December 5, 2023

Is Interest In ACA Truly Fading?

The Kaiser Family Foundation (KFF) poll says that the ACA and generally healthcare are fading as issues in the 2024 campaign.  The poll was done before Donald Trump’s remarks on the Affordable Care Act (ACA).

But let me take a slightly contrarian view here.  As the poll notes, about half of the 1,401 people surveyed said the future of the ACA is a key topic.  About 70% of Democrats thought so and 32% of Republicans thought so.  To me, in a close election, 32% of Republicans thinking the ACA is significant is, well, significant.  In a close election, how do you win if one-third of Republicans and a greater percentage of independents care about an issue?

KFF poll here: https://www.kff.org/health-reform/press-release/poll-by-a-wide-margin-democratic-voters-now-care-more-about-the-affordable-care-act-than-republican-voters-do-and-voters-trust-democrats-more-than-republicans-to-handle-its-future/

#aca #obamacare #exchanges #medicaid #healthcare #healthinsurance #healthcarereform

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CVS Follows Other Large PBMs in Reforming Reimbursement

CVS unveiled Tuesday that it will migrate to a transparent pricing systems as Capitol Hill grapples with significant PBM reforms. Additional article here: https://www.managedhealthcareexecutive.com/view/cvs-jumping-on-cost-plus-bandwagon

#pbms #drugpricing

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CVS Rebrands Health Services Business

CVS is rebranding its health services business to “CVS Healthspire” as it works to expand its non-pharmacy footprint.  Additional articles here: https://www.modernhealthcare.com/insurance/cvs-health-costvantage-drug-pricing-model and https://www.healthcaredive.com/news/cvs-retail-pharmacy-pricing-overhaul/701531/

(Some articles may require subscription.)

#cvs #pbms #pricetransparency

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CalAIM Mired in Complexity and Confusion

Many felt the California Medicaid initiative known as CalAIM was overly ambitious and the California Health Care Foundation has found that the innovation is mired in confusion, poor reimbursement, and a lack of education about the program. CalAIM seeks to innovate Medicaid by responding to mental health, social determinants, and other needs by linking vital community organizations to managed care plans.

Don’t give up yet, but it is a lesson in trying to do too much at one time.

(Article may require subscription.)

#managedcare #medicaid #ca #newsom #calaim

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Employed Doctors See Lower Patient Care Quality

Interesting survey of physicians about how leaving private practice has impacted patient care quality.  Almost 60% say patient care quality has dropped due to a lack of clinical autonomy and a focus on cost-savings. While cost-savings is likely a key theme for practices owned by public equity, there are also cost increases in the system for hospital-owned doctors. These doctors are told to practice at higher-cost settings owned by hospitals.

(Article may require subscription.)

#hospitals #providers #physicians

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Ochsner Health Using Digital Health And Addressing Social Determinants

Seems like a model program that should be replicated. New Orleans-based Ochsner Health has invested both in a digital medicine program and efforts to address social determinant barriers.  It is proving successful overall as well as with its Medicaid population. Better quality outcomes and cost-savings are being reported.

(Article may require subscription.)

#digitalhealth #sdoh #ochsner

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Interview With GE HealthCare’s Chief of AI

Interesting interview with GE Healthcare’s AI lead.  Focus in on his comments on how many fear AI as it would appear to be a black box.  He discusses the need to inform on parameters and how AI arrived at a decision.  He also stresses recommendations and AI being an “intelligent companion.”

(Article may require subscription.)

#ai #priorauthorizations

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New CMS Rule Would Penalize States On Medicaid Redeterminations

I don’t blame the Centers for Medicare and Medicaid Services (CMS) or even state Medicaid agencies for the debacle on Medicaid redeterminations.  I blame Congress for forcing through a last-minute “compromise” to phase out increased federal aid that has led states to begin the process without having a game plan or staff. 

But I will say that CMS’ proposed rule released this week will do little to reverse what is happening. Already 11.8 million have been cut off of Medicaid through the redetermination process, most of them for procedural reasons. 

CMS has ordered 30 states to reinstate enrollees wrongfully terminated.  This rule, which is draft but will go into effect Wednesday, would penalize states that do not provide CMS with monthly redetermination reports.  Corrective action plans would start the process. If found to still be out of compliance, reductions in the federal share of their Medicaid budgets will be put in place (up to 1 percentage point.) In addition, states that do not devise correction action plans or do not complete them may have to stop procedural disenrollments and face fines of up to $100,000 per day.

Additional article here: https://www.healthcaredive.com/news/medicaid-funding-reduction-redeterminations-cms-rule/701576/

(Some articles may require subscription.)

#medicaid #redeterminations

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More On Cigna-Humana Merger Rumors

More On Cigna-Humana Merger Rumors

As I commented in this newsfeed earlier, regulators will attempt to derail the merger, but the footprints (with possible selloffs of Cigna’s Medicare line of business, Humana’s commercial line of business, and Humana’s PBM) should pass muster.  But some are saying it will be a bit of a battle.

#cigna #humana #mergers #acquisitions #medicareadvantage #commercial #pbms

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KFF and NYT Series on Long-Term Care Continues

The latest entry discusses the search for affordable long-term care as well as staffing shortages and low wages in the industry. Additional information by Kaiser Family Foundation on what to know about finding care: https://kffhealthnews.org/news/article/what-to-know-about-home-care-services-dying-broke/

#ltss #ltc #longtermcare

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— Marc S. Ryan

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