Apr 7, 2023 | Managed Care Friday
3.4%: The average amount ACA health plan premiums increased between 2022 and 2023, likely due to inflation and increased healthcare spending. The increase in premiums reversed several years of declines. Unsurprisingly, markets with a single insurer had premiums that were $128 more than in markets with considerable competition, at least 5 insurers. Worker’s Comp Alumni: Any guess on one of the most common reasons for worker’s comp claims among teachers? – that’s right, alumni basketball games. Hole In The White Bag: Regence BCBS will launch a new specialty medication network in January 2024...
Apr 6, 2023 | Medicare Advantage, Part D
CMS recently released the 2024 Medicare Advantage and Part D Final Rule. CMS anticipates a +3.32% increase in MA revenue. Adjustments to the effective growth rate and risk model revision will be phased in over three years. Additional Part D implementations include a reduction or elimination of cost sharing for insulin, certain vaccines, and Part D drugs in the catastrophic phase. Click to read more.
Mar 31, 2023 | Managed Care Friday
25-35: The age group now charting their own path around what their “health plan” will be. For better or worse, younger populations are the likely target of a new wave of virtual-first health insurance plans that package telehealth services to ensure people have a medical home even if it’s not the traditional one. Some Anthem members in Georgia will now have access to their new Virtual-First health plans. Other insurers also offer these and use them almost as traffic cops for healthcare, steering patients to services as needed. These plans provide people access to an AI-driven symptom...
Mar 28, 2023 | Medicare, Physician Fee Schedule
Recent Developments in Emergency Medicine, Critical Care, and Infectious Disease: Impact of PFS policy creating modest pressure for emergency medicine, critical care, and infectious disease in 2023. Click here to read more.
Mar 28, 2023 | Medicare, Physician Fee Schedule
Recent Developments in Neurology and Neurosurgery: Impact of PFS policy creating modest pressure for neurology and neurosurgery in 2023. Spending for neurology was mixed in recent years, with neurosurgery experiencing increases. Click here to read more.
Mar 24, 2023 | Managed Care Friday
13: Percent of Cologuard tests that are reportedly positive, but the colonoscopy ends up negative, a "false positive," and so the anxiety of waiting isn't great for patients and now some payers are wondering exactly how many false positives there are, which might be a bigger issue. Where's The Surgery? Cigna has launched an education program for their Medicare members to push more procedures to non-hospital affiliated surgery centers, like shoulder arthroscopies and knee cartilage removal procedures at rates $1500 to $1800 less compared to health system owned facilities, a JAMA analysis...
Mar 21, 2023 | Legislation/ Budgets/ Macro
The Biden administration released its proposed budget for FY 2024, which includes a proposal to increase federal government healthcare spending by several hundred billion dollars above the current law baseline. Most of the larger policy proposals are unlikely to be enacted, but illuminate areas of policy emphasis for the administration, including pharmaceutical manufacturers and managed care plans. Click to read more.
