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Talent. Health. Retirement. Investments

In the Spotlight

An Interview with Michael R. Smith

a Principal in Mercer’s government sector . . .

Mike, you recently joined Mercer from CMS. What was your role and major focus of your position? 

As the former Director of the Division of Community Systems Transformation in the Disabled and Elderly Health Programs Group, a group within the Center for Medicaid and CHIP services, I was responsible for directing the division's grant programs as well as the the efforts to diffuse learning from demonstrations into Medicaid long term services and supports (LTSS) programs. Prior to employment with CMS, I served in leadership capacities within county, state, and non-profit organizations as a deputy administrator, chief of staff, and executive director, respectively. Integrating Medicaid-funded home and community-based services (HCBS) into the fabric of everyday life for people with physical, intellectual and age related disabilities has been the of my career.

How has the ACA Repeal/Replace affected your focus at Mercer?

What do you see are the challenges states are facing at this time regarding this topic?

Under the ACA, states have expanded their efforts toward greater utilization of HCBS for individuals needing long term services and supports. As of 2015, expenditures for . . .

An Interview with Dr. Laura K. Nelson, MD 

a Principal in Mercer’s government sector and a board-certified psychiatrist . . .

Laura brings extensive Medicaid managed care clinical and administrative expertise to the Mercer team in the areas of mental health, substance use disorders, and intellectual/developmental disabilities. Her experience ranges from direct care within inpatient and outpatient settings to state-level executive leadership positions in public health, behavioral health, and intellectual/developmental disabilities.

Prior to Mercer, she served as Arizona’s state behavioral health director.

Dr. Nelson, what do you see as major, current challenges related to behavioral health for states?

AHCA/ACA. One significant, and perhaps the most obvious, challenge is preparing for whatever happens related to the repeal and replacement of the Affordable Healthcare Act.  All states are waiting to respond to what could be some . . .

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Recent Mercer Communications

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MERCER GOVERNMENT NEWSLETTER - JULY 2017


HELPING SUPPORT HEALTHCARE'S FOUNDATION DURING THIS TIME OF CHANGE

Mercer has been partnering with states and other stakeholder organizations for over 30 years to support health care programs for the low-income and most vulnerable populations in this country. We face an unprecedented environment of uncertainty and change in the Medicaid and CHIP programs, and yet, there is a need to keep moving forward. This newsletter shares information you need to move your health programs forward.

AFFORDABLE CARE ACT REPEAL AND REPLACE EFFORTS:  UNCERTAIN TIMES

After a dramatic journey through the House and the Senate, Congressional efforts to repeal and replace the Affordable Care Act (ACA) are now stalled, with Medicaid a key focus of the Senate deliberations. At the time of the drafting of this article, Senate GOP leadership has announced plans to introduce a repeal and delay bill to repeal ACA but provide Congress...
 
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 Overcoming the VBP Challenge

https://info.mercer.com/rs/521-DEV-513/images/107670154_200x260.jpgHow will you maximize your Medicaid dollar while increasing access and quality in an uncertain healthcare environment?

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Medicaid/CHIP Parity Compliance

https://info.mercer.com/rs/521-DEV-513/images/135538194_200x260.jpgStates with Medicaid managed care organizations, alternative benefit plans, and separate CHIP programs are...

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Quality Encounter Data

https://info.mercer.com/rs/521-DEV-513/images/163392141_200x260.jpgQuality encounter data can seem like an elusive unicorn in the health care world. However, having complete, accurate...

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Medical Loss Ratio: Not as Bad as it Seems

https://info.mercer.com/rs/521-DEV-513/images/482912363_200x260.jpgNew medical loss ratio requirements play a prominent role in the Centers for Medicare and Medicaid Services...

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Management of Specialty Drug Trend

https://info.mercer.com/rs/521-DEV-513/images/162501764_200x260.jpgSpecialty drugs are generally considered to be high cost drugs that are used to treat complex, chronic, or rare medical...

