Aug 28, 2020 | Managed Care Friday
23,500: The number of Blue Shield of California members reporting weight loss, reduced stress, and even chronic condition reversal, under a program from non-profit digital app platform Wellvolution. In the program's first year, nearly half of diabetics who signed up for a digital app like Digbi or Betr experienced disease reversal, like normalized A1C. Emily Morales, 33, an intake therapist in Pasadena, stopped eating a meat-heavy European diet after getting gut-biome and genetics results. Elementary teacher, Abebi Bain, 47, says she was eating foods that were aggravating her asthma and...
Aug 25, 2020 | BRG Publications, Drugs, Medicare
Medicare Part B provides access to a limited but important range of drugs and biologicals administered in a physician’s office or other outpatient setting. Policy makers have scrutinized the separate payments that Medicare makes for Part B drugs based on rising aggregate and per capita spending. This report describes the geographic variation of Part B drug utilization across the United States using Core-based Statistical Areas (CBSAs) and examines potential drivers of these utilization differences. Click here to read the report.
Aug 21, 2020 | Managed Care Friday
134: The number of physicians who have begun to offer medication assisted treatment (MAT) for opioid use disorder in Michigan, under a plan’s new initiative. At least one new primary care provider is delivering MAT in 31 Michigan counties since the program started last fall. Specialty Pay per Episode: We are starting to see more examples of global-risk primary care medical practices setting up an episodic payment arrangement with one referral partner per specialty as a way to limit cost and improve outcomes when they have to refer. “If it’s a specialist we need who might need to see the...
Aug 20, 2020 | Medicare Advantage
On August 4, the DOJ alleged violations of the False Claims Act that resulted in overpayments to a national Medicare Advantage plan of over $1.4 billion. The alleged fraudulent diagnoses were submitted based on a health risk assessment that the plan implemented through contracted vendors, which are also named in the suit. Click to read more.
