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Managed care saves budgets in prison facilities
California has adopted some managed care principles, hoping to achieve accessible, cost-effective care.
NATIONAL REPORTS-Dexter Brown, 41, is not the only prison inmate who has complaints about his medical care. Charged with a 2003 robbery, the wheelchair bound inmate with kidney failure and a weak heart is housed in a single cell on the first floor of California's Vacaville prison.
"I've seen improvement since I've been here, but the biggest problem is the attitude of the medical staff and its adversarial approach," he says.
In 2001, a federal class-action lawsuit alleged that the medical care in the state's prison system was so poor that it amounted to "cruel and unusual punishment." A receivership was created in 2006 to make the structural, clinical, budgetary and organizational changes necessary to reform healthcare services. Clinical staff now report to the receivership, but once adequate quality is maintained, the state will resume management of medical services.
In 2006, one inmate died each week in the California prison system because of poor medical care-often attributed to overcrowding. The death rate has dropped by 10% to 12% since the federally appointed receiver took over. Estimates indicate that reducing inmate visits to the community for medical services could save $200 million to $400 million annually.
"A lack of access to care in general and more specifically to an appropriate provider have been responsible for many of the deaths in prison," says Joseph Bick, MD, chief medical executive of the 960,000-square foot California Medical Facility at Vacaville.
In 2008, referrals were out of control, according to Ricki Barnett, MD, deputy medical executive, utilization management for the Department of Corrections.
"We were faced by a hefty appetite for specialty care with little staff to address prison requests for outside medical care," Dr. Barnett says. "We brought many of the services inside that were once referred out."
David Calabrese of OptumRx Talks New Role, Market Insulin Prices and Other Topics 'On His Mind'
April 13th 2023In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.
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In this second part of a video series, AMCP CEO Susan Cantrell addressed the impact of high prescription drug prices on underserved communities, highlighting disparities in access caused by the pandemic's effects on minority populations. On the industry blame debate, she urged collaborative solutions, mentioning AMCP's engagement with diverse stakeholders to find comprehensive, patient-centric solutions and advocate for policy changes like the MVP Act to address rising costs and access challenges.
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Jack Linehan of Epstein Becker Green Discusses Drug Coupons, Accumulators
July 9th 2020In this week's episode of Tuning Into The C-Suite podcast, Senior Editor Peter Wehrwein has a conversation with John "Jack" Linehan, a lawyer for Epstein Becker Green, about coupons and accumulators. Jack is an expert on drug distribution and reimbursement, and few people know as much about coupons and accumulators as he does. Peter and Jack go over some of the basics, who is advantaged and disadvantaged, and then dive into some the details on CMS regulations and how recent proposed changes to Medicaid best price rules would, if finalized, affect coupons and accumulators.
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HHS Needs More Rebate Information To Negotiate Medicare Drug Prices, Say USC Experts
February 19th 2024The Health and Human Services department could wind up overpaying (or possibly underpaying) for the drugs for which it is negotiating a “maximum fair price” for Medicare under the Inflation Reduction Act, argue experts at the USC Schaeffer Center for Health Policy and Economics. A fuller picture of rebates and net prices could help that from happening, they say.
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