Feb 12, 2018 | Legislation/ Budgets/ Macro
In late January, Amazon, Berkshire Hathaway, and JP Morgan announced a partnership that aims to improve employee satisfaction and reduce healthcare costs. But what – if anything – does this initiative mean for the healthcare sector? Click to read more.
Feb 9, 2018 | Legislation/ Budgets/ Macro
Congress has passed and the president has signed a 2-year budget deal for FY2018 and FY2019. The budget deal will also suspend the debt limit through April of 2019. The legislation does have an extensive healthcare title – albeit composed mostly of provisions of relatively lesser magnitude. This is likely to be the last major healthcare policy effort until after the mid-term election in 2018. Click to read more.
Feb 5, 2018 | MedPAC, Physicians
MedPAC annually reviews Medicare payment policies and makes recommendations to Congress. In this brief, we highlight MedPAC’s assessment of Medicare payments to physicians and other health professional services along with the commission’s recommendation to repeal the Merit-based Incentive Payment System (MIPS) and replace it with a Voluntary Value Program (VVP). Click to read more.
Feb 2, 2018 | Managed Care Friday
1. 50.7: The percent of women in medical school, up about 3% since 2010. There are about 21,000 enrollees today. Two of my three kids want to be physicians – one boy and one girl. The boy wants to be a dermatologist or doctor of physical therapy, having spent a good part of his freshman year in PT. The girl wants to be an APRN or family doctor back in her home country of Thailand. In either case, neither solve the physician shortage on their own but in a straw poll of 38 medical directors this week, 37 said the girl gets their vole for ‘adding more value’. If you are looking at investing in...
Feb 1, 2018 | Commercial Insurance, Medicare, Physician Fee Schedule
BRG analysis of Truven data found that commercial telehealth utilization grew from 2014 to 2016. While this growth was seen across service types, it was most significant in physician services. Geographic variation in utilization was observed, with the highest rates in Delaware, followed by New Mexico. Government payers are emphasizing telehealth as well, with expansions to Medicaid coverage, the recently passed VETS Act, and monthly MedPAC meetings in advance of a mandated telehealth report due to Congress in March.Click to read more.
Jan 31, 2018 | Medicaid, Medicaid Managed Care, Medicare
Beneficiaries eligible for both Medicare and Medicaid (i.e. dual eligibles) are among the highest-cost enrollees in both programs, and Federal and state policymakers continue to attempt to find ways to better coordinate care and control costs. In its sixth year of operation, the Financial Alignment Initiative has operated in 13 states, testing a model to improve beneficiary quality and access to care, while reducing spending for public programs. Given the high cost and complexity of this population, any program shown to reduce utilization and spending while maintaining or increasing enrollee...
Jan 30, 2018 | Medicare Advantage
Special Needs Plans (SNPs) are distinct from other Medicare Advantage (MA) plans in that only certain beneficiaries are eligible to enroll. Originally authorized in 2003 as a temporary program to encourage innovation in MA, SNPs have since been continually extended by Congress. The SNP program was designed to provide targeted care to high-need and high-cost Medicare beneficiaries, and beneficiaries can enroll or disenroll year-round, unlike enrollees in most other MA plans. Several recent trends and proposed changes affect the SNP model and may pose risks or opportunities. Click to read...
Jan 29, 2018 | Medicare Advantage
In the coming week, we expect CMS to release its Medicare Advantage (MA) Advance Notice for plan year 2019. In this brief, we will discuss the main topics included within the release and reference recent developments within MA. Click to read more.
Jan 26, 2018 | Managed Care Friday
1. 59: The fee in dollars BCBS of Massachusetts will pay for a standard medical tele-health visit, up $10 from last year. 2. OB Pre & Post Term Pay: Changes are likely for OBs both for pre-term and post labor payment. A number of managed care plan case managers, 42% in our poll of 136 of them in January, said they are looking into new depression screening type programs to support moms-to-be, particularly higher-risk pregnancy patients with diabetes or those with prior mental health conditions. The programs may address what one nurse manager called a rise of about 12% in pre-term births...
Jan 25, 2018 | 340B, Drugs, Hospitals
The Energy and Commerce committee released a report after two years of research into the operations and oversight of the 340B Drug Pricing Program. The report identifies several weaknesses in program administration and oversight. In this brief, we will provide an overview of the program, as well as the highlights from the committee’s report. Click to read more.
