Managed Care Friday

Aug 28, 2020 | Managed Care Friday

23,500: The number of Blue Shield of California members reporting weight loss, reduced stress, and even chronic condition reversal, under a program from non-profit digital app platform Wellvolution. In the program's first year, nearly half of diabetics who signed up for a digital app like Digbi or Betr experienced disease reversal, like normalized A1C. Emily Morales, 33, an intake therapist in Pasadena, stopped eating a meat-heavy European diet after getting gut-biome and genetics results. Elementary teacher, Abebi Bain, 47, says she was eating foods that were aggravating her asthma and...

BRG Medicaid Update

Aug 26, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: – FL: Medicaid agency updates EVV parameters for managed care – IN: State awards two new managed care contracts – NY: Gov. extends health insurance special enrollment period through September 15, 2020 – VA: State implements EVV requirements for personal care, respite care, and companion services Click to read more.

Geographic Variation in Medicare Part B Drug Spending

Aug 25, 2020 | BRG Publications, Drugs, Medicare

Medicare Part B provides access to a limited but important range of drugs and biologicals administered in a physician’s office or other outpatient setting. Policy makers have scrutinized the separate payments that Medicare makes for Part B drugs based on rising aggregate and per capita spending. This report describes the geographic variation of Part B drug utilization across the United States using Core-based Statistical Areas (CBSAs) and examines potential drivers of these utilization differences. Click here to read the report.

Managed Care Friday

Aug 21, 2020 | Managed Care Friday

134: The number of physicians who have begun to offer medication assisted treatment (MAT) for opioid use disorder in Michigan, under a plan’s new initiative. At least one new primary care provider is delivering MAT in 31 Michigan counties since the program started last fall. Specialty Pay per Episode: We are starting to see more examples of global-risk primary care medical practices setting up an episodic payment arrangement with one referral partner per specialty as a way to limit cost and improve outcomes when they have to refer. “If it’s a specialist we need who might need to see the...

DOJ Alleges MA Risk Score Fraud, Based on Health Risk Assessments

Aug 20, 2020 | Medicare Advantage

On August 4, the DOJ alleged violations of the False Claims Act that resulted in overpayments to a national Medicare Advantage plan of over $1.4 billion. The alleged fraudulent diagnoses were submitted based on a health risk assessment that the plan implemented through contracted vendors, which are also named in the suit. Click to read more.

BRG Medicaid Update

Aug 19, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: – MA: MassHealth temporarily expands providers types that can order DME and home health services – MI: State rescinds policies that temporarily eased provider enrollment and revalidation requirements – MO: State expands Medicaid ABA coverage to include school-based services Click to read more.

Managed Care Friday

Aug 14, 2020 | Managed Care Friday

200K: The number of Medicare Advantage members across 23 states who will receive a free monthly membership to home delivery service, Shipt, through its new partnership with WellCare.  Going Downhill: Like an Alberto Tomba race, more insurers are pushing volume down and out of hospitals. BCBS Minnesota will require that certain hernia, gynecology, and orthopedic arthroscopy and foot procedures be performed in a non-hospital outpatient setting, as of October 2020. The insurer already established this policy for ENT and upper and lower gastrointestinal endoscopy procedures in 2019. There will...