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Hold Harmless Provision Change In Star Would Cost Plans Dearly

A Modern Healthcare article speaks to the fact that highly rated Medicare Advantage plans could lose billions in Star dollars if a change to the hold harmless provision for the quality improvement measures is changed.  I will have a LinkedIn post tomorrow on this and other changes the Centers for Medicare and Medicaid Services (CMS) could make to save dollars.

(Article may require a subscription.)

#medicareadvantage #stars #cms

https://www.modernhealthcare.com/insurance/medicare-advantage-star-ratings-centene-molina-bonuses

Major Developments In Direct To Consumer Pharmacy Market

Two major developments in the direct-to-consumer pharmacy market. A study published in the JAMA Health Forum suggests that most people that are insured are better off going through their insurance than through Mark Cuban’s Cost Plus Drug Company, although some deals are better for certain medications for the insured and those uninsured benefit.  I am not sure the purpose of the story. Of course, insurance should be a better deal than not going through insurance.  But the fact is that often Cuban’s outfit can offer better deals due to the opaqueness of the drug supply channel. The fact that 100 million of 844 million prescription fills (of 124 generic drugs) would have been cheaper under Cuban’s paradigm than insurance proves the system needs reform. Cuban is on to something.

In other news, Amazon Pharmacy has extended Amazon Pharmacy Rx Pass membership to Medicare enrollees. RxPass subscribers pay $5 a month to fill as many prescriptions as needed from a list of about 60 generic medications, including delivery to their doorstep.

Additional articles: https://www.fiercehealthcare.com/payers/mark-cubans-d2c-pharmacy-wont-beat-most-insured-patients-out-pocket-drug-prices-study-finds and https://thehill.com/policy/technology/4727072-amazon-pharmacy-expands-medicare-rxpass/

#drugpricing #cuban #pbms

https://www.healthcaredive.com/news/amazon-rxpass-medicare-generic-drug-subscription/719231

Scan CEO Right On MA and FFS

Scan CEO Sachin Jain, MD is one of the brightest minds in healthcare.  He has the right outlook on Medicare Advantage (MA) – it does a lot that is good but also needs reform.  In addition, he rightfully is asking why the traditional fee-for-service (FFS) program does not face reasonable scrutiny for its over-utilization.

#scan #medicare #medicareadvantage

https://www.fiercehealthcare.com/payers/ahip-2024-cutting-through-nostalgia-traditional-medicare

New Study Suggest FTC Scrutiny Of Hospital Mergers Is Meager

A new study says the Federal Trade Commission’s (FTC) scrutiny of mergers is low and mergers lead to increased prices. Part of the issue is low funding for the FTC.

(Article may require a subscription.)

#ftc #manda #mergers #acquisitions #hospitals

https://www.modernhealthcare.com/mergers-acquisitions/antitrust-enforcement-falls-short-hospital-mergers-study

CMS To Recalculate 2024 Medicare Advantage Star Ratings

After losing two lawsuits on their methodology, the Centers for Medicare and Medicaid Services announced it has recalculated 2024 Star measures for Medicare Advantage (MA) plans.  It will give plans that saw increases a short window to revise 2025 plan bids and benefits that have already been submitted.

Additional article here: https://insidehealthpolicy.com/daily-news/scan-cms-recalculate-ma-star-ratings-rebidding-process-come

(Some articles may require a subscription.)

#medicareadvantage #stars #cms

https://www.beckerspayer.com/payer/cms-to-recalculate-medicare-advantage-star-ratings-report.html

National Healthcare Spending Projections

The Centers for Medicare & Medicaid Services (CMS) Office of the Actuary released its annual re-estimates of spending over a 10-year horizon.  While 2023 healthcare expenditures will be finalized in December, current estimates are that national healthcare spending grew by 7.5% in 2023 to about $4.8 trillion, or 17.6% of gross domestic product (GDP). Part of the costs were record coverage.

Medicare spending is projected to have grown 8.4% in 2023, with costs over $1 trillion. Private health insurance spending is expected to have increased 11.1%.  Medicaid spending is expected to have grown by 5.7%.  This is lower due to dropping enrollment.

National health expenditures will rise to $7.7 trillion and capture nearly one-fifth of the U.S. economy by 2032.

I will have a blog next week digging into all the stats.

Additional articles: https://www.modernhealthcare.com/policy/national-health-spending-projected-reach-77t-2032-cms and https://www.healthcaredive.com/news/national-healthcare-spending-growth-cms-report/718718/ and https://www.cms.gov/newsroom/press-releases/cms-releases-2023-2032-national-health-expenditure-projections

(Some articles may require a subscription.)

 #healthcare #costs

https://www.fiercehealthcare.com/finance/cms-projects-national-health-spending-grew-75-2023-48t

More Information On Elevance Health Star Lawsuit Win

Yesterday we told you about Elevance Health’s win in court on the 2024 Star calculations.  Other healthcare publications have written stories today.  The pressure is on the Centers for Medicare and Medicaid Services (CMS) to respond.  I have also linked the lawsuit below.

Additional articles: https://www.modernhealthcare.com/insurance/elevance-medicare-advantage-star-ratings-lawsuit-cms and https://www.beckerspayer.com/payer/elevance-health-gets-partial-victory-in-star-ratings-lawsuit.html#:~:text=The%20judge%20ruled%20partially%20in,only%20for%20BCBS%20of%20Georgia.  and https://www.healthcaredive.com/news/elevance-wins-medicare-advantage-star-ratings-lawsuit-hhs/718550

Opinion: https://www.documentcloud.org/documents/24740919-elevance_becerra_6724_order

(Some articles may require a subscription.)

#medicareadvantage #stars #cms

https://www.fiercehealthcare.com/payers/elevance-health-earns-partial-win-legal-fight-over-ma-star-ratings

Elevance Wins Star Lawsuit

A second lawsuit has been decided in favor of a Medicare Advantage (MA) plan and against the Centers for Medicare and Medicaid Services (CMS) on the calculation of Star scores. In this case, Elevance Health won its suit and a judge declared that Georgia contract scores must be revised. It will be increasingly difficult for CMS to ignore these rulings. I will write on this on LinkedIn tomorrow.

(Article may require a subscription.)

#medicareadvantage #cms #stars #elevancehealth

https://www.modernhealthcare.com/insurance/elevance-medicare-advantage-star-ratings-lawsuit-cms

Oscar Continues Good Performance, Lays Out Strategy

Oscar Health reports its first quarterly net profit and hit 1.5 million enrollees in the Exchanges. It plans on investing in individual coverage health reimbursement arrangements (ICHRA) in tandem with its Exchanges offerings as well as re-entering Medicare Advantage.

Additional article: https://www.beckerspayer.com/payer/oscar-health-plans-to-double-its-membership-5-things-to-know.html

#oscar #exchanges #aca #obamacare #ichra #medicareadvantage

https://www.fiercehealthcare.com/payers/oscar-health-growth-ambitions-doubling-its-footprint-planned-ichra-products-launch-and-more