agents Archives - Page 25 of 30 - The Healthcare Labyrinth

May 22, 2024

May 22, 2024 No Comments

Providers Lose 340B Lawsuit Appeal To Drug Makers A U.S. Court of Appeals ruled that drug makers can limit and impose conditions on pharmacies participating in the 340B drug discount program. The federal government had sided with providers, but a federal court ruled against that position. I am no friend of drug makers but this ruling is a good one. The 340B program has been corrupted and abused by providers. It is not fulfilling its mission of getting discounted drugs to the most vulnerable. Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/second-appeals-court-rules-drug-makers-can-impose-340b-restrictions (Some articles may require a subscription.) #340b #drugmakers #hospitals #providers https://www.healthcaredive.com/news/appellate-court-rules-drugmakers-340b-novartis-pharmacies-specialty/716814 Hospitals Attack Drug Makers On Price and Shortages — But Here Is The Other Story A new analysis by a hospital lobby says that drugmaker price hikes as well as drug shortages jeopardize patient access to care. I do not doubt the conclusion, but would also point out that hospitals abuse the system

May 21, 2024

May 21, 2024 No Comments

Wyden Wants Tough Stance On Exchange Agents and Brokers Finance Chair Ron Wyden wants the Centers for Medicare and Medicaid Services (CMS) to crack down on rogue brokers and agents in the nation’s Exchange signup process. (Article may require a subscription.) #exchanges #agents #brokers #fwa https://www.modernhealthcare.com/insurance/ron-wyden-cms-exchange-marketers-aca Huge Proliferation Of Firms Devoted Just To GLP-1s More and more startups are popping up to promote GLP-1 use just for weight loss. This caters to the better off. Hims and Hers has been around for awhile and is jumping on the bad wagon but by offering compounded versions, largely due to the shortages. The overall trend has been a disservice to the nation as it tends to create shortages for those who need the drugs for disease state treatment. A new analysis by Kaiser says high prices of such drugs also lock out those with modest incomes. Additional article: https://www.modernhealthcare.com/digital-health/hims-hers-wegovy-weight-loss-drugs-novo-nordisk-eli-lilly-zepbound (Some articles may

What The Recent Report On The Medicare Trust Funds Tells Us About Healthcare Policy

May 20, 2024 No Comments

Each year, the trustees of both the Social Security and Medicare Trust Funds issue reports about the fiscal health of the funds. The practice is meant to spark a public policy analysis within the executive and legislative branches, but it almost never does. This year is no different. The Biden administration touted the recent report on the extension of the solvency of the Medicare Part A Trust Fund as some sort of evidence that it has worked diligently to ensure Medicare’s future. In its election-year press release from Health and Human Services (HHS) Secretary Xavier Becerra, it touted supposed remarkable achievements on the Medicare stabilization front: “The Biden-Harris Administration has left no stone unturned in our efforts to strengthen and preserve Medicare, not just for our parents and grandparents but for our children and generations to come.” But nothing could be further from the truth. The administration and Democrats have

More Disturbing Trends On Medicare Advantage Prior Authorization

May 16, 2024 No Comments

In these pages I have bemoaned the fact that the Centers for Medicare and Medicaid Services (CMS) and Capitol Hill are taking the managed care out of Medicare Advantage (MA). MA’s value proposition is based on the plans’ ability to save dollars in furnishing traditional Medicare fee-for-service (FFS) benefits and passing on the savings in the form of reduced cost-sharing, filling in gaps in the traditional benefit, and adding additional benefits. But when CMS reins in the ability to save these dollars, it will have a direct impact on the benefits American seniors and people with disabilities see. What’s more, the antiquated FFS system is fraud-ridden and of poor quality. We need innovation not mimicking the old way of delivering care. But by hobbling MA plans’ innovation, CMS and Capitol Hill are setting MA and the overall healthcare system back. Driven by some strange need to ingratiate themselves to provider

Strong Growth From April to May In Medicare Advantage

May 13, 2024 No Comments

I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing strong month-over-month increases. While we are outside of the two regular annual enrollment windows, increases in MA are still strong given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes throughout the year. As I have reported, growth from January 2023 to January 2024 was a robust 8.7% increase or 2.674 million. Enrollment in MA reached 30.799 million in January. Since that time, enrollment has continued to climb: Enrollment in MA has now hit 33.985 million. The growth from January 1 to May 1 represents an additional 1.53% increase or 512,000 lives. MA enrollment has now increased beyond 51% of all Medicare beneficiaries. As we saw with January 2023 to January 2024, PPO growth now significantly outstrips HMO growth. From January 1 to May 1, HMOs

MA Plans Should Ready For Changes To Risk Adjustment Submissions?

May 9, 2024 No Comments

Provider groups, anti-Medicare Advantage (MA) advocates and researchers, and even the congressional policy arm MedPAC are busy attacking MA for supposedly being over-reimbursed. Depending on the study you find, these folks will tell you that MA is over-reimbursed by as much as $88 billion annually. Of course, many of these calculations are speculative and throw in policy decisions by Congress to make Stars funding additive as well as to pay some areas of the country more than the fee-for-service (FFS) rate to promote more benefit choice in rural areas. They argue that risk adjustment coding is out of control and that MA has beneficial selection compared with the traditional program. I have told you often in these pages that I come somewhere up the middle here. I discount the critics’ views and analyses. It is strange that critics’ overpayment estimates jumped from under $20 billion for so many years to

Health Plan Economics Part 4: Other Healthcare Trends And Their Economic Impacts On Plans

May 6, 2024 No Comments

This blog is the last of a four-part series on Health Plan Economics. In this series, I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 4 – Other Healthcare Trends And Their Economic Impacts On Plans We are at the end of our four-part series on health plan economics. This last installment is on some healthcare trends we see in the marketplace and how that impacts

Health Plan Economics Part 3: How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike

May 2, 2024 No Comments

This blog is part of a four-part series on Health Plan Economics. In this series, I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 3 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike Now that we have covered Medicare Advantage and the Exchanges, let’s move this week to what is happening in Medicaid managed care. Note that I base many of my

Health Plan Economics Part 2: How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances

April 29, 2024 No Comments

This blog is part of a four-part series on Health Plan Economics. In this series I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 2 – How The Lapse Of Premium Subsidies Could Hurt The Exchange’s Relatively Stable Finances I hope you are enjoying this blog series on health plan economics. Last week we covered some economics in the news right now for Medicare Advantage. This

Health Plan Economics Part 1: Medicare Advantage And New Rumors Of A Cigna-Humana Combination

April 25, 2024 No Comments

This blog starts a four-part series on Health Plan Economics. In this series I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchange’s Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 1 – Medicare Advantage and New Rumors of Cigna-Humana Combination I had not thought much about the failed Cigna-Humana combination since it fell apart late last year. But I was intrigued by Jeffries analyst who just reported that the math now may work again

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