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The SILO ~ Senior Insurance Letter of Ohio
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Medicaid contracts to reward wellness
~#Ohio incentives aimed at improved health, lower costs~


The state’s #Medicaid_Ohio program will no longer pay #managed_care companies only for the care they provide to poor and disabled Ohioans in the tax-funded #health_insurance program.
Instead, the state wants the companies to better coordinate care for those who are sick and do more to keep others well.
Gov. John Kasich’s administration announced yesterday that it was rebidding the state’s Medicaid managed-care contracts that serve about three-fourths of the nearly 2.2 million people in the program.
The new Medicaid contracts will withhold a portion of each payment to a managed-care company until its plan meets performance standards aimed at improving patients’ health.
State officials say they hope the financial incentives will enhance the plans’ performance, which in addition to improving care should lower costs for taxpayers.

Last year, Ohio spent $14 billion on its Medicaid program.

“The purpose of managed care is to improve health outcomes for individuals enrolled in the Medicaid program,” said Ohio Medicaid Director John McCarthy.
“As our partners, managed-care organizations are expected to improve health outcomes by ensuring access to care and providing intensive case-management services to those individuals who have the highest need and often the most complex medical and social conditions.”
State officials say patients should see more-comprehensive benefits and an expanded choice of plans. For example, case managers can continue to contact patients by phone, but they also must have periodic face-to-face meetings.
Under the new contracts, Medicaid recipients will have a choice of four plans. Recipients now have two or three, depending on where they live.
To increase competition and lower administrative costs, the state will reduce the number of regions that managed-care companies serve from eight to three.
Contracts also will require managed-care companies to house their call centers in Ohio, a move that will retain and bring about 1,000 jobs into the state.
The announcement came just days after the administration said Ohio would be the first state Medicaid program to join Catalyst for Payment Reform, a nonprofit organization started in 2010 by several large employers joining together to curb rising health-care costs. Members include General Electric Co., Xerox Corp. and Wal-Mart.
Ohio will use model contract language developed by the nonprofit organization in its contracts with Medicaid managed-care companies.
Consumer advocates say they are encouraged by the state’s plan but are eager to see what incentives are included in the contracts.
“I want to see higher rates of participation of consumers in preventative care, better outcomes for patients with chronic conditions and reduced inappropriate use of emergency rooms,” said Cathy Levine, of Universal Health Care Action Network of Ohio. “To do that, patients must have a relationship with a primary doctor who is available to them.
“This is a diverse population and includes people who need assistance in understanding why it’s important to get preventative health care and who need help making appointments and getting transportation.”
State officials expect to announce preliminary contract awards in April and complete contracts by the end of the year.
Last year, the state linked nearly $300 million a year in Medicaid payments to nursing homes to whether they improved care for residents, with practices such as boosting the number of single-occupancy rooms and allowing at least half of their residents to decide when they get up, eat and go to bed, instead of at set times.
~ +C. Michael Croston

http://www.dispatch.com/content/stories/local/2012/01/12/medicaid-contracts-to-reward-wellness.html
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You are only as old as you feel

Old men shufflin'...
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Three Insurance salesman were sitting in a restaurant boasting about each companies service.

The first one said, "When one of our insureds died suddenly on Monday, we got the news that evening and were able to process the claim for the wife and had mailed a check on Wednesday evening.

The second one said, "When one of our insured died without warning on Monday, we learned of it in 2 hours and were able to hand-deliver a check the same evening.

The last salesman said, "That's nothing. Our office is on the 20th floor of a tall building. One of our insured who was washing a window on the 85th floor, slipped and fell. We handed him his check as passed our floor.
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Breaking News originally shared:
 
76% of registered US voters say most members of Congress do not deserve re-election
Princeton, N.J., USA

Fri Dec 9: About three-quarters of registered voters say most members of Congress do not deserve re-election, the highest such percentage Gallup has measured in its 19-year history of asking this question.

As has historically been the case, voters are much more positive about the U.S. representative from their own congressional district than they are about "most members of Congress," with 53% saying their representative deserves to be re-elected.

