Sep 10, 2021 | Medicaid Managed Care
7 out of 10: Medical directors we talked to this week who are pushing more “gold carding” to limit pre-authorization cost and reward practices that are reliably ordering the right tests and treatments, communicating decisions, and getting the right outcomes. Gold Card: But you need to understand the MCO’s point of view on when to pull back oversight, and when to keep it. Just because the payer approves 99% of your requests doesn’t mean they should remove pre-authorization requirements. Take oncology. There’s “pre-authorization,” but sometimes that PA is really more in place as a...
Sep 3, 2021 | Managed Care Friday
60: “Percent of the time…it works…EVERY time,” or so said Paul Rudd’s news character in Anchorman about his potent cologne, which Ron Burgundy sternly replied in a way that only Will Ferrell can, “Well that just doesn’t make sense” – which is of course logical and funny to say out loud, but Rudd’s stat isn’t so illogical if you think about it. In baseball, 60% gets you in the Hall of Fame, in high school it gets you a diploma and in healthcare it can get you “coverage” for novel treatments and increasingly that better-than-half goal will be part of more and more outcomes-based contracts,...
Aug 31, 2021 | Medicare, Physician Fee Schedule
Surgery: Recent developments in surgery includes mixed Medicare FFS reimbursement trends and stable Medicare spending. Click to read more.
Aug 31, 2021 | Medicare, Physician Fee Schedule
Orthopedics: Recent developments in orthopedics includes mostly positive Medicare FFS reimbursement trends, stable Medicare spending, and increased steering to centers of excellence by commercial payers. Click to read more.
Aug 27, 2021 | Managed Care Friday
41,000: The number of members in health insurer Highmark’s 2019 claims data diagnosed with alcohol use disorder (AUD), leading to more than $4 million in spending and there are assumptions these numbers are rising, and quickly, as recent data suggests more adults than ever are drinking excessively. Highmark is offering its members new ways to treat alcohol disorder. One new option is Ria Health, a technology-enabled telehealth medical practice that focuses on treating AUD by combining medically assisted treatment with digital tools to help members track and record progress. The Ria Health...
Aug 20, 2021 | Managed Care Friday
50: The number of new medical centers Anthem is opening in partnership with CareMax, a senior healthcare provider focused in the Florida market. The medical centers will primarily be in areas where Anthem is focused on value-based care efforts, including Indiana, Texas, Kentucky, Wisconsin, Georgia, Connecticut, and Virginia. Self Insured Strategy: Aetna is rolling out virtual primary care services to self-funded employers across the country. By partnering with Teladoc, the new Aetna Virtual Primary Care service will be available to members at no cost, and includes access to in-person visits...
