December 21, 2023

Prospects In 2024 For Payers and Providers

A good article on what is in store for payers and providers in 2024. Included is retail healthcare, health plan investments, hospital struggles, and M and A prospects.

#manda #retailhealthcare #healthplans #hospitals #providers #2024

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Star Achievement In Medicare Advantage Is Key

Good article on the financial impacts of the drop in Star power in Medicare Advantage and what plans need to do to get things back on track. Focusing on member satisfaction is key as is measuring well into the future to see how changes will impact ratings, including with the Health Equity change. There also is conversion to digital for a number of Star measures (from manual chart review). Technology investments, including data analytics, are also key.

#medicareadvantage #stars

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Will PBM Reform Bill Pass in 2024?

Good article on the prospects of PBM reform in 2024. It passed the House in December but no movement in the Senate. The article also addresses some changes occurring in the industry. For an in-depth review from me as well, check out the Blog Tab and read my 12/14 blog on the topic: https://www.healthcarelabyrinth.com/pbm-transparency-and-reform-is-a-big-trend-in-the-american-healthcare-system/

#pbms #drugpricing

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Federal Regulators’ Data Shows They Are Focusing On Consolidations

The federal report shows that scrutiny of mergers and acquisitions are way up and this trend will continue with new final guidelines

(Article may require a subscription.)

#ftc #doj #mergers #acquisitions #healthcare

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2024 Congressional Agenda Looks Unachievable Early On

A good article on what is in store for Congress when it returns in early January, including stopping the shutdown of government as well as numerous healthcare matters. Providers are especially worried about a series of rate cuts that will occur if not addressed by Congress.

(Articles may require a subscription.)

#2024 #medicare #healthcare #governmentshutdown

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Merger Guidelines Impact on M and A

Analysts suggest that, while subtle in some cases, the recent merger guidelines could impact M and A activity in healthcare.

(Articles may require a subscription.)

#ftc #doj #mergers #acquisitions #healthcare #manda

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CBO To Broaden Input On Medicare Drug Price Law

The Congressional Budget Office (CBO) will gather new data and input on how the Inflation Reduction Act’s Medicare price control policies are affecting pharmaceutical innovation. This is due to the Republican takeover of the House and pressure from Republican leaders.

(Article may require a subscription.)

#drugpricing ira #medicare

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Not All Golden In Medicare FFS Claims Reviews

The Centers for Medicare and Medicaid Services (CMS) has proposed a retrospective appeals process for beneficiaries who had inpatient hospital stays changed to outpatient observation status from 2009 on. In addition, there will be a new expedited appeals process for beneficiaries who continue to face a change in their hospital status. It shows that all is not rosy in terms of claims denials for the traditional system and seems to point to a desire to reduce costs. CMS’ new prior authorization rule for Medicare Advantage does the exact opposite. It seems to impact this exact scenario and more. Additional article here: https://www.modernhealthcare.com/policy/hospital-observation-appeals-medicare-cms-inpatient-outpatient .

(Articles may require a subscription.)

#medicare #medicareadvantage #claimsdenials #priorauthorization

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Kaiser Polling Continues To Show Unaffordability Crisis

This new Kaiser analysis adds to other published data this week on the nation’s crisis with affordability of healthcare. It leads to difficulty affording care and skipping it as well. As I often say, these folks are among the underinsured.

#underinsured #affordability #coverage #healthcare

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— Marc S. Ryan

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