Jan 12, 2024 | Managed Care Friday
2,005: The number of drugs excluded from the Big 3 PBM’s 2024 formularies. Caremark and Express Scripts both added more drugs while OptumRx’s list decreased slightly. CVS reported that 1.4% of its members will be affected by 2024 exclusions, which sounds like a small number, but in 2023 that number was only 0.28%. The other PBMs haven’t reported any numbers around patient impact. History of the Pre Auth: Pre-authorization seems to be disappearing faster than phone chargers in my house, but are the range of laws and policies to push insurers to curtail the practice really a big change at all?...
Jan 11, 2024 | BRG Publications
BRG researchers examined trends in commercial reimbursement across the nation to determine why variation in healthcare prices exist state by state. Using 2022 commercial healthcare claims data, BRG benchmarked commercial reimbursement for top services (CPTs 99214, 99203) against Medicare to see distribution of prices across the nation. To explain the variation in commercial prices, BRG investigated market dynamics of key states including provider consolidation, recent mergers and acquisitions, and payor landscape. Click to read more.
Jan 9, 2024 | BRG Publications
Results from a 2023 BRG poll of 130 people across 39 states and Washington, DC gives a sense of the pulse of the healthcare consumer three years post-COVID and highlights challenges faced by physician practices in the wake of rising inflation and staffing challenges. BRG researchers highlight how the use of extenders is becoming increasingly important to address some of these issues faced by both consumers and physician practices. Click to read more.
Jan 5, 2024 | Managed Care Friday
67: The percentage of hospitals where family practice doctors delivered babies, in a survey of 216 rural hospitals in 10 states. At 27% of the hospitals, they were the only physicians who delivered babies. Family doctors are heavily relied on for obstetric services in rural hospitals, and without them many patients would have to drive over an hour for care. With maternal mortality rates on the continual rise, rural areas are employing new strategies. For example, the University of Colorado’s College of Nursing received a $2 million federal grant this fall to train midwives to work in rural...
