weightlossdrugs Archives - Page 16 of 19 - The Healthcare Labyrinth

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

January 3, 2024

January 3, 2024 No Comments

Aggressive Agenda for Healthcare on Capitol Hill Good article on all the healthcare priorities for 2024. This tracks very closely to my predictions for 2024 blog ( https://www.healthcarelabyrinth.com/channeling-nostradamus-the-healthcare-labyrinths-2024-predictions/ ). As I noted, a continuing resolution (CR) or other funding bill must pass soon to keep healthcare agencies open. As well, the article says that price transparency reporting, PBM reforms, and site-neutral payments are on the agenda. Note the reference to the long shot possibility of Medicare Advantage (MA) payment reductions. Troubled by prior authorization and overpayment headlines, Congress could take a bite out of rates for MA plans. This was also a possibility I raised in my predictions. There is also the issue of physician fee cuts in Medicare. (Article may require a subscription.) #transparency #pricetransparency #governmentshutdown # crs #siteneutral #pbms #medicareadvantage #medicare #overpayments #providers #rates Link to Article FDA Approvals Up FDA approvals of new novel drugs are up.

January 2, 2024

January 2, 2024 No Comments

KHN Series On Rural Healthcare Crisis Good article from Kaiser Health News on the rural healthcare crisis. It tackles how primary care doctors may be able to help with the maternal healthcare crisis. #ruralhealthcare #healthcare Link to Article More States Cover Illegal Immigrants’ Healthcare This was surprising to me. Eleven states and Washington, D.C. provide full health insurance coverage to more than 1 million low-income immigrants regardless of their legal status. Most are in California, but even Republican Utah is getting into the act. Coverage is expected to almost double by 2025. In this other article, ABC News reports that CA becomes first state to offer full health benefits to all immigrants regardless of status: https://abcnews.go.com/Health/california-1st-state-offer-health-insurance-undocumented-immigrants/story?id=105986377 #immigrants #coverage #healthcare Link to Article Drug Price Hikes Coming As happens each January, drug makers plan to raise prices in the United States on more than 500 drugs, according to data analyzed by

January 1, 2024

January 1, 2024 No Comments

Happy New Year! The Healthcare Labyrinth Newsfeed is off January 1. We wish you a very Happy and Prosperous New Year! You can read previous Newsfeed entries at the Newsfeed page. Visit out Blog page for the latest Blogs. Also visit Spotify for The Healthcare Labyrinth Podcasts. Search “healthcare labyrinth.” We now have three posted. Stay tuned for our predictions blog coming out tomorrow. Read our year-in-review blog already posted first. As well, our podcast this coming Friday will summarize 2023 healthcare events and go into predictions. — Marc S. Ryan and The Healthcare Labyrinth Website

December 29, 2023

December 29, 2023 No Comments

Devoted Health Has Successful Funding Raise Kudos to Devoted Health for its successful Series E funding raise. Devoted has been one of the few very successful insurtechs. It has excelled in the Medicare Advantage (MA) market as a startup. Run by career veterans with discipline, it is giving big plans a run for their money in some markets. Devoted’s record is very different to some of the other insurtechs, who cratered this year or are performing poorly. (Article may require a subscription.) #insurtechs #devotedhealth #medicareadvantage Link to Article Buchanan Right On Scoring Reform Rep. Vern Buchanan, R-FL and chair of the Ways and Means health subcommittee, wants a bipartisan group of lawmakers to work on legislation to revise the Congressional Budget Office’s (CBO) scoring techniques to include long-term savings from preventive healthcare. Others have backed changes too. Without getting into the technical details of CBOs methodology (I often see it

December 28, 2023

December 28, 2023 No Comments

Retailers Targeting Senior Populations In Primary Care Investments Good article showing why retailers are targeting seniors for their primary care initiatives. Retailers are interested in the potential financial arrangements (risk funds) that Medicare Advantage plans are focusing on. In addition, the seniors will tap other important features of their offerings, including pharmacies. (Article may require a subscription.) #retailhealthcare #medicareadvantage Link to Article Rural Hospitals Cite MA For Plight As Medicare Advantage (MA) grows, rural hospitals are saying that MA is responsible at least in part for their financial plight. The argument is that even if MA plans pay traditional Medicare rates, they are getting so much less due to claim denials. The net is not the same. In addition, you have the wait time to get paid. This may be true in part, but I ask whether there is not waste and abuse in what the traditional system pays. Just

December 27, 2023

December 27, 2023 No Comments

Healthcare Lawsuits To Watch in 2024 Good article on the healthcare lawsuits to watch in 2024, including many challenging the Inflation Reduction Act’s (IRA) Medicare drug price negotiations as well as preventive service mandates in the Affordable Care Act (ACA). #aca #ira #exchanges #obamacare #drugpricing Link to Article Lower Quality When Private Equity Firms Acquire Hospitals There is a lot of good data on hospital combinations leading to higher costs and no improvement in quality. This study points to a rise in adverse events after a private equity takeover of a hospital. This is despite the pool of lower risk patients in PE targeted hospitals. Additional article here: https://www.medpagetoday.com/publichealthpolicy/practicemanagement/108014 #mergers #acquisitions #hospitals Link to Article Insurtech Overview In 2023 Interesting review of insurtechs in 2023. In general, insurtechs have been a huge disappointment for investors over the years and the companies have failed to make important gains in the market.

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