May 16, 2024

While Admirable, CalAIM Is Struggling

California has fashioned an ambitious healthcare and social service experiment known as CalAIM, but some aspects on the community health and services front are struggling. Many states have mimicked California by requesting similar but less ambitious initiatives through Medicaid. With the majority of health outcomes tied to social factors and not underlying clinical conditions, it is a worthy pursuit overall.  My fear is that California may be trying too much too quickly.

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#ca #calaim #healthcare #sdohs #socialdeterminants #medicaid #managedcare


Private Equity Firms Tout Value In Healthcare

Private equity is on a marketing campaign to tout the value it brings. Here is an example of what they are saying, although I think the negatives far outweigh the positives.

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#privateequityfirms #healthcare


Ascension Being Credited For Transparency On Cyberattack

Multi-state Catholic hospital system is being credited for its transparency and communication related to its recent ransomware cyberattack.  This stands in contrast to Change Healthcare’s and other entities’ responses.

#cyberattacks #healthcare


Becker’s Summarizes Issues Related To Two-Midnight Rule

Becker’s does a good job of summarizing thus far the impact of a 2024 Medicare Advantage (MA) rule restricting prior authorization. Plans have concerns about the fact that they must now follow the so-called two-midnight rule, allowing inpatient care if a physician estimates the patient would be in a facility for at least two midnights.

It notes a study that says over 20% of MA plan observation days could now be converted to inpatient stays.  Hospitals have seen increased inpatient volume in part related to the change. It says some MA plans are ignoring the rule. MA plans will increase anticipated costs because of it.

#priorauthorization #medicareadvantage


Hospital Inflation Is Back

After a lull, it appears that hospital inflation, the usual leader and battling out with drugs for the top spot, is back.  A 7.7% increase in prices at hospitals was recorded last month — the highest in 13 years.

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#hospitals #healthcare #costs


States Pass Debt Retirement Initiatives

Many states are passing initiatives to use state funds to retire citizen’s medical debt for pennies on the dollar.

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#medicaldebt #healthcare


Exchange Growth Biggest In Non-Expansion States

The results make sense. The Kaiser Family Foundation finds that the biggest gains in the Exchanges have occurred in states that have not expanded Medicaid and had very high uninsured rates. I am not a purist.  I feel like subsidized Exchange coverage is perhaps as good as Medicaid.  But I feel for the people caught in the coverage gap in the ten states that have not expanded coverage.  That needs to be fixed.

#aca #obamacare #medicaid #exchanges


— Marc S. Ryan

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