3.4%: The average amount ACA health plan premiums increased between 2022 and 2023, likely due to inflation and increased healthcare spending. The increase in premiums reversed several years of declines. Unsurprisingly, markets with a single insurer had premiums that were $128 more than in markets with considerable competition, at least 5 insurers.
Worker’s Comp Alumni: Any guess on one of the most common reasons for worker’s comp claims among teachers? – that’s right, alumni basketball games.
Hole In The White Bag: Regence BCBS will launch a new specialty medication network in January 2024 through their PBM, Prime. The new network, IntegratedRx – Medical, will allow providers to continue to buy and bill specialty medications if they become credentialed and contracted as a dispensing provider with Prime. The health plan said this network is essentially intended to be a compromise between employer groups who have been requesting “white-bagging solutions” and providers who feel they should be part of the dispensing process, keeping the “provider-patient relationship intact.”
Go Blue: BCBS Michigan, one of the more progressive commercial payers in moving away from FFS into value-based care, will be introducing a 1.5% allocation from commercial PPO professional fees to fund Blueprint risk arrangements for their commercial providers, starting July 1, 2023. These risk arrangements will be partially offset by the annual professional fee schedule update that will also take place July 1. The 1.5% allocation will be allotted to the Blueprint reward pool and used to reward eligible risk-bearing contracted entities for improving the quality of patient care and reducing costs.
Unusual Healthcare: People in Pennsylvania will soon be able to learn about their health care options at their weekly trip to the laundromat. UPMC Health Plan’s Medicaid managed care plan is partnering with Fabric Health of Philadelphia to give guidance on applying for coverage assistance programs such as Medicaid, Supplemental Nutrition Assistance and Low Income Energy Assistance. The state of Maine funded a similar program last year to bring telehealth technology to 10 libraries across the state for users to be able to have an opportunity to see a specialist.
Marriage Script: Pharmaceutical company Cosmos Health has acquired ZipDoctor, a subscription-based telemedicine platform that provides 24/7 access to physicians, behavioral health counselors and therapists. Cosmos hopes to target women’s health and weight loss in the future.
18 & Life: Jackie pinned the tale on the donkey and played ring around the rosie at my daughter’s 5-year-old birthday party back in 2010. If memory serves, she was the goose at least three times and she fell off that wobbly chair when the music stopped, laughing like a hyena. Jackie, a standout athlete, turned 18 last summer but her eyes started to hurt back in September at the beginning of her senior year in high school, the way they do when you’ve been up late typing on the laptop, and this week, when many of us were logging on or checking texts, her parents sadly had to let Jackie go after a painful 7-month struggle with a brain tumor. Why this happened is not something I can answer but sometimes there are sacrifices we can’t explain. Jackie’s sacrifice may just be to help us see the importance of not ignoring symptoms and to help her classmates see how precious life can be.
Vaccine Cut: Beginning July 2023, Empire BCBS in New York will reduce reimbursement for providers administering COVID-19 vaccines to align with other vaccine administration rates like flu shots.
Post Pay: Perhaps as a precursor to future post-pay audits of facility based care and possibly surgeries and OP care, Blue plans in Illinois and Texas will begin reviewing acute hospital claims for commercial members starting this summer if they are readmitted to the same facility within 30 days of discharge. BCBS may conduct a post-payment audit of the admission and readmission and deny or reduce payment if they determine that the readmission could be “considered a continuation of the initial treatment.”
Extra Point: A black eye is not a great look for me, particularly not on Easter Sunday. “What did you get in a scuffle with the Easter bunny?” my bride quipped. This was 8 years ago this weekend when Paul’s elbow came down on my cheek like a meteor strikes Jupiter, at least it felt that way. I’m 5 foot nothing with a vertical leap no better than an aging cricket and thought I could outrebound a 6 foot something who had boxed me out of the lane. I could not. My cheek swelled quickly and my jaw vibrated and twitched in excruciating, albeit perfect rhythm. On that Sunday, I cupped the left side of my face and slunked off the court but there were no ice bags, so I jammed my face left-side down onto the bubbler, letting the water envelop my burning face. Read more.