Gene Therapy Payment Innovation

Jul 24, 2020 | Drugs, Pharmacy

Outcomes-based payment models are emerging to address high-cost, high-value gene therapy. The strategies – from the likes of Cigna, CVS, and Anthem – are important for all of healthcare, as they illustrate how leading insurers and manufacturers will pay based on treatment success and, if successful, could be adapted to the chronic care payment space. In this special edition of Managed Care Friday, we take a look at some of the most creative approaches to paying for gene therapy and what it may mean for the future. Click to read more.

Surge in Exchange Enrollments Due to Job Losses

Jul 23, 2020 | Commercial Insurance, Exchanges

Nearly a million people enrolled in individual market Exchange health insurance plans in the 38 federally-run states through May 2020, using a special election period, with over half of new enrollees doing so because they lost another source of health insurance coverage. This reflects a nearly 50% increase over last year, directly attributable to COVID-19-related job losses and associated health insurance. Click to read more.

BRG Medicaid Update

Jul 22, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –  National: CMS extends Medicaid/CHIP provider relief funding application deadline to August 3 –  GA: State to submit waiver application to CMS expanding Medicaid coverage for new mothers –  OH: Gov. makes COVID-19-related telehealth polices permanent –  PA: State publishes medical necessity guidelines for intensive behavioral health services and ABA Click to read more.

Managed Care Friday

Jul 17, 2020 | Managed Care Friday

700: The amount of primary care clinics Walgreens is planning to open up in the next five years through a partnership with VillageMD, the home-based primary care group. The clinics will be called Village Medical at Walgreens and will integrate digitally with Walgreens to simplify the prescription process. The first clinics will be opened in Texas and Arizona, and more than half will be in government-designated medically underserved geographic areas. Match Game: Like a page out eHarmony’s book, a former teacher we chatted with this week has plucked 24 college kids in New England, started...

BRG Medicaid Update

Jul 15, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –  MA: Temporary rate updates for specific services –  OH: CARES Act relief funding approved for a variety of Medicaid providers –  PA: Medicaid MCO contract awards followed by protest by some plans –  WI: State seeking applications for collaborative development of Health Homes for SUD treatment Click to read more.

Managed Care Friday

Jul 10, 2020 | Managed Care Friday

988: The new National Suicide Prevention Lifeline phone number, available nationwide by 2022. The previous number, 1-800-273-TALK, was hard to remember, so advocates have changed it to three digits to make it “similar to 911 calls for emergencies.” High School Ups & Downs: Nearly three quarters of 394 sophomores and juniors in high school either lost significant weight or gained significant weight during the pandemic, citing lack of social interaction, according to a tracking poll of high school behavior we started in March. 9% self-acknowledged that they started “dabbling” in drugs or...

BRG Medicaid Update

Jul 8, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –  MD: State launches Psychiatric Collaborative Care Model (COCM) –  MI: State announces coverage of COCM services, effective August 2020 –  PA: New Opioid Use Disorder Center of Excellence (COE) specialty provider type –  VA: $30M funding for Medicaid providers during COVID-19 –  WA: Plans to increase rates for long-term care providers Click to read more.