November 7, 2023

The Healthcare Labyrinth Newsfeed Debuted This Week

Welcome to The Healthcare Labyrinth Newsfeed! Each weekday, I will review about two dozen healthcare websites for the most relevant information in the world of healthcare generally as well as managed care and health insurance specifically.

You can access the daily newsfeed in a few ways.

1 — Save this link in your favorites and visit each day

2 — If on LinkedIn, click on my daily post about the newsfeed and you will be redirected here.

3 — In the future, we will launch an email subscription (free) and we will email you each day on the newsfeed and other website activities.

Here is the rollout of the new Healthcare Labyrinth website:

November 6 — Newsfeed Debut

November 13 — Blog Debut

November 27 — Podcast Debut

I hope you enjoy the website and newsfeed.

Take care,


Harvard Study Shows MA Outcomes Better than FFS

Harvard study underscores what other studies do — that Medicare Advantage (MA) is better for the nation than traditional fee-for-service (FFS) as beneficiaries have better quality of care and health outcomes. MA enrollees experience 70% fewer readmissions than fee-for-service beneficiaries and 24% fewer preventable hospitalizations, primarily driven by 59% fewer preventable acute hospitalizations. “The study provides strong evidence that care management and coordination are key to better outcomes,” said Boris Vabson, health economist at Harvard Medical School and co-lead researcher on the project. Further a statement said that: “While recent reforms such as the introduction of accountable care organizations (ACOs) have attempted to improve Medicare care management, our research shows additional steps are needed to improve care coordination and quality of care under fee-for-service Medicare.” Lower use of high-risk medications was also seen. Earlier studies showed lower ER and hospital utilization as well.

This is dynamite stuff for MA. Continues to underscore the value of MA. Plans must use this to counter all the negative things going on in the MA world.

#medicareadvantage #medicare

Link to Article

More On New 2025 MA and Part D Rule

I have read the final regulation and accompanying documents for the draft 2025 MA and Part D rule. I will cover this in-depth in my first Healthcare Labyrinth Blog on 11/13. The link below has additional details from Fierce Healthcare on the rule. The CMS Fact Sheet is at: https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare . If you have a subscription to Inside Health Policy, great coverage here as well: https://insidehealthpolicy.com/ .

In summary, the rule does the following:

1 — Overhauled agent compensation

2 — Network requirements change for behavioral health

3 — Supplemental benefits oversight

4 — Health equity requirements for UM

5 — QIO appeals for additional services

6 — Duals and LIS SEP reform to promote enrollment in integrated SNPs

7 — RADV process changes

8 — Reining in D-SNP look-alikes

9 — Promotion of biosimilars

#medicareadvantage #partd #pdp #partc #snp #biosimilars #radv #healthequity

Link to Article

Health Officials Spar Over Drug Price Reform

Current HHS Secretary Xavier Becerra defended Medicare price negotiations against an attack by Trump HHS Secretary Alex Azar. Azar claimed it was price fixing and would cripple innovation. Drug industry studies say this, but most others do not show a huge impact on innovation. Remember Azar was once part of the drug industry. Bizarrely, Azar credited Trump with proposing international reference pricing for Part B drugs. That would not constitute price fixing in his view? It actually is a reasonable process as part of drug negotiations. Anyway, while I am a Republican, I support Becerra on all this. The drug market is not a free market. We need to lower costs/price, pivot to wellness and care management, and ensure affordable access to healthcare coverage. Then we will see costs go down and outcomes go up. Right now, we spend the most in the developed world as a percentage of gross domestic product and have the worst quality.

#medicare #partd #drugpricing #healthcarereform

Link to Article

CVS CEO Outlines Agenda

CVS CEO Karen Lynch outlined a good agenda for CVS today. She is right to be all-in on value-based care and with Oak Street. I continue to believe retail meeting healthcare is a wise investment, despite some notable risks we have seen in the market. Despite the demise of Olive, Lynch is also all-in on AI if it is a smart investment. Health equity is also key for her.

#cvshealth #ai #vbc #valuebasedcare #retailhealthcare

Link to Article

10M Have Lost Medicaid Coverage Through Renewed Redeterminations

The Kaiser Family Foundation reports that over 10 million have now lost Medicaid because redeterminations have been unfrozen with the end of the COVID pandemic allowances. Most of these folks have lost coverage on administrative grounds. Disenrollments are trending very high just six months in. While some will gain coverage again in Medicaid or get coverage in CHIP, in the Exchanges or with employers, our uninsured rate will increase when all is said and done.

#medicaid #redeterminations

Link to Article

Some Good News on ACA And Perhaps Medicaid

While the ACA open enrollment is just kicking off, health plans are stating that enrollment in the Exchange line is doing well overall. And while there will be losses in Medicaid, plans are saying that 20% to 30% of people who lost coverage are regaining it. (May require subscription.)

#medicaid #aca #exchanges #obamacare

Link to Article

Site Neutral Payments Would Save On Out-of-Pocket Costs

Wakely Consulting concluded a tremendous study on site neutral payments. Wakely found that beneficiaries in eight studied disease groupings would experience significant savings, sometimes thousands of dollars, in out-of-pocket cost-sharing if site neutral policies were in force. Site neutral is simply paying the same rate across different ambulatory settings for those services deemed safe and appropriate to be performed in all settings. Hospitals and other entities often are paid far too much for these services that could be performed at lower-cost settings. As Wakely notes, it is not just about saving money overall but helping people burdened with heavy cost-sharing requirements. Usually more expensive settings have higher cost-sharing requirements.

#siteneutral #hospitals #healthcarereform

Link to Article

— Marc S. Ryan

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