Managed Care Friday

Oct 23, 2020 | Managed Care Friday

1.1B: The amount of money Highmark's True Performance value-based reimbursement program saved in healthcare costs. The savings were related to ED visits and hospitalizations and were generated from 2017-19. About 2M Highmark members see a primary care doctor through the True Performance program. Payer results in value-based care vary - one Blue plan told us they lowered cost of care by about 3%, Aetna and Cigna somewhat less, while United has saved more (7-9%). In one example the plan saved $1.5M via value-based design (which they describe as not a lot of money), keeping about $1M of that....

Nearly 2M Years of Life Lost Since COVID-19

Oct 22, 2020 | Legislation/ Budgets/ Macro

BRG collaborated with Health Care Cost Institute (HCCI) to estimate the impact of COVID-19. A new report, published by HCCI, found that between April and August, 1.9 million excess years of life have been lost. Despite lower COVID-19 mortality rates, working age adults 20-64 account for 47% of excess years of life lost. Click to read more.

Weekly Medicaid Update

Oct 21, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: •  GA: CMS approves waiver allowing adults who are ineligible for Medicaid to buy into Medicaid coverage, upon meeting certain criteria •  IL: State announces implementation plans for new community-based services for children with complex behavioral health needs • WA: State announces plans to return rates to pre-pandemic levels for certain services Click to read more.

Ambulance Prior Authorization Expansion and New Ambulance Demo Launch

Oct 19, 2020 | Ambulance, Ground, Medicare

Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization(RSNAT) Model: CMS announced the expansion of this model nationwide. The RSNAT model has saved CMS $650 million over the past four years, with analysts suggesting the improper payment rate for non-emergent ambulance transport declined 4% from 2017 to 2018. CMS did not find any evidence of the RSNAT model impacting the quality of care in a negative way. Click to read more.

ESRD Treatment Choices Model Finalized for January 2021 Start

Oct 19, 2020 | ESRD, Medicare

ETC Model Begins in 2021, Encourages Home Dialysis and Transplant Use CMS has released the final rule for the ESRD Treatment Choices (ETC) Model, which will begin on January 1, 2021 and run through June 30, 2027. The model aims to expand the use of home dialysis and kidney transplants by providing additional financial incentives for providers in select geographies. Model participation is mandatory to limit adverse selection for financial gain. Click to read more.