partd Archives - Page 29 of 29 - The Healthcare Labyrinth

2024 Star Ratings Turmoil Creates Huge Vulnerability for Medicare Advantage Plans

November 16, 2023 No Comments

While the Medicare Advantage (MA) Star Program has always made it difficult for plans to achieve and maintain high Star scores, the Star roller coaster ride has been much more profound over the past several years. We now have had two years of pretty bad news, which puts a blemish on the program (fair or not). What’s more, the percentage of high-scoring contracts and the percentage of enrollment in them are now below pre-COVID years. To refresh a bit on this, during the COVID pandemic, the Centers for Medicare and Medicaid Services (CMS) created fairly major calculation allowances for both Star 2021 (2019 and 2020 data) and 2022 (2020 and 2021 data). These allowances had the effect of boosting Star scores. We saw a surge in Star scores in 2022, including for plans that historically did not have a great track record of consistently hitting 4 Stars and above. However,

November 15, 2023

November 15, 2023 No Comments

Great Series on America’s Long-Term Care Problem Congratulations to the Kaiser Family Foundation and The New York Times on the first in a series of articles on America’s long-term care crisis. America needs an aging policy. The series shows real-life examples of the impact of not having a national agenda on aging. It clearly shows that the lack of adequate supports for the elderly also impacts other generations, including children’s loss of income to take care of an elderly loved one. In my book (available for purchase on this website), I devote a chapter to aging and recommend ways to make services available to all in an income-based buy-in strategy. Not addressing aging will only drive long-term care and medical costs even higher in the future. In addition to the NYT story and press release at the link below, here is a link to the KFF summary of a survey

November 14, 2023

November 15, 2023 No Comments

Health Tech Still Growing Despite some notable failures in the health tech world and tightness in equity markets, deals and mergers continue. Two notable examples in this article. #digitalhealth #healthtech Link to Article Kaiser Sees Deep Drop in Star Scores Kaiser Permanente saw deep drops in its Medicare Advantage Star scores for 2024, with four of its seven plans losing out on bonus payments (dropped below 4 Star). The CMO of Kaiser discusses this in the article below. Plans big and small suffered the past two years (2023 and 2024 Star Years). While achieving and maintaining high scores has always been a challenge, that a strong integrated system’s plans was a victim speaks volumes. You could always count on most Kaiser plans to be 5 Stars. Weighting, statistical changes, and new complex measures are catching plans by surprise. Based on the Stars road map, this will continue. Plans need data-driven

November 13, 2023

November 13, 2023 No Comments

Startup PBMs See Growth in Price Transparency A series of startup PBMs are seeing some success signing up health plans by riding the price transparency train. They have even set up their own trade group to differentiate themselves from traditional PBM lobbying efforts. An interesting development, but one that will take time to break the dominance of the three giants, which control about 80% of all the business. (may require subscription) #medicareadvantage #commercial #medicaid #pbms #pricetransparency Link to Article Health Affairs Forefront Blog on FDA Process I am a notable critic of the FDA. I see it as a revolving door agency (FDA to brand PhRMA and back again) and dominated by pressure from the drug industry to approve drugs that are not often ready for launch. In fairness to the FDA, here is a good article on the process and challenges FDA has, including from advocates. (may require subscription)

Major Changes in Medicare Advantage Oversight

November 13, 2023 No Comments

The Centers for Medicare and Medicaid Services (CMS) have been active this year proposing major new restrictions on Medicare Advantage (MA) plans. Many of the changes are in reaction to provider lobbying efforts on Capitol Hill as well as public outcry over misleading tactics by third-party entities who enroll individuals in the popular senior and disabled plans. Let’s start out with the changes effective January 1, 2024, from the 2024 MA and Part D rule finalized earlier this year. It is important to note that CMS issued a memo that states that it will enforce the 2024 rule beginning January 1, 2024. Usually, such rules are enforced through the regular program audit process and it takes a number of years before regulatory changes are rolled into the audit protocols. That seemed fair as major changes take time for plans to implement. But in the October 24, 2023, memo issued through

November 10, 2023

November 10, 2023 No Comments

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 or December 4 — Podcast Debut I hope you enjoy the website and newsfeed. Take care, Marc BCBSA

November 9, 2023

November 9, 2023 No Comments

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, Marc Medicare Advantage Plans and

November 8, 2023

November 8, 2023 No Comments

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, Marc Best Buy Health and

November 7, 2023

November 8, 2023 No Comments

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, Marc Harvard Study Shows MA

November 6, 2023

November 1, 2023 No Comments

The Healthcare Labyrinth Newsfeed Debut 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, Marc CMS Is Strengthening Hospital Price Transparency