Pennsylvania-based Big Blue Highmark Health says it is seeing the same sort of Medicare Advantage (MA) trends other plans have reported. It sees increased utilization across inpatient and outpatient as well as rising costs of GLP-1 drugs.
#highmark #medicareadvantage #weightlossdrugs
Congratulations to Clover Health by unveiling its Clover Assistant as a SaaS technology offering. Clover Assistant, now marketed as Counterpart Assistant, is available to Medicare Advantage (MA) payers and providers to improve outcomes and close care gaps.
Additional article: https://www.modernhealthcare.com/insurance/clover-health-assistant-medicare-advantage
(Some articles may require a subscription.)
#medicareadvantage #clover #healthplans #providers
https://www.fiercehealthcare.com/payers/clover-assistant-ai-tool-now-available-payers-providers
President Joe Biden is attacking former President Donald Trump on his healthcare stances and indicating he wants to repeal the Affordable Care Act (ACA). Polling shows Biden is better trusted on healthcare and this could help him in swing areas of the country.
See my blog on this topic: https://www.healthcarelabyrinth.com/election-update-and-the-potential-role-of-healthcare-issues/ .
(Article may require a subscription.)
#election2024 #healthcare #aca #exchanges #medicaid #obamacare
The major healthcare news services were off today for Memorial Day. Please check out the blog we published today on my modest proposal for healthcare reform: https://www.healthcarelabyrinth.com/a-modest-election-year-proposal-for-healthcare-reform/
— Marc S. Ryan
Nursing home associations are suing in federal court to overturn a new staffing ratio rule. The rule will lead to a massive consolidation in the industry and the loss of independent homes.
Additional articles: https://www.modernhealthcare.com/providers/nursing-home-staffing-mandate-ahca-lawsuit and https://insidehealthpolicy.com/daily-news/nursing-homes-sue-cms-over-staffing-rule-aarp-backs-agency
(Some articles may require a subscription.)
#nursinghomes #staffing
Physician pay increased by 5.9% in 2023 after dropping 2.4% in 2022. At the same time, physician groups were on Capitol Hill lobbying for a Medicare physician payment fix and more changes to prior authorization. Some indicated that it was hard to compete against hospital-owned docs because of higher payments. The independent docs want site-neutral payments implemented.
Additional article: https://www.fiercehealthcare.com/providers/20-highest-paid-specialties-2023-doctors-see-6-boost-pay-doximity
#physicians #rates #medicareadvantage #medicare #priorauthorization #siteneutral
https://www.medpagetoday.com/practicemanagement/reimbursement/110302
A U.S. Court of Appeals ruled that drug makers can limit and impose conditions on pharmacies participating in the 340B drug discount program. The federal government had sided with providers, but a federal court ruled against that position.
I am no friend of drug makers but this ruling is a good one. The 340B program has been corrupted and abused by providers. It is not fulfilling its mission of getting discounted drugs to the most vulnerable.
Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/second-appeals-court-rules-drug-makers-can-impose-340b-restrictions
(Some articles may require a subscription.)
#340b #drugmakers #hospitals #providers
Finance Chair Ron Wyden wants the Centers for Medicare and Medicaid Services (CMS) to crack down on rogue brokers and agents in the nation’s Exchange signup process.
(Article may require a subscription.)
#exchanges #agents #brokers #fwa
https://www.modernhealthcare.com/insurance/ron-wyden-cms-exchange-marketers-aca
Pressured by the rise of transparent pricing models, Optum Rx has announced its own approach to greater transparency. I would call it transparency-like. It is offering a single per member cost, encompassing retail, home delivery, specialty drug and rebate components.
#transparency #pbms #optumrx
https://www.fiercehealthcare.com/payers/optum-rx-puts-emphasis-predictability-new-pricing-model
Inequities in mental health will cost $332 billion on premature death and $116 billion in productivity loss in 2024. These combined numbers could grow to $1.3 trillion by 2040.
The inequities also mean greater healthcare spending. $5.3 billion in 2024 excess costs are tied to overutilization and excessive reliance on the emergency room for acute mental health incidents. That number could rise to $17.5 billion in 2040.
#mentalhealth #behavioralhealth #healthcare
https://www.fiercehealthcare.com/payers/mental-health-inequities-cost-478b-unnecessary-expenses-2024
