Managed Care Friday

Sep 9, 2019 | Managed Care Friday

1.   Lyft In & Off:  The ROI on getting patients to appointments is so good that a network contracting team decided to hire rideshare company Lyft, even though industry commenters say Lyft does not have the same type of credentialing standards for drivers as traditional medical transport businesses (such as medical vans), according to a poll of our network operations managers. Some figured the ROI was good enough just to keep patients from using hospital ERs that they could worry about consequences later, like a lawsuit because the driver isn’t vetted and gets in an accident. Other...

CMS Proposes Modest Changes to CY2020 DME Payments

Sep 4, 2019 | DMEPOS, Medicare

With competitive bidding Round 2021 already underway, the CY2020 proposed rule for Durable Medical Equipment would make relatively minor changes to pricing for new DME items on the fee schedule. It would also make changes to the eligibility process for DME items potentially subject to prior authorization or face-to-face encounter requirements. Click to read more.

Managed Care Friday

Aug 30, 2019 | Managed Care Friday

1.   No House of Cards: Health plans are continuing to act on the link between stable housing and better health. Illinois’ Blue plan recently invested in housing to improve the health of homeless Chicagoans by partnering with private and public funders, investing as much as $1M in the project in Chicago’s Flexible Housing Pool. The two-year grant will fund housing, paired with intensive case management services, for people who are homeless and have been frequent visitors to hospital emergency rooms. The city of Chicago aims to host 750 units of supportive housing in the future. United...

CMS Finalizes +1.5% Update To 2020 IPFs

Aug 28, 2019 | Inpatient Psych, Medicare

CMS has finalized the Inpatient Psychiatric Facility (IPF) rule for FY2020. The rule has no major policy changes and updates rates by +1.75% which combined with adjustments to the outlier threshold is projected to increase IPF payments by +1.5%. Click to read more.

Budget Deal for FY2020 and FY2021

Aug 26, 2019 | Legislation/ Budgets/ Macro

Recently, Congress passed—and President Trump signed—a budget agreement for FY2020 and FY2021. The deal ends the possibility of government shutdowns for this fall and next fall, and removes the politically contentious issue of the debt limit from the agenda by suspending the limit through July 31, 2021. Click to read more.

Managed Care Friday

Aug 23, 2019 | Managed Care Friday

1.   Younger but Not Better: Millennials are a less healthy generation compared to Generation X at the same age. One in three millennials do not have a primary care physician and are less likely to seek preventative care on a regular basis, based on a new study of medical claims by the BCBS Health Index. The report found that millennials had substantially higher diagnoses for eight of the top 10 health conditions than Generation X, and based on their current health status, millennials are more likely to be less healthy when they’re older, compared to Gen Xers. These findings are based off a...

MedPAC Redesign for Part D Addresses High-Cost Drugs

Aug 21, 2019 | Drugs, Medicare, Part D

An increasing share of Medicare prescription drug (Part D) spending is made up of expensive specialty drugs and biologics. This has driven up costs for both Part D enrollees and the Federal government’s subsidies of the Part D program. This brief summarizes MedPAC’s study of the impact of specialty drugs on the Part D program and recommendations to Congress. Click to read more.