CMS touts that improper payments were under 10% in traditional Medicare and in Medicaid, but it is nothing to be proud of. The traditional estimator of 10% for fraud, waste, and abuse (FWA) is a misnomer. Recent studies suggest that true FWA is perhaps 25% of all healthcare expenditures. In 2021, healthcare expenditures were $4.3 trillion. That means almost $1.1 trillion is true FWA.
#fwa #medicare #medicaid
With a large proportion of the 10M Medicaid disenrollees cut from the program for procedural reasons, a group of civil rights entities are issuing report cards to states. The report cards seek to call out whether each state has done the necessary due diligence during unwinding to ensure those who remain eligible retain coverage. While states and the Centers for Medicare and Medicaid Services (CMS) are at some fault, Congress is really to blame for not passing legislation that allowed for a longer transition time.
#medicaid #redterminations
The Centers for Medicare and Medicaid Services (CMS) is mandating that State Exchanges follow federal network adequacy as well as open enrollment periods, among other changes.
#networkadequacy #cms #aca #exchanges #obamacare
Congratulations to the Kaiser Family Foundation and The New York Times on the first in a series of articles on America’s long-term care crisis. America needs an aging policy. The series shows real-life examples of the impact of not having a national agenda on aging. It clearly shows that the lack of adequate supports for the elderly also impacts other generations, including children’s loss of income to take care of an elderly loved one.
In my book (available for purchase on this website), I devote a chapter to aging and recommend ways to make services available to all in an income-based buy-in strategy. Not addressing aging will only drive long-term care and medical costs even higher in the future. In addition to the NYT story and press release at the link below, here is a link to the KFF summary of a survey on long-term care: https://www.kff.org/health-costs/poll-finding/the-affordability-of-long-term-care-and-support-services/
#aging #ltc #medicare #medicaid #kff #nyt
Despite some notable failures in the health tech world and tightness in equity markets, deals and mergers continue. Two notable examples in this article.
#digitalhealth #healthtech
A series of startup PBMs are seeing some success signing up health plans by riding the price transparency train. They have even set up their own trade group to differentiate themselves from traditional PBM lobbying efforts. An interesting development, but one that will take time to break the dominance of the three giants, which control about 80% of all the business. (may require subscription)
#medicareadvantage #commercial #medicaid #pbms #pricetransparency
Welcome to The Healthcare Labyrinth Newsfeed! Each weekday, I will review about two dozen healthcare websites for the most relevant information in the world of healthcare generally as well as managed care and health insurance specifically.
You can access the daily newsfeed in a few ways.
1 — Save this link in your favorites and visit each day
2 — If on LinkedIn, click on my daily post about the newsfeed and you will be redirected here.
3 — In the future, we will launch an email subscription (free) and we will email you each day on the newsfeed and other website activities.
Here is the rollout of the new Healthcare Labyrinth website:
November 6 — Newsfeed Debut
November 13 — Blog Debut
November 27 or December 4 — Podcast Debut
I hope you enjoy the website and newsfeed.
Take care,
Marc
Welcome to The Healthcare Labyrinth Newsfeed! Each weekday, I will review about two dozen healthcare websites for the most relevant information in the world of healthcare generally as well as managed care and health insurance specifically.
You can access the daily newsfeed in a few ways.
1 — Save this link in your favorites and visit each day
2 — If on LinkedIn, click on my daily post about the newsfeed and you will be redirected here.
3 — In the future, we will launch an email subscription (free) and we will email you each day on the newsfeed and other website activities.
Here is the rollout of the new Healthcare Labyrinth website:
November 6 — Newsfeed Debut
November 13 — Blog Debut
November 27 — Podcast Debut
I hope you enjoy the website and newsfeed.
Take care,
Marc
Welcome to The Healthcare Labyrinth Newsfeed! Each weekday, I will review about two dozen healthcare websites for the most relevant information in the world of healthcare generally as well as managed care and health insurance specifically.
You can access the daily newsfeed in a few ways.
1 — Save this link in your favorites and visit each day
2 — If on LinkedIn, click on my daily post about the newsfeed and you will be redirected here.
3 — In the future, we will launch an email subscription (free) and we will email you each day on the newsfeed and other website activities.
Here is the rollout of the new Healthcare Labyrinth website:
November 6 — Newsfeed Debut
November 13 — Blog Debut
November 27 — Podcast Debut
I hope you enjoy the website and newsfeed.
Take care,
Marc
Welcome to The Healthcare Labyrinth Newsfeed! Each weekday, I will review about two dozen healthcare websites for the most relevant information in the world of healthcare generally as well as managed care and health insurance specifically.
You can access the daily newsfeed in a few ways.
1 — Save this link in your favorites and visit each day
2 — If on LinkedIn, click on my daily post about the newsfeed and you will be redirected here.
3 — In the future, we will launch an email subscription (free) and we will email you each day on the newsfeed and other website activities.
Here is the rollout of the new Healthcare Labyrinth website:
November 6 — Newsfeed Debut
November 13 — Blog Debut
November 27 — Podcast Debut
I hope you enjoy the website and newsfeed.
Take care,
Marc
