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New Poll Suggests MA Enrollees Have Issues With Prior Authorization, But Some Use Added Benefits

A new poll says Medicare Advantage (MA) enrollees are more likely than those in traditional Medicare fee-for-service (FFS) to experience care delays due to prior authorization, but they do receive supplemental benefits not in the traditional program. While the rates of such use can always be better, a 70% member-use rate is encouraging.  Still, it is indeed time for MA plans to show their value by encouraging the use of all of the added benefits at reasonable rates. Proposed supplemental benefits reporting rules will encourage this trend. Overall, MA plans need to educate members thoroughly on all benefits, lest critics and researchers build a case that there is no added value. The critics continue to argue massive overpayments, which I do not agree with.

One point just does not resonate with me. About 12% of MA members said they had affordability issues while about 7% of traditional Medicare enrollees said so. With all that MA does to reduce gaps in traditional benefits, it makes little sense to me.

Additional article:  https://www.medpagetoday.com/special-reports/features/108846

#medicare #medicareadvantage

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New CMS DSH Rule Will Reduce Medicaid Hospital Payments

Medicaid disproportionate share hospital (DSH) payments are being cut by $8 billion annually for the nest five fiscal years based on a new rule finalized by the Centers for Medicare and Medicaid Services (CMS).  The rule is purported to rein in overpayments. A recent study suggested that a liberal formula calculation meant a third of all qualifying hospitals should not have received payments.  CMS has been pushing to reduce such payments in favor of broad coverage.

Additional articles: https://www.fiercehealthcare.com/providers/many-disproportionate-share-hospitals-face-lower-medicaid-payments-under-new-final-rule and https://www.modernhealthcare.com/policy/medicaid-dsh-cuts-safety-net-hospitals-cms-final-rule

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#medicaid

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Analysts Say Digital Health Facing Funding Challenges

After record years of funding, digital health ventures are facing lean times to stay solvent.

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#digitalhealth #healthcare

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