Feb 9, 2024 | Managed Care Friday
99: No, not the number of red balloons one guy is sending his girlfriend on Valentine’s Day, but the amount in dollars that it costs out of pocket for a coronary CT calcium score test that gives PCPs and cardiologists a window into heart attack risk, but insurers basically do not cover the test, which 84% of cardiologists we polled find absurd. “It’s a baseline and an important one – it shows the amount of hardened plaque and guides treatment, particularly for those in their 50s,” one cardiologist said. Insurers may argue about its utility and value, as it typically kicks off other tests...
Feb 6, 2024 | BRG Publications, Medicaid
BRG's 2023 Medicaid Policy Review focuses on recent Medicaid initiatives addressing the nonmedical factors affecting beneficiaries' well-being or health-related social needs. This report highlights CMS guidance to fund nonmedical benefits through existing authorities and programs in three states - California, North Carolina, and Pennsylvania. Click to read more.
Feb 5, 2024 | BRG Conference Call Replays, Medicare, Medicare Advantage
Conference Call | Wednesday, February 7, 1:00 PM ET Join BRG experts, John Barkett, Misha Segal, and Ruth Tabak, to discuss CMS’s recent announcement of preliminary Medicare Advantage rate updates for 2025 and other policy and market trends that affect the MA outlook for 2024 and 2025. The call will end with an open Q&A for all participants. Please register in advance of the Zoom call. Following registration, you will receive a confirmation email containing information about joining the meeting. Pre-register here.
Feb 2, 2024 | Managed Care Friday
140,000: The number of Tyson Foods employees who will now have their pharmacy benefit managed by PBM Rightway, as the company announced plans to drop Caremark. Rightway says it can guarantee employers savings of 15% on pharmacy benefit costs. Rightway will be one of the first PBMs to work with a Fortune 100 company. Unlimited Labs: As of January 15, Cigna removed annual limits for presumptive and definitive drug testing. Pre-Natal Nonsense: In interviews with a handful of Medicaid MCOs, each said they continue to struggle to find ways to get newly pregnant beneficiaries to use an OBGYN for...
Jan 30, 2024 | BRG Publications
Quarterly Compliance and Program Integrity Developments: The Departments of Justice and Health and Human Services announced several enforcement actions. Click here to read more.
Jan 30, 2024 | Medicaid, Medicare, MedPAC
MedPAC & MACPAC: MedPAC updated mandated reports for Congress and MACPAC shared reports on Medicaid HCBS and school-based services. Click here to read more.
Jan 26, 2024 | Managed Care Friday
55%: The portion of rural hospitals that don’t offer maternity care, according to a new report for the Center for Healthcare Quality. And in 10 states, that portion is more than two thirds. More than 200 rural hospitals have stopped delivering babies over the past decade, leading to increased travel times for expecting mothers, and often poorer outcomes. Staffing Pivot: A new initiative funded by Bloomberg Philanthropies is pairing high schools with health systems, setting up students with guaranteed jobs in the healthcare sector. The first partnership is between a public school in Boston...
