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November 22, 2023

November 22, 2023 No Comments

CMS’ UM Rule for Medicare Advantage Already Being Debated The new CMS 2024 Medicare Advantage (MA) rule prohibiting the use of most evidence-based criteria by MA plans is already being debated. Hospital lobbies are saying plans are out of compliance and January 1 has not even hit yet. Read my new companion blog at the blog tab on this site. I tell you why this rule is a terrible idea. Additional article here: https://www.modernhealthcare.com/politics-policy/health-plans-2024-medicare-advantage-rule-aha-cms-unitedhealthcare #hospitals #medicareadvantage #medicare #ncd #lcd #priorauthorization Link to Article Interesting Article on Cancer Care Between MA and FFS Interesting study on cancer care differences between MA and FFS. Touches on prior authorization and networks. Something for MA plans to think about as the PA debate heats up and the new UM rule comes unto effect. #medicare #medicareadvantage #cancercare #priorauthorization #networkadequacy Link to Article FL Blue Using AI to Speed Authorizations While many plans are being criticized

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November 21, 2023

November 21, 2023 No Comments

Out For Blood Is Right: Great Example of Outrageous Prices And The Need For Reform Kaiser Health News, the healthcare news aggregator, also does tremendous original news stories. One of its series is “Bill of the Month,” where it features one person’s heartache related to a recent healthcare bill. In this article, KFF intervened to get the patient’s bill cancelled, but she is among the lucky ones. It is also important to remember that not all surprise bills you receive will suddenly go away under the No Surprises Act. This surprise bill was from an in-network provider (hospital), which was charging outrageous lab fees on everyday tests. The health plan negotiated a poor discount and the patient’s plan had the insured covering a percentage of allowable costs. The article touches upon the need for site neutral payments to lower costs in the system and protect consumer’s from high costs. Why

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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

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