Read more:

- Gallup - http://www.gallup.com/poll/151433/Record-High-Anti-Incumbent-Sentiment-Toward-Congress.aspx
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Ohio will play a huge role in the 2012 elections...
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Obama Administration Proposes Wage Protection For Home Care Workers
via: Steve Greenhouse - NY Times

The Obama administration proposed regulations on Thursday to give the nation’s nearly two million home care workers minimum wage and overtime protections. Those workers have long been exempted from coverage. Labor unions and advocates for low-wage workers have pushed for the changes, contending that the 37-year-old exemption improperly swept these workers, who care for many elderly and disabled Americans, into the same “companion” category as baby sitters. The administration’s move calls for home care aides to be protected under the Fair Labor Standards Act, the nation’s main wage and hour law.

“They work hard and play by the rules,” President Obama said about a group of workers who often feed patients, tend wounds or help with physical therapy. “Today’s action will ensure that these men and women get paid fairly for a service that a growing number of older Americans couldn’t live without.”

These workers, according to industry figures, generally earn $8.50 to $12 an hour, compared with the federal minimum wage of $7.25 an hour. The White House said 92 percent of these workers were women, nearly 30 percent were African-American and 12 percent Hispanic. Nearly 40 percent rely on public benefits like Medicaid and food stamps. While industry experts say an overwhelming majority are paid at least the minimum wage, many do not receive a time-and-a-half premium when they work more than 40 hours a week. Twenty-two states do not include home health care workers under their wage and hour laws.

“The job they do is a real job and they deserve the same basic rights as any other workers,” said Steven Edelstein, national policy director of PHI PolicyWorks, a nonprofit group that seeks to improve conditions for home care workers. “This industry has one of the nation’s fastest-growing work forces, and the challenge is to make these better jobs if we’re trying to attract good people to come and provide the services.”

According to the federal government, six million of the 40 million Americans older than 65 now need some form of daily assistance to live outside a nursing home. That number, government officials say, is expected to double to 12 million by 2030. Republican lawmakers and business groups criticized the proposed rules, which might be modified after a 60-day public comment period. Industry officials said the proposals would push up costs and might cause home care agencies to reduce the hours of aides who work more than 40 hours a week and instead hire more aides.
“The president’s goal is commendable, but the likely result of this new rule is reduced hours for home care workers and higher costs for taxpayers,” said John Kline, a Minnesota Republican who is chairman of the House Education and the Work Force Committee, and Tim Walberg, a Minnesota Republican who heads the panel’s subcommittee on work force protections. “Moreover, our nation’s elderly may pay the greatest price in the form of more costly services and fewer opportunities to obtain the care they need in the comfort of their own homes.”

William A. Dombi, vice president for law at the National Association of Home Care and Hospice, said workers might not receive much overtime pay as a result of these changes. “These new rules might come out with everybody behind,” he said. “Workers might not get the hours they want and agencies might have higher administrative and recruiting costs.”

Labor Secretary Hilda Solis said any increased costs would be modest. She said it was hard to project exactly what employers would do, whether they would have many employees continue to work overtime or would hire additional workers to minimize overtime. She estimated that Medicare or Medicaid, which cover 75 percent of the nation’s home care costs, would pay $31.1 million to $169.5 million more each year toward home care aides, which she said would represent 0.06 percent to 0.29 percent of federal and state outlays for home care.

Secretary Solis said the proposal would ”level the playing field for staffing agencies, who will no longer be pressured to underpay their competitors on wages to gain an edge.”

Noting that nearly 90 percent of the nation’s home care aides work for agencies, Labor Department officials said such aides would receive the new wage and hour protections. The department said some companions employed by individuals for activities like helping them take walks or engage in hobbies would still be exempt from minimum wage and overtime coverage. In 1974, the Labor Department exempted “companionship” workers from coverage under the Fair Labor Standards Act, a move that focused on baby sitters at a time when the home care industry was in its infancy. In 2007, the Supreme Court issued a decision involving a New York home care aide, Evelyn Coke, who often worked 70 hours a week, ruling that she was not entitled to overtime pay under existing regulations. The court said it was up to Congress or the Labor Department to change the rules.
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People
In their circles
442 people
Have them in circles
360 people
Francisco Geraldo's profile photo
Story
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Honest Insurance and Retirement Information for the 50 and Older Group
Introduction
Helping folks understand this insurance deal. Too much cock-eyed chatter about it.