Perverse Financial Incentives Driving Atypical Use and Medicaid Costs Ed Knight, PhD, CPRP Co-Investigator UCLA Health Sciences Service Research Center.

Slides:



Advertisements
Similar presentations
More Security and Stability If You Have Health Insurance, the Obama Plan: Ends discrimination against people with pre-existing conditions. Limits premium.
Advertisements

Getting It Right for Young People in Health 17 May 2012 | Birmingham ‘What Matters? Health Matters!
Connecting Muslims to Coverage AMHP Where Faith and Healthy Communities Come Together.
Tad P. Fisher Executive Vice President Florida Academy of Family Physicians Patient Centered Medical Home A Medicaid Managed Care Alternative.
1 Managing Medication Costs: Discount Cards. 2 Software Screen.
PBHCI Project Sustainability Analyzing Clinical Workflows to Support Integrated Care and Seamlessly Maximize Revenue 1:00 – 2:00 PM ET 3/15/2012.
HIV Clinical Trials Janice Price, M.Ed, RN HIV Clinical Research Program Coordinator Swedish Medical Center Seattle, WA USA.
Saeed A. Khan MD, MBA, FACP © CureMD Healthcare ACOs and Requirements for Reporting Quality Measures © CureMD Healthcare Saeed A. Khan MD, MBA, FACP.
Health Care Facilities. Hospitals Provide Diagnosis, Treatment, Education, Research, Cure.
Employees’ Interest in Health Plan Consumer Support Services February 2008 Ted von Glahn Director of Performance Information and Consumer Engagement Pacific.
Chapter 2 Health Care Systems.
Communities of Care NASCSP Conference Marisue Garganta Director, Community Health Integration Dignity Health, St. Joseph’s Hospital and Medical Center.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chapter 8 The Personal Health Record.
How Available is Healthcare Principles of Health Science.
FTS Health & Wellness “We Change Lives”. Take Control of Your Health As our health care system evolves, many questions remain. What are the impacts of.
Testing People Scientifically.  Clinical trials are research studies in which people help doctors and researchers find ways to improve health care. Each.
PROPRIETARY AND CONFIDENTIAL Internal Strategic Pharmacy Programs Placemat Background 1  Prescriptions are the most frequently used health care benefit,
Getting Better Value in Health Care Public Employers Health Purchasing Committee 5-23 DRAFT.
MEDICATION THERAPY MANAGEMENT SERVICES Getting the most from your medicine.
The Impact of Patient Opinion in an Acute Trust Dr Ben Mearns Clinical Lead for Acute & Elderly Medicine Surrey & Sussex Healthcare NHS Trust 5 th November.
HEALTH CARE SYSTEMS. Health care systems include many agencies, facilities, and people involved in the delivery of health care. Private facilities: Require.
Medicare Unit 7. Medicare Part A Payment Plan Beneficiary Pays (2009) Hospital Stays 1-60 days $ days $267/day days $534/day 151+ days.
Pay for Performance
State of New Hampshire Pharmacy Benefit Changes Effective November 1, 2011 Presented By: Melisa Briggs.
Waiting for Medicare: Disparities in Health Care Experiences of Adults Age Compared to Adults 65 and Older Cathy Schoen Vice President, The Commonwealth.
Healthcare rationing is used by health insurers, the government and individuals to save money. Most of us believe that if there is a treatment available,
Presented by Vachette Pathology Mick Raich, President.
The Great Healthcare Debate Presentation made by: Alex Garcia, Carlo Torres, Edgar Castillo, Gricelda Vera, Lorena Arroyo, and Margarito Rofledo.
Self-funded Health Plans Pay Too Much!!! Don’t let your plan trap you in financial quicksand. Learn How to save 10%, 15%, maybe more, Please read on.
MO 270 SEMINAR 8 HEALTHCARE FACILITIES. HOSPITALS GENERAL HOSPITALS: treat everyone, those without insurance, costs go to those who have insurance. Scholarships/grants/donors.
Over the Counter & Rx Drugs
Medicare Part A Payment Plan Beneficiary Pays (2004) Hospital Stays 1-60 days$ days$210/day days$420/day 151+ daysall costs SNF 1-20 daysnothing.
Health Reform: Local Safety Net Implications Karen J. Minyard, Ph.D., Executive Director, Georgia Health Policy Center, Georgia State University.
Government, Non- profit agencies, & Insurance Plans.
1.03 Healthcare Finances. Health Insurance Plans Premium-The periodic amount paid to an insurance company for healthcare or prescription drugs Deductible-Amount.
Introduction.
Quality Healthcare Includes You! Volunteer Opportunities at University Medical Center.
Your Local State Health Insurance Assistance Program (SHIP) office: Tom Everett ex. 104 This presentation may.
Alyssa R. Vangeli Families USA Health Action Conference February 5, 2016 Using Medical Evidence to Design Health Insurance Benefits: Massachusetts No Copay.
Health Care Reform (Medicare and Medicaid) Emily Ray Period 7.
More Security and Stability If You Have Health Insurance, the Obama Plan: Ends discrimination against people with pre-existing conditions. Limits premium.
Beth Witten, MSW, ACSW, LSCSW Witten and Associates, LLC 1.
COMMUNITY HEALTH ASSOCIATES OF SPOKANE LOCATED IN SPOKANE WASHINGTON.
NAMI Smarts for Advocacy Medication: Protecting Choice
USING MEDICINES SAFELY how carers can help
Introduction What is the purpose of this treatment?
Drug Management Updates
Government, Non-profit agencies, & Insurance Plans
Enormous Expenditures
Medicare Part D Program and Outreach Clinics-2017 University of the Pacific Thomas J. Long School of Pharmacy and Health Sciences.
Finding a doctor What kind of doctor do you need for your situation.
Medicare Part D Program and Outreach Clinics-2017 University of the Pacific Thomas J. Long School of Pharmacy and Health Sciences.
MEDICATION THERAPY MANAGEMENT SERVICES
What Are the Differences? (Part 1)
Donald W. Kemper, MPH Session :15 AM Friday, February 27, 2004
Government, Non-profit agencies, & Insurance Plans
Pharmacy practice experience I
MAA 102_Intro. Billing & Coding
Medicaid Matters: Depression and other Psychiatric Illnesses
MAA 102_Intro. Billing & Coding
West Virginia Bureau for Medical Services (BMS)
What healthcare services are covered by insurance?
SAMPLE ONLY Dominion Health Center: Excellence in Medicaid Managed Care (or another defining message) Dominion Health Center is a community health center.
SAMPLE ONLY Dominion Health Center: Your Community Partner for Excellent Care (or another defining message) Dominion Health Center is a community health.
SAMPLE ONLY Dominion Health Center: Your Community Healthcare Home (or another defining message) Dominion Health Center is a community health center.
SAMPLE ONLY Dominion Health Center: Your Community Partner for Excellent Care (or another defining message) Dominion Health Center is a community health.
Rona Schechter MPH, RD, CDE
Dr Philip Koopowitz Ms Jacinta Edgar Mr Mark Stone
Presentation transcript:

