Dec 22, 2023 | Managed Care Friday
490,000: The number of surprise billing disputes submitted by providers and insurers from April 2022 through June 2023. 61% of those are still unresolved, according to a new report from the Government Accountability Office. A single disputed claim can take up to six months to settle. Broken Record: By the end of the year, the FDA is expected to have approved 51 specialty drugs in 2023, which would break the previous record of 40 approvals back in 2021. No Room At The Inn: 80% of mental health provider listings in Medicare Advantage directories are inaccurate or, as a recent Senate Committee...
Dec 15, 2023 | Managed Care Friday
$2.2 Billion: The estimated price tag for the first CRISPR gene-editing treatment for sickle cell disease approved by the FDA last week. But health systems, health plans, employers and patients all face potential challenges in paying for the potential cure. ICER says the price tag may be justified compared to the cost of lifelong treatment, but paying for a lump sum of that size all at once is something our healthcare system has been struggling with how to handle as more and more high-cost gene therapies continue to be approved. 4th & Goal: Tom Brady may be able to find new work. We...
Dec 8, 2023 | Managed Care Friday
348: The number of post-residency fellowships available in geriatric internal medicine available this year, but less than half of those spots were filled. The fill rate for geriatric family medicine was even lower, at 26.8%. Doctors specializing in geriatric medicine are increasingly in demand as the population ages, but younger physicians and those in medical school don’t seem to be interested in the specialty. Some of this could be due to low reimbursement compared to other specialties - in one of our polls of physicians in training in 2018, 73% said compensation would be a factor in their...
Dec 1, 2023 | Managed Care Friday
10%: The amount of all physicians in the US who are now employed or affiliated with UnitedHealth, according to the healthcare group’s investor day this week. That equals roughly 90,000 doctors who are part of the behemoth that includes a health plan, a PBM, a specialty pharmacy, and more. Drug Authorizations: Highmark BCBS will begin requiring prior authorization for 60 high-cost drugs in January 2024 for their Federal Employee Program (FEP) members. The change will move the medical necessity review from post-service to a pre-service review. And starting in January, BCBS Tennessee will no...
Nov 17, 2023 | Managed Care Friday
12.6: The percentage of high schoolers who reported they used tobacco products in 2023, down from 16.5% in 2022 according to the CDC’s National Youth Tobacco Survey. E-cigarette usage also decreased from 14.1% to 10%. The trend mimics a similar drop in length of stay for SUD cases in hospitals, down from 10.1 to about 7.5 from ’21 to ’22 according to one commercial plan. The trends are promising but given the potential for so many high costs and recurrence in SUD, the “work is far from over” according to experts at the CDC. GLP Changing Employer Policies: More union plans are starting to...
Nov 10, 2023 | Managed Care Friday
46: The percentage of veterans who have self-reported PTSD and depression in a recent poll, a slight decrease from the same poll in 2022. The U.S. Defense Health Agency has a transition program available to all service members and veterans regardless of how long they’ve served and connects them to those services using coaches. “What’s great about the program is we are diagnosis agnostic, meaning you don’t need a diagnosis or to already be in care to participate,” says Nicholas Polizzi, a psychologist who works at the DHA. “We are come one come all. If you’re experiencing stress about the...
