Jul 20, 2021 | ESRD, Home Care, Home Health, Physician Fee Schedule
ESRD: CMS has proposed a +1.0% increase to the End-Stage Renal Disease (ESRD) base rate for CY 2022, and changes to the ESRD Treatment Choices (ETC) Model to continue to promote the use of home dialysis while addressing socioeconomic disparities between patients. Click to read more. Home Health: For CY 2022, CMS estimates a +1.7% update to home health payments, resulting in an estimated $310 million payment increase. This reflects a +1.8% proposed increase and -0.1% decrease in payments due to reduction in the rural add-on payment. Click to read more.
Jul 16, 2021 | Managed Care Friday
25: The number of retail pharmacies health system Intermountain is closing, citing declining business and a new deal with CVS Health. Intermountain will keep its pharmacy at Primary Children’s Hospital in Salt Lake City open as a home delivery, retail, and specialty pharmacy. All others will transfer inventory and patient files over to CVS by August. Spartan Care: Michigan State University Health Care is partnering with Everside Health, a direct primary care provider, to provide employer-sponsored health plans with access to direct and virtual primary care across the state. Employers who...
Jul 13, 2021 | BRG Publications
In a poll of 52 health plan network contracting sources from the top 30 U.S. plans, BRG’s managed care team found that the likelihood of getting the same contract when acquiring a practice in a different city is difficult if the markets are unique but increases if the acquiring practice is in a value-based arrangement. Likelihood also varies based on factors related to individual physician specialties. Click to read more.
Jul 9, 2021 | Managed Care Friday
42: Percent of kids going off to college in August, according to a poll of my son’s 1,700 Instagram followers—up from 30% recently—who say they are bringing the following to college: a 10-pack of blue iPhone chargers, an old “beat up locker passed down from generations,” and the phone number and text for a mental health therapist. Here’s to something borrowed, something blue, and something new. Insulin? Aisle 12: Walmart is launching its own brand of insulin, a less expensive version of Novo Nordisk’s analog insulin product, Novolog. The insulin will be under Walmart’s private label and will...
Jul 2, 2021 | Managed Care Friday
5: The number of BCBS plans that have created a new pharmacy solutions company, Evio. The Blues plans in Massachusetts, Michigan, and California, along with Highmark and Independence are behind the company, which will use member data to track how drugs perform. One main goal is to enter into outcomes-based arrangements with drug manufacturers, so the plans are only paying when drugs are effective for members. Biosimilar Bait & Switch: Cigna is also looking into innovative ways to save on drug costs, by focusing on biosimilars. The health plan is launching the new Shared Savings Program...
Jun 28, 2021 | Physician Fee Schedule, Physicians
Recent developments in interventional pain management (IPM) include increases in Medicare FFS spending, mostly positive FFS reimbursement trends, and more sophistication among commercial payers in managing utilization of IPM procedures. Click to read more.
Jun 25, 2021 | Managed Care Friday
31: Percent of 17 to 20 year-olds in my son’s poll of his 1,379 so called Instagram followers who say they found a mental health therapist recently before they head off to college. “It’s a good idea to get that relationship formed before going into college,” says Ivy Patt, a therapist in Connecticut who deals mostly with private pay teens. Most of these relationships will be virtual and from a managed care point of view that’s perfect, as long as it is privately paid and if through insurance, the encounters make sense to “help with the transition” as long as they are necessary. Therein lies...
