February 19, 2024

A Look At Growing Provider-Payer Disputes In California

A good article from Kaiser Health News (KHN) that looks at growing contract disputes between providers and payers.  This one was in CA, but this is occurring nationwide.  KHN mentions higher costs coming from provider consolidation as well as increasing leverage when payers merge. The Biden administration is on to something with its anti-trust initiative.

#providers #healthplans #coverage #payments

Link to Article

Wakely’s Assessment Of The 2025 Medicare Advantage Advance Notice

As it does each year, Wakely has issued its annual assessment of the advanced notice for Medicare Advantage (MA).  My analysis is here: https://www.healthcarelabyrinth.com/2025-rates-for-medicare-advantage-plans-look-tight/ .

#2025 #rates #medicareadvantage

Link to Article

Dual Eligible Special Needs Plan Analysis By Kaiser Family Foundation

The Kaiser Family Foundation (KFF) published a look at Dual Eligible Special Needs Plans (D-SNPs).  Among the findings:

  • 3 in 10 dual eligibles enroll in a D-SNP
  • 52% of those duals in SNPs are enrolled in a Humana or United D-SNP plan
  • Major increase in D-SNP offerings
  • There are fewer prior authorizations for D-SNPs, but higher denial rates.

My own research shows that SNPs in general, most of it dual ones, have grown from 5.75M in January 2023 to 6.93 million in February 2024.

#snps #specialneedsplans #dualeligibles #medicareadvantage

Link to Article

Life Expectancy Much Lower In The United States

Life expectancy remains much lower in the United States than in other developed countries.  The Peterson-Kaiser Family Foundation Health Tracker gives us the latest comparison.  The lower life spans in the United States are despite spending considerably more on healthcare.

#lifeexpectancy #healthcare #quality

Link to Article

— Marc S. Ryan

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