Perverse Financial Incentives Driving Atypical Use and Medicaid Costs Ed Knight, PhD, CPRP Co-Investigator UCLA Health Sciences Service Research Center

Atypical Side Effects are the Highest Medicaid Cost 1) Medicaid and medicare costs are out of control. 2) The largest costs are safely preventable and will save lives. 3) The largest and fastest growing costs are the co-occurring medical costs connected to mental health services. Much from off label use which the FDA does NOT approve. Dr Sederer has done an excellent job of documenting this. 4) Off label use of anti psychotic medications for things like sleep and anxiety causes diabetes, obesity, high blood pressure and high cholesterol. This is wide spread.

Less Toxic or Non Toxic Products Not Eliminated 5) Most often clinically tested non-toxic alternatives are not used or even mentioned. Things like CBT for anxiety, behavior interventions for anxiety. Acceptance and Commitment Therapy for anxiety. Nor are less toxic medications often offered. NOR ARE PATIENTS TOLD OF THE LIFE THREATENING SIDE EFFECTS of atypical or other antipsychotics.

Charge to prescribe Charge to Manage Disease caused 6) Many providers, hospitals, managed care companies then charge disease management costs in addition to the prescribing. In other words what diseases they caused by these off label prescriptions are being billed for and profits made.

Perverse Financial Incentive 7) This payment for managing disease on top of off label use is a perverse financial incentive to cause disease to make money managing it.

Multiple anti psychotics. 8) Many people are on multiple antipsychotics. Each additional one added does not increase any beneficial effects but does increase obesity, diabetes, high cholesterol. This also results in billing and profits to manage the diseases caused this way. This is a perverse financial incentive to cause disease also. There is no profit in taking people off one drug before putting on another. As a matter of fact good care costs money. What are we paying for? Not who is profiting!!! What are likely savings. VA high ranking Doctors tell me they save 30% per patient by controlling atypical uses.

Stop companies from making money by causing disease 9) STOP THIS NOW!!! Make any medical business responsible for the costs of disease management for the diseases they cause. STOP THE MEDICAID RIP OFF OF DOUBLE COLLECTING FOR DISEASES THEY CAUSE. Make Sure these incentives are NOT in your rfp. All companies or their partners make money this way. I WILL CONSULT ON THESE ISSUES IF YOU LIKE

What to do Ethical Medicaid Medicare Cost Savings will Save Lives TOO. Please call your Senator or Representative Capitol Switchboard Ask for your Senator or Representative by name Find their s at enter your zip code

Web Stuff See blogs Perverse Financial Incentives Driving Medicaid Costs and DiseasePerverse Financial Incentives Driving Medicaid Costs and Disease lets-fix-perverse-financial-incentives.html Contact Ed Knight for further information