March 1, 2024

Medicare Advantage Will Remain Viable Over The Long Run

Good article in Modern Healthcare discussing the fact that, while there will be major bumps in the road, Medicare Advantage (MA) will remain viable and strong.  A great quote from Paul Ginsburg, senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics. “We’re not talking about any risk to the financial integrity of these companies at all. The Medicare Advantage business is very viable long-term because they’re providing something that more and more Medicare beneficiaries are deciding they want,” Ginsburg said. “Will it be as great for the next few years as it has been? Probably not. It’ll still be very good, though.”

This echoes what I said in a January 29, 2024 blog ( https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ ) as well as a February 9 Podcast ( https://www.healthcarelabyrinth.com/9-is-medicare-advantage-exploding-after-its-boom-or-simply-adjusting/ ).

As I say, the real victims of terrible policies from the Centers for Medicare and Medicaid Services (CMS), such as the prior authorization rule, will be fixed income seniors who will lose a great deal of benefits.  It is a shame.

(Article may require a subscription.)


Link to Article

More Change Healthcare Cyber Attack Coverage

Given the significance and scope of the Change Healthcare cyber attack, here are some additional articles to peruse. Good article here on importance of prioritizing cyber security: https://www.fiercehealthcare.com/health-tech/cybersecurity-patient-safety-what-ransomware-attack-change-healthcare-should-teach

Additional article says Change has set up an alternate system for pharmacy services and created a financial assistance program for healthcare providers: https://www.modernhealthcare.com/cybersecurity/change-healthcare-outage-cyberattack-unitedhealth-financial-assistance

The article at the link addresses the wide-ranging systems Change has as well as the nationwide impact.

(Some articles may require a subscription.)

#changehealthcare #cyberattacks

Link to Article

Three Strikes Now On Brand Drug Makers’ Lawsuits

A federal judge in Delaware rejected drug makers’ arguments that the Medicare drug price negotiation law is unconstitutional and that drug makers are being forced into negotiations. A Texas federal judge dismissed a drug lawsuit a month ago. And in September, an Ohio federal judge rejected a preliminary injunction sought by the Chamber of Commerce on behalf of drug makers.

It is clear that the constitutional arguments will not hold water.

(Article may require a subscription.)

#ira #drugpricing

Link to Article

Preventive Services In The ACA Hang In The Balance

In 2022, a federal drug struck the preventive services provision in the Affordable Care Act (ACA).  The order has been stayed for all but the plaintiffs, but an appellate court will now hear the case and decide free preventive benefits’ fate. The case was brought on religious grounds but may also rest on a series of technical arguments related to regulatory powers.

#aca #prevention #preventivebenefits

Link to Article

Medicare Part D Cost-Sharing Smoothing Additional Guidance

The Centers for Medicare and Medicaid Services (CMS) continues to issue guidance on implementation of the Medicare Part D Prescription Payment Plan.  A series of reforms are being introduced, including elimination of member payments in the catastrophic phase and a cap on overall out-of-pocket costs (OOP) in Part D of $2,000.  In addition, the complex smoothing provision would allow members to choose to make their cost-sharing over 12 months rather than at differing levels at the pharmacy for each sales.  The guidance lays out how to identify those who may want to take advantage ($600 cost at the point of sale), technical issues related to enrollment and payment, and disenrollment for lack of payment to the plan by the member.  There are numerous other provisions.

I have to tell you I am not a huge fan of the provision.  It is not like I do not think we should help as many as possible.  But there are so many moving parts right now in Part D.  There is good reason to believe that both CMS and health plans do not understand all the repercussions of this program and there will be great member confusion. I would have argued that the program should have battle-tested the lower OOP and catastrophic phase cost-sharing elimination first.  It also may be very hard to tell whether someone will really benefit from the program with deductibles, new drugs that members may go on throughout the year, the $2,000 cap, and catastrophic change. And it is yet another thing seniors need to try and understand and worry about.  Administrative burdens on plans will be big as well. And with no enrollment at the point of sale (pharmacy), how will all this really come together? But perhaps the Low Income Subsidy (LIS) change process could be mimicked.

I hate to be a whiner, but the complexity of all this is amazing and I question who really will take advantage and that it will indeed work.

Additional blog here from Wakely: https://www.wakely.com/blog/impacts-medicare-prescription-payment-plan

Additional article on guidance: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/final-mpp-plan-guidance-cements-method-enrollee-id

(Some articles may require a subscription.)

#partd #medicareadvantage #pdp

Link to Article

Berwick Interview On Medicare Advantage

I publish this simply to show what Medicare Advantage is up against.  The reporter is a known critic of MA, although I suppose she aimed to bring some balance even as her views were clear.  She interviewed Don Berwick, who is someone I respect but is simply dead wrong on his views on MA.  The dialogue in the article speaks to a whole bunch of half truths – huge overpayments, administrative costs between fee-for-service (FFS) and MA, the MA program being unstable, and more.  Berwick goes on to suggest he is happy to be in the traditional program, but he probably has the means to navigate the high-cost traditional program and supplement it with a Medigap policy.   

As with the earlier interview done with MedPAC chairman, there were plenty of opportunities to speak to the oversight of MA plans, studies that do show better outcomes, and the safety net MA provides fixed income seniors. But little to nothing has been included in either article in the series.

Does MA need some reforms – yes, even in areas cited by Berwick.  But the hyperbole from critics is amazing and it is taken hook, line, and sinker by a willing media.  And more and more, there looks to be a cabal forming that wants to rip down MA to get to the eventual goal of Medicare for All.


Link to Article

Highly Recommended Webinar On Interoperability And Emerging Standards

I highly recommend folks attend this webinar from Point of Care Partners, an absolute expert on interoperability in general and the new interoperability rule.  They literally have a seat at the table plotting the strategy for the future world of information and data exchange. More information about the interoperability rule and the webinar at the link.

#interoperability #fhir

Link to Article

— Marc S. Ryan

Leave a Reply

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

Available Now