Primary Care Market To Shift by 2023
A Bain & Company study on primary care suggests non-traditional providers, including retailers, payers, and advanced primary care providers, are expected to capture 30% of the U.S. primary care market by 2030. Bain says payers will continue to invest in primary care and population-focused models and will capture 20% of the market. How retailers will fare is more of a question. Bain also says providers will pivot to and grow their value-based care focus.
#primarycare #healthplans #insurers #providers
CMS Says Exchanges To Hit Record Numbers Again, But That May Be In Doubt
The Biden administration says nearly 1 million new customers have enrolled in coverage through the Affordable Care Act’s (ACA’s) Exchanges during open enrollment so far and that 4.4 million people have returned to a marketplace plan for 2025. The Centers for Medicare and Medicaid Services (CMS) says 2025 could set yet another record for enrollment. For the 2024 plan year, there were 21.4 million enrollees. But in truth, new signups and returning signups are both down considerably so far in 2025 — about 1.3 million less. This likley is a result of significant anti-fraud changes made by CMS due to fraudulent enrollments and changes in the past.
Health plans have expanded yet again in the Exchanges for 2025 and remain hopeful that some deal would be arrived at to extend enhanced premium subsidies. Between 3 and 4 million would lose coverage if the enhancements sunset.
CMS Fact Sheet and Press Release: https://www.cms.gov/newsroom/fact-sheets/marketplace-2025-open-enrollment-period-report-national-snapshot-0 and https://www.cms.gov/newsroom/press-releases/nearly-988000-new-consumers-selected-affordable-health-coverage-aca-marketplace-so-far
#exchanges #obamacare #aca #coverage
Levitt Predicts ACA and Medicaid Cuts
In a Jama Forum article, Larry Levitt of the Kaiser Family Foundation, predicts Affordable Care Act (ACA) and Medicaid cuts under the incoming Trump administration. As I do, he ties the likelihood of cuts the desire among the GOP to extend the 2017 tax cuts. And as I say too, even if an ACA repeal and replace effort does not occur, cutbacks could come to Exchanges and the ACA. Enhanced premium subsidies could sunset. Other cuts could include Medicaid block grants, lowering reimbursement for the Medicaid expansion, other Medicaid reimbursement changes, and more. Coverage would be impacted markedly.
#aca #obamacare #exchanges #medicaid #trump #kff
https://jamanetwork.com/journals/jama-health-forum/fullarticle/2827780
Certain Elevance Health BCBS Plans Back Away From Controversial Anesthesia Reimbursement Change
Anthem Blue Cross Blue Shield has pulled back on a controversial policy that would cap the amount of time it would reimburse providers for anesthesia services during surgery. The proposal would have implemented Physician Work Time Values set by CMS for anesthesia reimbursement. The policy was set to take effect in February. It backed off after political and provider pushback.
Additional article: https://www.beckerspayer.com/policy-updates/anthem-walks-back-anesthesia-coverage-policy-after-backlash.html
#providers #healthplans #elevancehealth #reimbursement
https://thehill.com/policy/healthcare/5025236-anthem-reverses-anesthesia-payment
— Marc S. Ryan
