Oct 19, 2020 | Hospice, Medicare, Medicare Advantage
CMS announced that nine MA organization have elected to participate in the voluntary hospice demo starting in January 2021, covering nearly 575,000 enrollees in 2020, or about 2.5% of overall MA enrollment. The demonstration program allows MA plans to cover hospice services, which under current statute are covered only under fee-for-service (FFS) Medicare. Congress would need to act to make hospice a permanent part of the MA benefit. Click to read more.
Oct 16, 2020 | Managed Care Friday
68: Percent of older adults exactly one year ago who said the quality of care during a telehealth encounter would not be as good as a face-to-face visit, according to a University of Michigan poll on aging, with half saying they did not feel personally connected to the healthcare professional and four in ten reporting difficultly seeing or hearing. The poll asked a national sample of 2,200 adults, ages 50 to 80, about their ‘tele’ experience and, welp, things sure have changed. By May, according to our own poll of 1,362 adult parents aged 35-55, 51% preferred virtual over in-person as...
Oct 13, 2020 | Legislation/ Budgets/ Macro
The Supreme Court is scheduled for oral arguments on the constitutionality of the individual mandate on November 10, 2020. A final decision will likely be made in the summer of 2021, with the preponderance of potential outcomes having only modest impacts on the healthcare sector. Hospitals, Medicaid MCOs, and behavioral providers are at risk of the downside scenarios. Click to read more.
Oct 9, 2020 | Managed Care Friday
2021: Cigna will offer telehealth services to all Medicare Advantage members next year, including virtual visits with behavioral health providers at no cost. They will also offer a $0 premium plan next year. Biosimilar or Different?: Regence Blue Cross in the northwest is implementing a new step therapy program for medications covered under Medicare Part B in 2021, like biosimilar Zirabev. What’s interesting is that Pfizer launched it earlier this year at a wholesale acquisition cost of around $60 for every 10 mg, which is nearly 25% less than its reference product Avastin, a Pfizer...
Oct 8, 2020 | Physician Fee Schedule, Physicians
Recent developments in ophthalmology and optometry reimbursement and legislation. Click to read more.
Oct 6, 2020 | Drugs, Legislation/ Budgets/ Macro
Recently, the Trump Administration has produced a flurry of drug policy-related announcements and executive orders. These have garnered headlines but are unlikely to result in substantive policy impacts in the near term – if ever. Click to read more.
Oct 2, 2020 | Managed Care Friday
$200M: The amount Blue Cross NC is giving out in health and wellness retail cards to fully insured members during October and November. The cards will be pre-loaded with between $100-500 and members will be able to use them to purchase anything over the counter. Blue Cross in Tennessee mailed rebate checks to 143,000 members in September because their health insurance costs were lower than originally anticipated. Members who purchased individual health insurance coverage through the Federally Facilitated Marketplace in 2019 qualify. Which Specialty? A new report by Doximity shows that...
