Medicare and Medicaid benchmarking data, when compared
between years, help medical directors, pharmacists,
and other practitioners foresee changes in these
programs. Tracking patterns of utilization, cost, and strategy is
especially significant now, with health care reform at the center
of political debate and with many Americans facing unemployment
and economic uncertainty.
As this document goes to press, the sanofi-aventis Public Payer
Digest is in production; it will be released in November. The
Public Payer Digest combines data that appeared in two predecessors
in the Managed Care Digest Series®—the Government Digest
and the Senior Care Digest1—and provides a comprehensive
overviewof theMedicare andMedicaid programs and of key elements
of senior care in a single publication.
POTENTIAL IMPACT OF HEALTH CARE REFORM
It is nearly impossible to discuss any aspect of care without
considering the potential effects of the economy and
health care reform. During a July 22, 2009, press conference,
President Barack Obama talked about requiring Congress to
vote on recommendations by the Medicare Payment
Advisory Commission (MEDPAC) to incentivize and
empower important changes. He stressed that the recommendations
would not change benefits but instead would
change how benefits are delivered. Nonetheless, it is still
unclear what shape reform will take or even how a public
option might look.
Darlene M. Mednick, RPh, MBA, PhD, FAMCP, senior vice
president of Strategic Business Development, Managed
Markets, at CareMed Pharmaceutical Services, notes, “There
are different health care reform components on the table.
The government may gravitate toward initiatives modeled
after those that already have been implemented—such as a
Part D−like benefit.”
According to Dan Mendelson, president of Avalere Health,
“What’s being proposed for health care reform sounds great,
but the question remains how we will do it. It’s too early to tell
what coverage might look like in a public option.” However,
he says, “Controlling costs often involves saying no, and we
haven’t seen the government do much of that to date.”