrators. OASH’s experience working within Region X, a large territory that covers Idaho, Oregon, Washington, and Alaska, proved to be a helpful lesson in how strong community partnerships can work for any organization. With limited resources and a staff stationed in Seattle, the regional office formed partnerships with state and local health departments, various health systems, and community-based organizations to successfully connect families across all states in the region to health coverage. While partner relationships are very important, it is also essential to form meaningful relationships directly with families. The Native American Rehabilitation Association of the Northwest (NARA) has provided physical and mental health services, including dental clinics, wellness health centers, and drug and alcohol treatment programs, to American Indians and Alaska Natives (AIs/ANs) in rural communities since 1970. NARA specializes in boosting enrollment in areas that are geographically isolated and lack adequate healthcare facilities and staff. The organization works to combat the cultural factors that deter rural families from enrolling in coverage, such as feelings of distrust towards outsiders and general misconceptions about the services provided through Indian Health Service. Staying up-to-date on key rural health issues helps make outreach efforts relevant to the families and organizations you serve. Rural Health Information Hub (RHIhub) is an online guide to improving health within rural communities and provides current resources and tools that can help your organization learn more about rural health-specific needs. RHIhub features a selection of different evidence-based online toolkits, including resources specifically designed for rural community health workers, oral health and health literacy. New Rural Health Initiative Page and Campaign Materials The Connecting Kids to Coverage National Campaign: Reaching Rural Communities web page contains resources specific for conducting rural health outreach, including the “5 Ways to Conduct Outreach in Rural Communities” tip sheet. This tip sheet contains tips for identifying eligible rural families, partnering with local organizations and small businesses, and leveraging partnerships with health providers. And the “Connecting Kids to Coverage: Kentucky” outreach video demonstrates how health centers, like Mountain Comprehensive Health Corporation, are working to expand access to health care in rural communities. The Campaign’s Outreach Tool Library also features ready-to-use tools like message guides, templates, and resource links, and offers social media graphics for Facebook and Twitter We want to hear your success story! Does your organization use targeted outreach strategies to enroll rural families in Medicaid and CHIP? If so, we'd like to learn how your organization is connecting kids to coverage! Share details with the Campaign via email at ConnectingKids@cms.hhs.gov or on Twitter using the hashtags #Enroll365 and #KidsEnroll.  Stay Connected with the Campaign  Share our materials widely. We have an ever-growing Outreach Tool Library featuring resources to use in outreach and enrollment efforts, including materials in other languages. Contact us to get more involved with the Campaign at ConnectingKids@cms.hhs.gov Follow the Campaign on Twitter. Don’t forget to re-tweet or share our messages with your network or use our #Enroll365 and/or #KidsEnroll hashtags in your posts.  The Connecting Kids to Coverage National Campaign Notes eNewsletter is distributed throughout the year and provides updates on Campaign activities. If a friend or colleague forwarded this email to you, sign up to receive this eNewsletter directly to your inbox.

The Centers for Medicate & Medicaid Services (CMS) To contact CMS, please visit our contact us page.

Prevent osteoporosis

Many people don’t know they have osteoporosis until they break a bone. Did you know Medicare can help you prevent or detect osteoporosis at an early stage, when treatment works best? Talk to your doctor about getting a bone mass measurement (bone density). If you’re at risk, Medicare Part B covers this test once every 24 months (more often if medically necessary) at no cost to you, when your doctor or other qualified provider orders it. You can take steps to make your bones stronger and healthier, no matter your age.Talk to your doctor, and visit Medicare.gov to find out how Medicare can help protect your bones. Sincerely, The Medicare Team

August 23, 2018

Associated Press August 23, 2018 

WASHINGTON (AP) — A congressional watchdog said the Trump administration needs to step up its management of sign-up for former President Barack Obama's health care law after mixed results last year in the throes of a failed GOP effort to repeal it.

The report due out Thursday from the Government Accountability Office is likely to add to Democrats' election-year narrative that the administration actively undermined "Obamacare" without regard for the consequences to consumers.

The nonpartisan Government Accountability Office was more nuanced. On one hand, it found problems with consumer counseling and advertising and recommended such basic fixes as setting enrollment targets. But it also credited administration actions that did help people enroll, such as a more reliable HealthCare.gov website and reduced call center wait times.

Sign-ups for 2019 begin this November.

A copy of the report from the investigative agency for Congress was provided to The Associated Press.

It found that:

— The Health and Human Services Department under Trump broke with its own previous practice by failing to set enrollment targets for HealthCare.govlast year. The watchdog recommended that HHS resume setting goals, a standard management tool for government agencies. Without setting numeric goals, HHS won't be able to measure whether it is meeting "its current objective of improving Americans' access to health care," the report said. The administration responded that it does not believe such targets are relevant.

— HHS used "problematic" and "unreliable" data to justify a 40 percent cut in funding for enrollment counseling programs known as Navigators. HHS responded that it's making changes to how those counseling programs are evaluated. But it has cut funding again, by about 70 percent.

— When HHS slashed money for open-enrollment advertising by 90 percent overall, officials said they were doing away with wasteful spending. But an internal study by the department had actually found paid television ads were one of the most effective ways to enroll consumers. The budget for TV ads went from $26.6 million in the Obama administration's final year to zero under President Donald Trump.

"This independent and nonpartisan GAO report confirms that the Trump administration's sabotage of our health care system is driving up costs for consumers and leaving more Americans without health insurance," said a statement from a group of Democratic lawmakers led by Rep. Frank Pallone of New Jersey.

HHS said in a statement that the 2018 enrollment season was the "most cost-effective and successful experience" for consumers, citing a 90 percent customer satisfaction rate with the HealthCare.gov call center.

Republicans' drive to "repeal and replace" the health care law stalled in the Senate last year, and the Trump administration instead found itself having to run a program the president repeatedly branded a "disaster."

The watchdog found that sign-ups in the 39 states served by HHS through the federal HealthCare.gov website dipped by 5 percent last year, while states running their own enrollment effort maintained their sign-up levels. A total of 11.7 million people enrolled for 2018 coverage, with about 85 percent receiving subsidies to help pay their premiums.

The report validated a longtime Republican criticism that high premiums discourage consumers from signing up for coverage. But it also found that Trump contributed to premium increases for 2018 by canceling payments that reimburse insurers for lower deductibles and copays provided to low-income people. That forced the carriers to jack up rates.

"Substantial increases" in premiums triggered by Trump cut both ways, the watchdog found. People with modest incomes entitled to subsidies got more financial aid from the government, and their coverage became more affordable. But solid middle-class customers paying full premiums were priced out of the market.

https://insurancenewsnet.com/oarticle/report-trump-administration-needs-to-step-up-on-obamacare