January 30, 2024

Health Policies To Watch In 2024

The Peterson-Kaiser Family Foundation Health Tracker has a good briefer on expected healthcare policy issues to watch in 2024.  Among the many include site-neutral policies, price transparency, drug pricing and trends, PBM reform, drug price differences around the developed world for weight-loss drugs, value-based care and payments, and anti-trust activity.  A great primer!

#peterson #kff #healthcare #healthcarereform

Link to Article

Kaiser Family Foundation Publishes Analysis Of Medicare Advantage Enrollment Drivers

The Kaiser Family Foundation (KFF) briefer on why Americans are choosing Medicare Advantage (MA) is an important read.  I do not agree with everything in it, including references to a recent MedPAC analysis, but MA proponents will have a very good understanding of the threats presented. KFF providers ten reasons.

MA is expected to hit at least 60% of beneficiaries by 2030 and that payments to MA are right now about 123% higher, or $88 billion annually, than the traditional fee-for-service (FFS) program.  What is missing is that at least some of the reason for added dollars is in the law, whether additive Star dollars, rates to incentivize MA in more rural areas, etc.

MedPAC’s recent report concluded many things I disagree with, including that there is beneficial selection in MA that equates to a 6% to 13% overpayment and that risk scores that are over 20% higher than FFS are automatically suspect.

That said, some of the areas called out in the KFF analysis do need some reform, such as concentration on health risk assessment and chart reviews for risk adjustment, brokers and marketing, education on tradeoffs between MA and FFS, and perhaps tackling the Medicare Supplement for those wanting to switch back to FFS.

#medicareadvantage #medpac #medicare #kff

Link to Article

Drug Lawsuits Set To Begin As Initial Offer Price Set Under IRA

Just as the initial offers for maximum prices for the 10 drugs for 2026 Medicare drug price negotiations are ready to be set, the various lawsuits are beginning.  The suits argue that the Inflation Reduction Act’s (IRA) Medicare drug price negotiations violate both constitutional provisions as well as rule-making processes.

Additional article here: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/doj-rejects-novo-nordisk-s-claim-cms-illegally-counts-6-drugs-1-under

(Article may require a subscription.)

#ira #drugpricing

Link to Article

Dueling Positions On Medicare Advantage

Dueling positions on the Medicare Advantage (MA) program in Congress, with MA-friendly groups arguing the program should remain stable, while opponents argue overpayments, quality, and supplemental benefits all must be looked into. It will be a rough ride in Congress and at the Centers for Medicare and Medicaid Services (CMS) in 2024.  See my recent blogs on the subject at the Blog Tab of this site.  A lot of activity: https://www.healthcarelabyrinth.com/category/blog/

(Article may require a subscription.)


Link to Article

Kaiser Family Foundation Finds Over 16 Million Have Lost Coverage Halfway Through Process

Ten months into the restart of Medicaid redeterminations and regular enrollment rules in the program, 16.2 million have been disenrolled and the Kaiser Family Foundation (KFF) notes we are only about halfway through the process.  Most projections said total losses would be about this number.  Some have and will continue to regain eligibility but many give up after their procedural disenrollment.  While Exchanges picked up some in their record enrollment, it is a small percentage, which means our uninsured rate will go up by millions.

KFF press release here: https://www.kff.org/medicaid/press-release/halfway-through-the-medicaid-unwinding-about-16-million-enrollees-have-been-dropped/

Additional article from KFF on 2024 Medicaid issues, including coverage and access, long-term care, and social determinants:  https://www.kff.org/medicaid/issue-brief/medicaid-what-to-watch-in-2024/

#medicaid #redterminations #kff

Link to Article

Fitch Says Non-Profit Hospitals Will See Lower Overall Margins

Fitch Ratings says that non-profit hospitals’ operating margins have reset below traditional levels following the COVID pandemic.

#hospitals #margins

Link to Article

Addressing Language Proficiency For Dual Eligibles

The Health Affairs Forefront Blog has a good article in a continuing series on dual eligibles.  This one addresses how integrated programs can improve on language communication for limited English proficient duals.

(Article may require a subscription.)

#dualeligibles #sdoh #socialdeterminants

Link to Article

— Marc S. Ryan

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now