#bluesplans

HHS Issues Cybersecurity Rule The U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), issued a proposed rule to improve cybersecurity and better protect the healthcare system from cyberattacks. The proposed rule modifies the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. It requires health plans, healthcare clearinghouses, most healthcare providers, and most business associates, to strengthen cybersecurity protections against external and internal threats. It requires updates to existing cybersecurity safeguards, using modern best practices, to reflect advances in technology and cybersecurity. It provides greater detail on what covered entities and business associates need to do to protect the security of electronic protected health information (PHI). Policies and procedures would have to be in writing, reviewed, tested, and updated on a regular basis. Specifically, HHS says the rule reacts to: The rule is in response to growing cybersecurity incidents, including the

Wakely Finds VBID Sunset Could Impact Medication Adherence Rates Many Medicare Advantage (MA) proponents have said that the sunset of the Value Based Insurance Design (VBID) in Medicare Advantage (MA) as of 2026 could have impact on outcomes and complicate affordability of healthcare for beneficiaries. Wakely Consulting, an actuarial and consulting firm, has found that this could be true in the area of medication adherence. Plans have used the VBID program to target waiver of pharmacy cost-sharing for low-income (LI) beneficiaries. These are the same targeted individuals in the new Health Equity Index (HEI) rolling out in Star Year 2027. Wakely found that medication adherence for diabetes, hypertension, and hyperlipidemia could be impacted if the cost-sharing waivers disappear. The analysis found that removing copays on maintenance medications improved beneficiary adherence, which is tied to improved quality of care and health outcomes. These are three key star measures in the Part

What More Could The CMS Actuary Do For Its Annual Healthcare Spending Report? Interesting Health Affairs Forefront Blog on what more the Centers for Medicare and Medicaid Services (CMS) Actuary could do in terms of analysis of National Healthcare Expenditures Data (NHED) each year. As the author notes, there are some crucial missing pieces that could aid analysis and reform. (Article may require a subscription.) #nhed #cms #healthcare #spending https://www.healthaffairs.org/content/forefront/beyond-national-health-expenditure-data-three-things-wish-were-better-measured Fierce Healthcare’s Top 10 Payer Stories of 2024 Fierce Healthcare has issued its article on the top ten payer stories of 2024. The events include the Change Healthcare breach, numerous financial woes and cutbacks at major plans, the UnitedHealthcare CEO shooting, and Cigna selling its Medicare Advantage (MA) line. I will have my normal year-end wrap up and predictions soon at the blog tab. #healthcare #2024 #healthplans https://www.fiercehealthcare.com/payers/editors-corner-fierce-health-payers-top-10-stories-2024 Multiplan Reaches Debt Refinancing Deal Healthcare analytics company Multiplan reached an agreement

CMS Pushing Streamlining Of Quality Measurement Interesting article on the Centers for Medicare and Medicaid Services’ (CMS) push to streamline quality metrics across programs. Its approach, called the Universal Foundation, is meant to ease complexity, burden, and the administrative costs on providers and health plans by establishing standardized metrics and financial incentives. Right now, CMS has about 20 measure sets that encompass hundreds of discrete measures. I certainly endorse standardization and streamlining, but migrating to the Universal Foundation will take years. Further, given differences in demographics, we will always have some unique measures in each program. But standardizing Accountable Care Organization (ACO) and Medicare Advantage (MA) measures would be a great place to start. (Article may require a subscription.) #quality #stars #acos #medicareadvantage #cms  https://www.modernhealthcare.com/policy/cms-universal-foundation-quality-data-reporting-measurement What Might HHS Look Like Under RFK Jr. An interesting article on what might occur under the Trump administration as Robert F. Kennedy Jr. pursues