Dec 4, 2018 | Medicaid, Medicare
With 2019 approaching, our team has put together a quick reference for investors and industry professionals to turn to for a point-in-time overview of healthcare policy. We provide an outlook on Medicare and Medicaid policy, managed care, and data analytics. Click to read more.
Dec 3, 2018 | Legislation/ Budgets/ Macro
Amidst real and persistent challenges of structural upheaval, political uncertainty, and change resistance, the US healthcare market abounds with opportunities for private equity managers. Healthcare represents 17% of US gross domestic product this year and is projected to account for more than 20% within the next 10 years, virtually assuring top-line growth for many ventures across the entire sector. BRG experts John Kelliher and Bryan Cote discuss these opportunities here. To read more pieces published by BRG’s ThinkSet, click here.
Nov 30, 2018 | Managed Care Friday
1. 41: The percentage of parents in our poll who said they are hiring a home health aide for their mom or dad to help prevent another fall. Falls have increased in New England (during the winter months ), largely due to dehydration, lack of a consistent diet, orthostatic/BP issues, and a range of dementia or psych influences, parents said. Of those hiring an aide, 46% said their mom or dad has a Medicare Advantage plan with Humana, United Healthcare, or BCBS, though nearly all (90%) said they aren’t sure what if any of these aide services are covered by insurance. About 85% of those hiring...
Nov 19, 2018 | Medicaid Managed Care, Payers
CMS recently proposed changes to the Medicaid and CHIP managed care programs, increasing flexibility in actuarial soundness and network adequacy standards requirements. While CMS Administrator Seema Verma had promised to revise a managed care rule finalized under the Obama administration that she deemed restrictive, the proposed changes are more of a tweak than an overhaul. This brief highlights key provisions of the proposed rule. Click to read more.
Nov 16, 2018 | Managed Care Friday
1. 181%: Rise in total ER costs in the last few years according to a Blue Texas study of its membership. The increase correlates in part to the rise in freestanding ERs in this state. Blue TX is taking on more of an effort to do claims reviews to manage claims – described to us as a soup to nuts review for HMO patients using OON ERs. The plan is going to be ‘holding the claim requesting medical records, checking the bill to make sure that’s what happened in ER matches the record, and combing the record to assess patient history and whether the patient’s decision to go to the ER was what a...
Nov 15, 2018 | ASC, Hospitals, Outpatient
CMS finalized Medicare payment policies for CY2019 for services provided in the hospital outpatient department (HOPD) and ambulatory surgery center (ASC) settings. CMS only finalized part of its HOPD site neutral policy and will phase in the remaining policy, mitigating the impact to HOPDs, and estimates the net payment effect will be +0.6%. The estimated payment rate update for ASCs will be +2.1%, consistent with the proposed rule. This brief highlights key provisions from the rule. Click to read more.
Nov 9, 2018 | Managed Care Friday
1. 511: In our poll of 511 primary care providers with board certification in geriatric medicine, a startling 84%, up slightly from last year, said that physical therapy services for seniors are likely unnecessary or at least need deeper evaluation to determine whether the patient has other comorbidities or causes of pain, such as substance abuse, dehydration, untreated PTSD or depression, or a sedentary lifestyle. 2. GI Bundle, With A Twist: A health plan in the east has created an episodic payment model for those treating Crohn’s disease. Payment includes behavioral health treatment for...
Nov 8, 2018 | Legislation/ Budgets/ Macro
The 2018 mid-term election has delivered divided government to Washington, which is a positive outcome for the healthcare sector. Democrats have gained control of the House while Republicans have retained control of the Senate. At the state level Democratic governor pick-ups and 3 ballot initiatives bring Medicaid expansion to additional states. Click to read more.
