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June 19, 2024

Hold Harmless Provision Change In Star Would Cost Plans Dearly

A Modern Healthcare article speaks to the fact that highly rated Medicare Advantage plans could lose billions in Star dollars if a change to the hold harmless provision for the quality improvement measures is changed.  I will have a LinkedIn post tomorrow on this and other changes the Centers for Medicare and Medicaid Services (CMS) could make to save dollars.

(Article may require a subscription.)

#medicareadvantage #stars #cms

https://www.modernhealthcare.com/insurance/medicare-advantage-star-ratings-centene-molina-bonuses

White House Espouses Drug Purchaser Incentives And Penalties To Help Curb Drug Shortages

A White House official pointed to a lack of transparency in the drug supply chain, concentrations of supply, and issues at manufacturing facilities for drug shortages. But the official correctly also noted that drug buyers, such as hospitals, should be incentivized (and penalized) to examine ways to procure from high-quality manufacturers and protect against shortages (including buffer stocks). Hospital lobbies oppose penalties, but I think what the White House is saying makes sense. Greater transparency, though, is needed in the supply chain.

(Article may require a subscription.)

#drugpricing #drugshortages

https://insidehealthpolicy.com/daily-news/wh-official-drug-buyers-should-be-incentivized-prioritize-resiliency

AMA Survey More Propaganda To Further Prior Authorization Restrictions

To bolster its efforts to enact further prior authorization restrictions, the American Medical Association comes out with a shocker survey — more than 90% of physicians say health plans’ prior authorization requirements lead to delayed care and bad outcomes. What is important to remember is that doctors today are largely owned by private equity firms or large hospital or health systems. These entities are seeking simply to drive their margins.

#providers #healthplans #priorauthorization

https://www.managedhealthcareexecutive.com/view/physicians-say-prior-authorization-leads-to-bad-outcomes

— Marc S. Ryan

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