Feb 9, 2024 | Managed Care Friday
99: No, not the number of red balloons one guy is sending his girlfriend on Valentine’s Day, but the amount in dollars that it costs out of pocket for a coronary CT calcium score test that gives PCPs and cardiologists a window into heart attack risk, but insurers basically do not cover the test, which 84% of cardiologists we polled find absurd. “It’s a baseline and an important one – it shows the amount of hardened plaque and guides treatment, particularly for those in their 50s,” one cardiologist said. Insurers may argue about its utility and value, as it typically kicks off other tests...
Feb 2, 2024 | Managed Care Friday
140,000: The number of Tyson Foods employees who will now have their pharmacy benefit managed by PBM Rightway, as the company announced plans to drop Caremark. Rightway says it can guarantee employers savings of 15% on pharmacy benefit costs. Rightway will be one of the first PBMs to work with a Fortune 100 company. Unlimited Labs: As of January 15, Cigna removed annual limits for presumptive and definitive drug testing. Pre-Natal Nonsense: In interviews with a handful of Medicaid MCOs, each said they continue to struggle to find ways to get newly pregnant beneficiaries to use an OBGYN for...
Jan 26, 2024 | Managed Care Friday
55%: The portion of rural hospitals that don’t offer maternity care, according to a new report for the Center for Healthcare Quality. And in 10 states, that portion is more than two thirds. More than 200 rural hospitals have stopped delivering babies over the past decade, leading to increased travel times for expecting mothers, and often poorer outcomes. Staffing Pivot: A new initiative funded by Bloomberg Philanthropies is pairing high schools with health systems, setting up students with guaranteed jobs in the healthcare sector. The first partnership is between a public school in Boston...
Jan 19, 2024 | Managed Care Friday
2,719: The number of 20–30-year-olds out of 8,600 we polled who said they will likely try to forgo using traditional health insurance if possible and instead use other means to pay for healthcare if needed. Nearly twice that many – 5,330 – say they won’t use a primary care doctor, instead relying on urgent care. A majority said they’d rather use funds for exercise programs, better sneakers, and concert tickets and aren’t worried about not having a PCP. About half said their instincts are drawn from frustration their parents go through with insurers and wait times and physicians who aren’t...
Jan 12, 2024 | Managed Care Friday
2,005: The number of drugs excluded from the Big 3 PBM’s 2024 formularies. Caremark and Express Scripts both added more drugs while OptumRx’s list decreased slightly. CVS reported that 1.4% of its members will be affected by 2024 exclusions, which sounds like a small number, but in 2023 that number was only 0.28%. The other PBMs haven’t reported any numbers around patient impact. History of the Pre Auth: Pre-authorization seems to be disappearing faster than phone chargers in my house, but are the range of laws and policies to push insurers to curtail the practice really a big change at all?...
Jan 5, 2024 | Managed Care Friday
67: The percentage of hospitals where family practice doctors delivered babies, in a survey of 216 rural hospitals in 10 states. At 27% of the hospitals, they were the only physicians who delivered babies. Family doctors are heavily relied on for obstetric services in rural hospitals, and without them many patients would have to drive over an hour for care. With maternal mortality rates on the continual rise, rural areas are employing new strategies. For example, the University of Colorado’s College of Nursing received a $2 million federal grant this fall to train midwives to work in rural...
