Jan 3, 2020 | Managed Care Friday
39: Percent of insurers, up from 14% last year, who will focus on adjusting or trying to ‘rework’ value/shared savings contracts given first wave of contracts are ‘too easy’ to hit targets for. Results published in the upcoming Managed Care Investment Index. ENT's Balloon: A number of insurers are updating policies for balloon procedures done by ENTs to address chronic rhinosinusitis. Starting this year, several Blues will require a full course of treatment for all of the following before considering balloon dilation: nasal lavage, intranasal corticosteroids, and antibiotic therapy if the...
Dec 30, 2019 | Legislation/ Budgets/ Macro
The 5th Circuit Court of Appeals has affirmed a District Court ruling that the individual mandate detached from a tax penalty is unconstitutional as it violates the commerce clause of the US constitution. The court did not affirm the lower court decision to void the entire ACA, instead directing the lower court to reconsider how to sever the mandate from the larger law. This ruling has no substantive impact as the mandate is not being enforced and the court ruling is stayed pending further action on the case. Click to read more.
Dec 20, 2019 | Managed Care Friday
1. New #1: Primary care moves up 9 spots to become the top priority in our 2020 Managed Care Investment Index, results to be released in January. Telehealth, for all its critics, jumps 15 spots to #3 as part of a move to use it as a triple threat: interceptor of care, diverter and treatment. ‘We had been missing the point of tele for a lot of years. It’s a better way to do network steering,’ says Charles Bright, network relations for BCBS. Infusion, a staple in the top 20 recently, moves into the top 5, while PT, which had slipped, moves into the top 10. The changes are generally good...
Dec 18, 2019 | Medicare, Medicare Advantage
CMS released the expected inflation factor for Medicare per capita costs in 2021, which is one of the major components used for determining Medicare Advantage (MA) benchmarks. Click to read more.
Dec 17, 2019 | Hospitals, Medicare, Payers
In November 2019, CMS finalized policies in support of President Trump’s June executive order to establish greater price and quality transparency for the nation’s hospitals. Under the final rule, hospitals would be required to publicly post standard charge information beginning in 2021, although we expect lawsuits that could delay or change the rules. Click to read more.
