careoregon Archives - Page 5 of 12 - The Healthcare Labyrinth

May 30, 2024

May 31, 2024 No Comments

Big Blue Highmark Sees Bad Trends in Medicare Advantage Pennsylvania-based Big Blue Highmark Health says it is seeing the same sort of Medicare Advantage (MA) trends other plans have reported. It sees increased utilization across inpatient and outpatient as well as rising costs of GLP-1 drugs. #highmark #medicareadvantage #weightlossdrugs https://www.fiercehealthcare.com/payers/highmark-health-seeing-medicare-advantage-and-glp-1-headwinds What Would GOP And Trump Healthcare Agenda Look Like? Many are readying for a new Trump administration and looking at what healthcare policy changes could occur. Many say that the GOP will not go for a full repeal of the Affordable Care Act (ACA), but that enhanced subsidies will die at the end of 2025. The GOP might not fully repeal Medicare drug negotiations, but tweak the law. Trump, too, could revive international reference pricing in Part B and perhaps in Part D. This is where Trump and Biden look a lot alike. The biggest changes could come with Medicaid,

May 29, 2024

May 30, 2024 No Comments

Clover Health Unveils Clover Assistant As SaaS Offering Congratulations to Clover Health by unveiling its Clover Assistant as a SaaS technology offering. Clover Assistant, now marketed as Counterpart Assistant, is available to Medicare Advantage (MA) payers and providers to improve outcomes and close care gaps. Additional article: https://www.modernhealthcare.com/insurance/clover-health-assistant-medicare-advantage (Some articles may require a subscription.) #medicareadvantage #clover #healthplans #providers https://www.fiercehealthcare.com/payers/clover-assistant-ai-tool-now-available-payers-providers New 340B Reform Bill Would Attempt To Return Program To Original Intent A new House Republican Bill would create major reforms to the 340B program. Hospitals of course are panning the proposal. But more and more studies show that hospitals are abusing the program by claiming discounts and then massively marking up drugs anyway. It is driving costs for inpatient care dramatically for individuals, especially those with cancer. The program was intended to ensure access to those with low incomes. #340b #hospitals https://www.fiercehealthcare.com/providers/house-republicans-new-340b-bill-pharmaceutical-industry-wish-list-hospitals-say AI Promotion and Regulation On Capitol Hill Docket

May 28, 2024

May 28, 2024 No Comments

Biden On Healthcare Attack In Election 2024 President Joe Biden is attacking former President Donald Trump on his healthcare stances and indicating he wants to repeal the Affordable Care Act (ACA). Polling shows Biden is better trusted on healthcare and this could help him in swing areas of the country. See my blog on this topic: https://www.healthcarelabyrinth.com/election-update-and-the-potential-role-of-healthcare-issues/ . (Article may require a subscription.) #election2024 #healthcare #aca #exchanges #medicaid #obamacare https://www.modernhealthcare.com/politics-policy/joe-biden-ad-aca-affordable-care-act-donald-trump-health-issues Calls For Medigap Reform New calls for Capitol Hill to reform Medigap coverage if someone wants to rejoin the traditional fee-for-service (FFS) program. Ideas include both guaranteed issue and community rating. Researchers want this coupled with solving for overpayments and enhancing the traditional program to fill gaps in the benefit. Additional article: https://www.healthaffairs.org/content/forefront/improving-access-medigap-beneficiaries-leave-medicare-advantage (Some articles may require a subscription.) #medicaresupplement #medigap #medicare #medicareadvantage https://crr.bc.edu/medigap-and-the-one-way-street-problem/ Sanders’ GLP-1 Criticism Has Injected Some Guilt Into Novo Nordisk Demark-based Novo Nordisk said it

May 27, 2024

May 27, 2024 No Comments

The major healthcare news services were off today for Memorial Day. Please check out the blog we published today on my modest proposal for healthcare reform: https://www.healthcarelabyrinth.com/a-modest-election-year-proposal-for-healthcare-reform/ — Marc S. Ryan

May 24, 2024

May 24, 2024 No Comments

Nursing Homes Sue On Staffing Ratios Nursing home associations are suing in federal court to overturn a new staffing ratio rule. The rule will lead to a massive consolidation in the industry and the loss of independent homes. Additional articles: https://www.modernhealthcare.com/providers/nursing-home-staffing-mandate-ahca-lawsuit and https://insidehealthpolicy.com/daily-news/nursing-homes-sue-cms-over-staffing-rule-aarp-backs-agency (Some articles may require a subscription.) #nursinghomes #staffing https://www.fiercehealthcare.com/providers/nursing-home-groups-file-lawsuit-block-cms-staffing-mandate More Layoffs At Highmark Highmark Health, a PA-based Blue, is undergoing a third round of layoffs. Additional article: https://www.modernhealthcare.com/labor/highmark-health-layoffs-engen (Some articles may require a subscription.) #healthcare #healthplans #layoffs https://www.beckerspayer.com/workforce/a-third-round-of-highmark-job-cuts.html House Budget Committee Rallies Around Consolidation Scrutiny And Site-Neutral Policies The House Budget Committee seems to have a bipartisan consensus on reining in hospital consolidations and mergers. As well, there seems to be consensus on the need to enact site-neutral payments. Hospitals will vigorously object and try to torpedo any bill. A bill to begin such policies passed the House but did not in the Senate. #hospitals #consolidations #mergers #manda

