Jan 20, 2023 | Managed Care Friday
28: Amount of market share on average that commercial payers say you probably need to have a fighting chance at leverage in reimbursement rate negotiations. The number varies by sub-sector and service and definitely geography. More recently payers are trying to hold the line on increasing rates, only allowing them if you are performing well, particularly around where you refer and how you treat. For instance, an OBGYN practice in the South has a high postpartum care and colorectal screening rate – 95% better than everyone else – and credentials all of its mid-levels with the payers, a...
Jan 17, 2023 | Medicare Advantage, Part D, Payers
CMS has issued a proposed rule for MA and Part D policy for the 2024 plan year and later that includes proposals related to coverage policies, prior authorization requirements, Star Rating calculations, behavioral health, and health equity. Click to read more.
Jan 13, 2023 | Managed Care Friday
1,000: The approximate number of deaths prevented by a naloxone vending machine, according to a recent study published by the University of Cincinnati and Caracole. The vending machines are placed outside a targeted naloxone distribution and syringe service program. Anyone can access the program’s counselors as well as two injectable doses and two nasal spray doses of naloxone, a sharps disposal kit, kits for safe injections, smoking, and sex, as well as a pregnancy test, PPE and a box of bandages every seven days. 637 individuals registered for the program in the first year, 12% of them...