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MERCER GOVERNMENT FLASH NEWS - FDA APPROVES MAVYRET


On August 3rd, the Food and Drug Administration (FDA) approved Mavyret™ (mav-EH'-rit), a new product manufactured by Abbvie for the treatment of hepatitis C virus (HCV).  Mavyret™ is approved for the treatment of all six major HCV genotypes for both treatment naïve and treatment experienced patients. Mavyret™ is a combination of two new HCV antivirals, glecaprevir and pibrentasvir. An estimated 95% of patients with chronic hepatitis C in the U.S. could be candidates for treatment with Mavyret™. The list price of Mavyret™ is significantly lower than the list price for other HCV antiviral regimens.  

Mavyret™ is a game changer in the Hepatitis C market. Its approval for a short 8-week regimen for treatment naïve patients across all genotypes coupled with a list price that is less than half of the competition will position it well for preferred placement on Medicaid fee-for-service (FFS) and managed care formularies.  Abbvie representatives have stated publicly that they are focusing on getting coverage approved through the Medicaid, Medicare, and Veterans Administration markets. 

Read more about Indication and Use, Place in Therapy, and Cost

We are on the Road Again!

Mercer participates in and sponsors a number of health care conferences each year. Members of our leadership team will be at the following events and hope to see many of our country's top state officials. If you are interested in meeting with us during these events, feel free to contact us.
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NASUAD HCBS CONFERENCE

Mercer will be leading two workshops: Realizing the Value of VBP and another on MLTSS Program Design and Implementation.

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HSFO Annual Conference

70th Annual National Association of State Human Services Finance Officers will be held in New Orleans this year. Mercer will be presenting.

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NASHP Annual Conference

Mercer will facilitate a roundtable at the National Academy for State Health Policy conference on Medicaid and SUD.

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The AAA Health Practice Council Weighs in on the AHCA

Mercer contributes to the American Academy of Actuaries' letter on AHCA to House Speaker Ryan and House Democratic Leader Pelosi

 

A collaborative effort by individuals on the AAA Individual and Small Group Markets Committee, the Medicaid Subcommittee, along with Mercer staff.  View the letter here

Services

Overview

Mercer Government Human Services Consulting provides a full range of consulting services.

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Strategy

Policy and Operations

Rich in experience with strategic planning, interpretation and application of regulations and policy, managed care procurement, operations, waivers, financing, and rate setting.

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Financial

Actuarial and Financial

Mercer is well positioned to assist clients on a variety of topics ranging from traditional capitated rate setting to program development and compliance with these new health care delivery models.

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Impact of the New Administration on Medicaid

Mercer's Dedication to Keeping our Clients Informed
 

The outcomes of last month’s elections will certainly result in changes to the rules that govern/impact the health care system as a whole, including the Medicaid program. Although the details of those changes remain uncertain today, we want to assure our clients that we are actively exploring the possible changes that lie ahead and building the tools and resources our clients will need to assess these new policy directions. In the next few weeks and throughout the transition period post-inaguration, we will provide informational resources and updates. In the meantime, please contact us with your questions and concerns via email.

Mercer Contributes to NGA's Medicaid Compendium

Released in 2016, NGA's Medicaid Health Care Purchasing Compendium is "intended to serve as a reference guide for states when purchasing health care services for their Medicaid program..."
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The NGA Compendium

"States face the ongoing challenge of managing the costs of their Medicaid programs while ensuring beneficiaries have access to quality health care."

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Section II - Federal Authorities and Compliance

Employees contributing to Compendium Section II include Leena Hiilivirta, Bill Lasowski and Stephanie Kurlanzik

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Section V - Financial Models

Including rate setting, risk adjustment, performance indicators. Contributors were Fred Gibison, Kevin Lurito, Gabe Smith, Doug Shannon, Amanda Rhodes

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An overview of our experience assisting government with their Medicaid and Medicare programs.

Our passion is to work as a team with our clients to help those in need throughout the country.

DID YOU KNOW?
Mercer Government includes more than 15 former state and federal health care leaders and:
290+ Staff - 27 ASAs - 20 FSAs - 5 CPAs - 9 Clinicians - 6 Pharmacists

  Download overview