longtermcare

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May 29, 2024

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

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May 28, 2024

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

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May 27, 2024

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

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A Modest Election-Year Proposal For Healthcare Reform

In a recent blog, I made the case that Election 2024 will come down to a handful of states and districts/counties deciding both  the presidency and control of the House of Representatives. In the Senate, almost every competitive race has an incumbent Democrat or open Democratic seat.  Everything would have to go right for them to maintain control of the Senate. I also stated that I think healthcare could be a bit of a sleeper issue even though it theoretically ranks low on the list of Americans’ priorities this year. I say theoretically because pocketbook issues do rank high and healthcare is a key component of that. More important, these swing states and areas tend to have independents and more moderate voters who will decide outcomes. They may indeed prioritize healthcare more than the rest of the nation. See my recent blog at this link for my election analysis and

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May 24, 2024

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

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May 23, 2024

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

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Election Update And The Potential Role of Healthcare Issues

While healthcare has been displaced by other economic issues and immigration as the compelling Election 24 issues of the day, I have taken the position that healthcare could very well play a role in this year’s election outcome. How so? How close is it? Let’s take a look at how close things are for the presidency and the houses of Congress. For reliable forecasts on elections, I always go to at RealClear Politics. It is very reliable and unbiased.  I also like the fact it uses polling averages to determine the current prospects of various political contenders. In addition, I have a special connection as its publishing arm, RealClear Publishing, was one of the publishers of my book, The Healthcare Labyrinth (available via this site). I went to RealClear Politics for the presidential and Senate races and looked at a few other sources for the House races. Presidential race –

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May 22, 2024

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

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May 21, 2024

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

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May 20, 2024

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

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