January 9, 2024

NY Wins Medicaid Waiver Approval

New York received an 1115 Medicaid waiver approval from the Centers for Medicare and Medicaid Services (CMS) covering a myriad of innovations, including recruitment and retention of Medicaid providers, eligibility to bill social needs spending, primary care investments, behavioral health investments, and health equity pilots. CMS press release here: https://www.cms.gov/newsroom/press-releases/cms-approves-new-yorks-groundbreaking-section-1115-demonstration-amendment-improve-primary-care

#medicaid #cms #waivers #socialneeds #healthequity

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January 8, 2024

Aetna Turnaround On Stars And Enrollment Is Amazing

At the JP Morgan conference, CVS President and CEO Karen Lynch was taking a well-deserved victory lap.  With all that is going on at CVS, the Aetna turnaround on enrollment and Stars in Medicare Advantage (MA) is amazing.  It is no small feat given competitiveness in the MA world and the major changes in Star for 2024. 

#cvsaetna #cvshealth #aetna #medicareadvantage

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January 5, 2024

FDA Approves Florida Drug Importation

The Food and Drug Administration (FDA) has approved Florida to import prescription drugs from Canada via bulk purchasing.  This would mean Florida residents would have access to Canadian wholesale prices, which are far lower than in the United States.  Brand drug makers immediately attacked the waiver as reckless and claimed it could endanger health.  Nonsense.  Canada is a developed country with a great safety record. The waiver also has strict quality control measures in it. This is yet another stunt by Big Pharma to maintain its high prices in the United States. It likely will sue to stop it. Canada, too, could disrupt the plan if it results in shortages there.  Although the targeted drugs right now look like they are in reasonable supply, look out for a “manufactured” crisis to emerge.

This is a feather in the cap of presidential candidate and Fl. Gov. Ron DeSantis, who has been pressing the Biden administration for the waiver. Biden will surely tout this during his run. Donald Trump too, as he passed the original rules to allow states to do this.  Florida sued the federal government when its application stalled.

Florida says residents could save $150 million annually, but Florida will start very slowly, with a few classes of drugs and government programs now. Other states have pending applications and others could submit as well. So, broad relief will take time and the program would have to grow in Florida and other states.  Many currently import drugs individually through Canadian pharmacies and it is technically illegal. But with Medicare drug price negotiations, this is yet another way to solve a huge affordability crisis in America over time.

Other articles here:




#drugpricing #drugimportation #fl #brandrugmakers

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January 4, 2024

Hospitals, Payers Have Better Compliance With Transparency Requirements

Hospitals and payers seem to be complying more with required price transparency postings.  As well, the Centers for Medicare and Medicaid Services (CMS) has ramped up enforcement.  New rules went into effect 1/1 and Congress wants to codify the rules and enhance them. Additional article here: https://www.medpagetoday.com/special-reports/features/108126

#transparency #pricetransparency #healthplans #hospitals #cms

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January 3, 2024

Aggressive Agenda for Healthcare on Capitol Hill

Good article on all the healthcare priorities for 2024.  This tracks very closely to my predictions for 2024 blog ( https://www.healthcarelabyrinth.com/channeling-nostradamus-the-healthcare-labyrinths-2024-predictions/ ).

As I noted, a continuing resolution (CR) or other funding bill must pass soon to keep healthcare agencies open. As well, the article says that price transparency reporting, PBM reforms, and site-neutral payments are on the agenda. Note the reference to the long shot possibility of Medicare Advantage (MA) payment reductions. Troubled by prior authorization and overpayment headlines, Congress could take a bite out of rates for MA plans. This was also a possibility I raised in my predictions. There is also the issue of physician fee cuts in Medicare.

(Article may require a subscription.)

#transparency #pricetransparency #governmentshutdown # crs #siteneutral #pbms #medicareadvantage #medicare #overpayments #providers #rates

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January 2, 2024

KHN Series On Rural Healthcare Crisis

Good article from Kaiser Health News on the rural healthcare crisis.  It tackles how primary care doctors may be able to help with the maternal healthcare crisis. 

#ruralhealthcare #healthcare

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January 1, 2024

Happy New Year!

The Healthcare Labyrinth Newsfeed is off January 1. We wish you a very Happy and Prosperous New Year! You can read previous Newsfeed entries at the Newsfeed page. Visit out Blog page for the latest Blogs. Also visit Spotify for The Healthcare Labyrinth Podcasts. Search “healthcare labyrinth.” We now have three posted. Stay tuned for our predictions blog coming out tomorrow. Read our year-in-review blog already posted first. As well, our podcast this coming Friday will summarize 2023 healthcare events and go into predictions.

— Marc S. Ryan and The Healthcare Labyrinth Website

December 29, 2023

Devoted Health Has Successful Funding Raise

Kudos to Devoted Health for its successful Series E funding raise. Devoted has been one of the few very successful insurtechs. It has excelled in the Medicare Advantage (MA) market as a startup. Run by career veterans with discipline, it is giving big plans a run for their money in some markets. Devoted’s record is very different to some of the other insurtechs, who cratered this year or are performing poorly.

(Article may require a subscription.)

#insurtechs #devotedhealth #medicareadvantage

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December 28, 2023

Retailers Targeting Senior Populations In Primary Care Investments

Good article showing why retailers are targeting seniors for their primary care initiatives. Retailers are interested in the potential financial arrangements (risk funds) that Medicare Advantage plans are focusing on. In addition, the seniors will tap other important features of their offerings, including pharmacies.

(Article may require a subscription.)

#retailhealthcare #medicareadvantage

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December 27, 2023

Healthcare Lawsuits To Watch in 2024

Good article on the healthcare lawsuits to watch in 2024, including many challenging the Inflation Reduction Act’s (IRA) Medicare drug price negotiations as well as preventive service mandates in the Affordable Care Act (ACA).

#aca #ira #exchanges #obamacare #drugpricing

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