In late May, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule aimed at improving the quality and performance of Medicaid managed care organizations (MCOs).

The rule is a doozy. It includes more than 650 pages of proposed reforms to “modernize the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems.” More simply put: it aims to align with existing commercial, Marketplace, and Medicare Advantage regulations in order to improve the quality of care.

Improve the quality of care. That sounds an awful lot like what we at AdverseEvents set out to do more than four years ago. While there are a number of factors that may have a negative impact on health outcomes, adverse drug events present a significant safety and economic risk to our healthcare system. We believe this risk can be managed by analyzing existing post-approval adverse drug data and incorporating this intelligence into prescription drug decision making.

So, what does this have to do with this proposed rule? More than half of all Medicaid beneficiaries (at least 39 million individuals in 39 states and the District of Columbia) have coverage through MCOs and prescription drug benefits cost Medicaid more than $28 billion annually. We see this as a huge opportunity to make a significant impact in improving healthcare quality and lowering healthcare costs for many Americans.

Any current effort to modernize healthcare must include provisions about leveraging vast stores of healthcare data that are now available. In its proposed rule, CMS must look for ways to use available data to help Medicaid MCOs drive significant improvements in patient care and lower overall costs. Incorporating analysis of data that can help reduce of preventable events affecting outcomes and costs, including analysis of adverse drug events, as part of CMS’ overall quality strategy is one way to modernize and affect positive change.

Opportunities such as this don’t come along every day and the timeframe in which to affect change doesn’t stay open long. CMS will be accepting public comment on this proposed rule until July 27. We plan to make our voice heard. We hope you’ll join us in our effort. More to come soon.


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Brian Overstreet

Brian Overstreet


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Brian Overstreet

Written by Brian Overstreet