Weekly Medicaid Update

Mar 10, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: GA:  House budget proposal focuses on behavioral health services IL:    HFS carves out emergency ground ambulance services from managed care MA:  AG files lawsuit against MassHealth orthodontist TX:   State publishes proposed rates for new autism services, effective February 2022 Click to read more.

Shared Savings ACO Participation Declines Slightly in 2021

Mar 9, 2021 | Medicare

ACOs offered through the Medicare Shared Savings Program declined in 2021 to 477, an -8% decrease from 2020.  Aligned beneficiaries decreased -4% to 10.7 million. The decrease is due in part to more stringent risk-taking arrangements required by the Trump Administration, as well as a freeze for 2021 in new participants due to COVID-19. Click to read more.

Managed Care Friday

Mar 5, 2021 | Managed Care Friday

200,000: Highmark’s increase in membership now that state regulators approved an affiliation agreement with HealthNow New York last week. They will be the primary Blue plan in western and northeastern NY, plus in central and western Pennsylvania, West Virginia and Delaware. If you’re doing managed care contracting and looking to expand your healthcare business in this region, Highmark matters – it can help you take a young model to another state, or on the flip side put pressure on payment and utilization. Cancer Care Bundle: Memorial Sloan Kettering in New York is partnering with Carrum...

Weekly Medicaid Update

Mar 3, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: MA:  Gov. Baker releases FY22 budget proposal NC:  DOJ announces Medicaid fraud cases TX:   Medicaid agency's Executive Director delivers budget presentation to legislature VA:   Legislature passes amended FY21-22 biannual budget Click to read more.

Managed Care Friday

Feb 26, 2021 | Managed Care Friday

5: The number of chronic conditions that cost employers $2.5B over 2 years, according to a new study published by UnitedHealthcare’s Center for Advanced Analytics, using claims issued by the Health Action Council’s 57 employer members. Asthma, diabetes, hypertension, mental health/substance abuse, and back disorders were the top offenders and the study found that more than 60% of workers experience at least 1 of these conditions. This probably comes as no surprise to most employers, who are increasingly turning to new programs and strategies, including digital health options, to help manage...

Recent Developments in Podiatry

Feb 25, 2021 | Physicians

Recent developments in podiatry include E&M reform, positive FFS reimbursement changes, and increased demand due to aging population and rising prevalence of diabetes. Click to read more.

Medicaid Weekly Update

Feb 24, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CA:  State further delays Medi-Cal Rx transition due to Centene-Magellan deal IL:    Gov. Pritzker releases FY22 state budget proposal TX:  State to hold public hearing for proposed Medicaid rates for autism services Click to read more.

Eating Disorder Treatment Data Shows Major Access Drop-Off

Feb 23, 2021 | Behavioral, Eating Disorders

In recognition of National Eating Disorder Awareness Week (February 22-28, 2021), BRG analyzed commercial eating disorder treatment utilization data across the US. Our research found that gaps in access to treatment remain an issue in many areas. The opportunity to expand access to ED treatment is substantial, especially as the health system continues to adapt to federal mental health parity regulations and awareness of the condition grows. Click to read more.

Managed Care Friday

Feb 19, 2021 | Managed Care Friday

3D: Beginning in April, Harvard Pilgrim Health Care will provide reimbursement for digital breast tomosynthesis (3D mammography) for commercial members in all states the plan covers. Harvard Pilgrim recently merged with Tufts Health Plan, although the two will keep their products separate for the time being. Lab Disruption: United is planning to launch a Designated Diagnostic Provider program in July 2021 and there is already pushback against the health insurer’s plan. The program is designed for commercial members and will only cover outpatient lab services when delivered by freestanding or...