Aledade Touts Primary Care and VBC Growth
Value-based enablement company Aledade added more than 700 primary care practices to its network for 2026 and sees strong momentum for value-based care (VBC) growth.
Aledade has more than 3,000 primary care organizations across the country with over 3 million patients in VBC programs. These include Medicare Shared Savings Program (MSSP), Medicare Advantage (MA), Medicaid, and commercial contracts.
Transition to VBC from transaction payments has been slow with a mixed record on savings and better outcomes. See my blog today on VBC: https://www.healthcarelabyrinth.com/the-2027-aca-exchange-rule-the-good-and-bad/ .
In other news, Humana President and CEO Jim Rechtin said the company is looking to expand its primary care footprint. He says a strategic acquisition should be announced soon. But as I noted earlier and Becker’s says in its article, the biggest national health plans are under heavy criticism about sweet-heart deals of plans and pharmacy benefits managers (PBMs) with sister company entities. A Health Affairs analysis found that plans using their own providers can inflate medical spending figures and limit their rebate responsibilities. United’s ambulatory surgery center (ASC) acquisitions led to steep price increases for competing insurers. The study’s authors want disclosure of internal payment arrangements.
Additional article: https://www.beckerspayer.com/m-and-a/humana-ceo-hints-at-upcoming-primary-care-deal/
#healthplans #verticalintegration #providers #vbc
Plans Endorse ACCESS Model Goals
Fourteen health insurers have voluntarily committed to align by 2028 with the Centers for Medicare and Medicaid Services’ (CMS) “Advancing Chronic Care with Effective, Scalable Solutions” or ACCESS model to launch soon in traditional Medicare. The plans represent 165 million Americans.
ACCESS will leverage technology in chronic disease management of high blood pressure, diabetes, chronic musculoskeletal pain, and depression.
#access #cms #medicare #healthplans
https://www.beckerspayer.com/policy-updates/14-payers-pledge-support-for-access-model/
Drug Price Hearing In House Contentious
Lawmakers on both sides of the aisle decried the high cost of drugs at a House Energy and Commerce subcommittee Wednesday, but the parties viewed things differently for the most part. Trade groups representing pharmaceutical manufacturers, group purchasing organizations, distributors, pharmacy benefit managers (PBMs), employers, and pharmacies all testified.
Democrats attacked major cuts to Medicaid, the Exchanges, and science and health grants as well as the lapsing of enhanced Exchange subsidies. They argued the GOP is making things worse.
The parties did agree on PBM reforms, citing recent reforms passed in the budget bill recently. And more changes on the PBM front could come as well. The Department of Labor (DOL) has also proposed a rule that would require PBMs and benefits consultants to disclose information to self-funded and level-funded group plans about drug maker rebates, formulary placements, and other types of compensation.
Healthcare policy group KFF found in a recent poll that one-third of adults failed to fill a prescription, skipped doses, cut pills in half, or opted for over-the-counter (OTC) medications due to costs.
Additional article: https://www.healthcaredive.com/news/drug-costs-supply-chain-energy-commerce-pharmacy-benefit-managers-gop-policies/812043/
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#drugpricing #pbms
https://www.modernhealthcare.com/politics-regulation/mh-dol-rule-pbm-benefit-consultants
— Marc S. Ryan