May 23, 2024

May 23, 2024 No Comments

Physician Pay Up; Docs Want Medicare Fix Physician pay increased by 5.9% in 2023 after dropping 2.4% in 2022. At the same time, physician groups were on Capitol Hill lobbying for a Medicare physician payment fix and more changes to prior authorization. Some indicated that it was hard to compete against hospital-owned docs because of higher payments. The independent docs want site-neutral payments implemented. Additional article: https://www.fiercehealthcare.com/providers/20-highest-paid-specialties-2023-doctors-see-6-boost-pay-doximity #physicians #rates #medicareadvantage #medicare #priorauthorization #siteneutral https://www.medpagetoday.com/practicemanagement/reimbursement/110302 Numerous Layoffs Hitting Healthcare Numerous layoffs are hitting healthcare. In the health plan world there have been notable layoffs, including at United’s Optum. UPMC’s health system is laying off as is Walmart in its soon-to-be-shuttered healthcare division. Additional articles: https://www.fiercehealthcare.com/finance/fierce-healthcare-layoff-tracker-highmark-axes-200-jobs-march and https://www.modernhealthcare.com/providers/walmart-health-layoffs-virtual-care-phoenix (Some articles may require a subscription.) #walmart #upmc #healthcare https://www.fiercehealthcare.com/providers/upmc-mckinsey-layoffs-organizational-restructure-university-pittsburgh-medical-center Express Scripts Embracing Independent Pharmacies In an effort to boost its image after bad press regarding pharmacy benefits managers (PBMs), Express Scripts is entering

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

May 20, 2024

May 20, 2024 No Comments

Optum Announces Transparent-Like Pharmacy Model Pressured by the rise of transparent pricing models, Optum Rx has announced its own approach to greater transparency. I would call it transparency-like. It is offering a single per member cost, encompassing retail, home delivery, specialty drug and rebate components. #transparency #pbms #optumrx https://www.fiercehealthcare.com/payers/optum-rx-puts-emphasis-predictability-new-pricing-model Health Plan CEO Compensation Fierce Healthcare assembles the top 5 in terms of health plan compensation in 2023. #healthplans https://www.fiercehealthcare.com/payers/unitedhealth-ceo-andrew-witty-was-2023s-highest-paid-payer-ceo-heres-what-his-peers-earned Government To Fund $50 Million For Cybersecurity The Department of Health and Human Services’ (HHS’) research funding agency will provide more than $50 million to developers who can build a scalable cybersecurity platform to protect hospitals for cyberattacks. Additional articles: https://www.modernhealthcare.com/cybersecurity/hhs-arpa-h-hospital-cyberattacks-unitedhealth-change-healthcare-ascension and https://www.healthcaredive.com/news/healthcare-cybersecurity-arpa-h-upgrade-program/716609/ and https://www.healthcareitnews.com/news/hhs-offers-50m-help-providers-patch-ransomware-vulnerabilities (Some articles may require a subscription.) #cyberattacks #healthcare https://www.fiercehealthcare.com/health-tech/hhs-arpa-h-offering-over-50m-hospital-cybersecurity-platform-pitches Senate Finance Joins HELP Committee In Wanting To Reform Medicare Doc Pay The Senate Finance Committee joins the HELP Committee in wanting to fix the Medicare physician payment

May 17, 2024

May 17, 2024 No Comments

Mental Health Inequities Have Huge Toll Inequities in mental health will cost $332 billion on premature death and $116 billion in productivity loss in 2024. These combined numbers could grow to $1.3 trillion by 2040. The inequities also mean greater healthcare spending. $5.3 billion in 2024 excess costs are tied to overutilization and excessive reliance on the emergency room for acute mental health incidents. That number could rise to $17.5 billion in 2040. #mentalhealth #behavioralhealth #healthcare https://www.fiercehealthcare.com/payers/mental-health-inequities-cost-478b-unnecessary-expenses-2024 Bipartisan Group Of Senators Want To Reform Retail Drug PA A group of senators want to further rein in and reform prior authorization (PA) for retail prescription drugs. The proposed bill has no details, but senators say they want to digitize PAs. Perhaps they don’t understand that Medicaid, Medicare Advantage, and Part D have some of the strictest turnaround times and there is a robust electronic PA process in America. (Article may require

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