November 16, 2023

CMS Changes Network Adequacy And Open Enrollment For State Exchanges

The Centers for Medicare and Medicaid Services (CMS) is mandating that State Exchanges follow federal network adequacy as well as open enrollment periods, among other changes.

#networkadequacy #cms #aca #exchanges #obamacare

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Commonwealth Fund Study Shows Impact of High Cost Healthcare System In The U.S.

Must read report from the Commonwealth Fund on the impact of our high costs in America on citizens’ access to healthcare. Commonwealth compares us to eight other countries and finds that Americans skipped medical care more often and had more problems handling or paying a bill. American adults face wider income-related disparities in healthcare affordability compared to adults in other high-income countries. This all links back to the fact that America is the only developed nation without affordable universal access to healthcare. It should be noted that other developed nations do much better than the U.S. on quality outcomes, regardless of the type of system they have: government-run socialized medicine, single payer, or private delivery with affordable universal access. In addition to the link to the Fierce Healthcare article, here is the link to the report itself: https://www.commonwealthfund.org/publications/issue-briefs/2023/nov/cost-not-getting-care-affordability-high-income-countries-survey . Note, too, that my book, available on this site, goes into great detail on America’s outlier status when it comes to high healthcare costs and low quality outcomes.

#healthinsurance #quality #affordability #healthcarereform #affordableuniversalaccess

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Humana Reports on Value-Based Care

Humana has invested significantly in creating value-based care arrangements and payments to its network providers. It regularly reports out on the initiative and indicates how it is demonstrably helping with better outcomes. The insurer released its 10th annual look and found that patients treated under VBC had better CAHPS survey results, are more engaged in preventive and primary care, and have fewer inpatient admissions and visits to the ER. Physicians reported better satisfaction, too. About 70% of Humana enrollees have physicians in VBC relationships with Humana.

#humana #vbc #medicareadvantage #valuebasedcare

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Congress Averts A Government Shutdown

The Senate bowed to the will of new House Speaker Mike Johnson, R-LA, by passing his laddered approach to funding the government in the short-term. The measure will keep the government funded at 2023 levels. The bill extends funding until Jan. 19 for the Veterans Affairs, Transportation, Housing and Urban Development and Energy departments, as well as for military construction. The rest of the government is funded until Feb. 2.

#governmentshutdown #speakerjohnson

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Kaiser Family Foundation Briefer on Long-Term Care

As a follow-up to the launch of the KFF/NYT series on long-term care (LTC or LTSS), the Kaiser Family Foundation (KFF) has published ten things you should know about LTC/LTSS in America. Great analysis for everyone. A common misperception people have is that LTC/LTSS is covered by Medicare. But that is only for short stays related to a medical event as you are recovering and there are limits to the benefit. Chronic long-term care is not covered. You either pay on your own (if you can afford it) or go on to Medicaid (which means you largely spend down your assets). KFF says that there is a wide disparity in states as to the availability of alternatives to nursing home institutionalization (e.g., home care, assisted living, etc.)

#ltc #ltss #medicaid #kff #longtermcare

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— Marc S. Ryan

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