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The Hertel ReportThe Hertel Report

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Winter State of the State: 2021

Winter State of the State: 2021

State of the State
Medicaid Block Grants: A Primer

Medicaid Block Grants: A Primer

Arizona News
OIG Concerned Over Billions in Estimated MA Payments From Chart Reviews

OIG Concerned Over Billions in Estimated MA Payments From Chart Reviews

CMS Rules

AZ COVID-19 Update January 21

On Wednesday, January 20, Arizona reported 4,845 new cases, bringing the state total to 690,544. There were 262 new deaths reported Wednesday with total deaths from the pandemic at 11,528. Deaths reported Wednesday will be retroactively assigned to...

Study Explores Role of Firewall Between Employer Insurance and the ACA Marketplaces

As millions of workers lose income through furloughs and wage cuts, COVID-19 may exacerbate the trend of employer-based health insurance becoming less affordable and premium contributions and deductibles taking up a larger share of household income. The process needs to be made easier for workers and their families to enroll in...

Delta Dental of Arizona Gifts $525,000 to Help Uninsured Dental Patients

Delta Dental of Arizona partnered with Neighborhood Outreach Access to Health (NOAH) and HonorHealth Foundation to fund expert emergency dental treatment at NOAH for uninsured patients who visit HonorHealth emergency departments with dental issues. The new Delta Dental of Arizona Dental Connect program is made possible by a $525,000...
Arizona News

Creighton University Receives $25 Million Donation for Medical Program

Creighton University's Arrupe Global Scholars and Partnerships Program, which addresses health issues of the international poor as well as a fund for the education of future doctors, has received a $25 million donation from an anonymous foundation. The medical program will benefit roughly 120 students at Creighton campuses in Phoenix,...
Arizona News

Pandemic Exacerbates Children's Mental Health Crisis

The pandemic’s adverse effect on mental health has been well documented and much discussed, but the strain on children, who have been deprived of in-person school and interactions with friends, has been especially worrisome.  For children with mental health issues, the pandemic has been especially difficult; many relied on...
Arizona News

Data: Study Shows Pediatric COVID-19 Hospitalizations on the Rise in AZ

In a news release Monday, Banner Health said Arizona is seeing an increase in the number of pediatric patients hospitalized with COVID-19. On January 11, the JAMA Network published a study examining pediatric COVID-19 hospitalization trends for 22 states; compared to other states, Arizona had the second highest rate of pediatric...
CMS Rules

CMS Finalizes Prior Authorization Rule

Last Friday, the Centers for Medicare and Medicaid Services (CMS) approved a final rule requiring payers to build application program interfaces to support data exchange and streamline prior authorization. Medicaid and the Children’s Health Insurance Program (CHIP); healthcare exchange plans are also required to comply with the...
News

COVID-19 Arizona Vaccination Update January 21

Arizona’s vaccine rollout is full steam ahead, with state officials encouraging enrollment. Rural areas are slower to receive vaccines needed. University of Arizona is beginning vaccination of Phase 1B recipients. Arizona Department of Health Services (ADHS) announced Arizona has reached 300,000 vaccinations on January 20. The...
Arizona News

Politics & Healthcare: Azar & Verma Resign, Stakeholders Withhold Donations, Arizona Budget Notes

As the Biden Administration prepared for its new role leading U.S. health policy and Arizona became the new national poster child for the ravages of the COVID-19 pandemic, political lines were drawn and Governor Ducey listed his budget priorities. Last week, U.S. Health and Human Services Secretary Alex Azar and CMS Administrator...
Arizona News

MFAR Officially Dead

Last year, The Centers for Medicare & Medicaid Services pitched the proposal as an effort to improve Medicaid accountability and transparency, AHCCCS countered the rule could cost the Arizona Medicaid program about $2 billion in funding. The rule was officially withdrawn Jan. 19, 2021 as posted on the Federal Register; in...
CMS Rules

New Rule Gives Web-based Brokers Access to 2023 ACA Exchange Markets

Last Thursday, the Centers for Medicare & Medicaid Services proposed that states could use Section 1332 waivers to customize their Exchanges and allow web-based insurers to sell insurance by 2023; some stakeholders contend the changes undermine key tenets of the Affordable Care Act. The  agency's final rule, Notice of Benefit and...
Arizona News

COVID-19 Weekly Update Including New CMS Pandemic Plan

Today, Arizona reported 5,629 new confirmed cases of COVID-29, bringing the state total to 641,729 since the pandemic began. There were 191 new deaths reported and the total number of deaths is now 10,673. Deaths recorded today will be retroactively reassigned to the date the death occurred. Arizona's total percent positive is 13.4%....
Arizona News

2019 Next Generation ACO Results: $462M in Shared Savings

The 2019 data, just released by the Center for Medicare and Medicaid Innovation, shows financial and quality performance results for 37 of the 41 Accountable Care Organizations (ACOs) who participated in Performance Year (PY) 2019 of the Next Generation ACO (NGACO) model, including the Phoenix-based Arizona Care Network. Four...
Arizona News

COVID-19 Vaccine Rollout Update Jan. 14

It’s been widely reported that national efforts for vaccine rollout and distribution is going much slower than government and stakeholder organizations initially anticipated. Both in Arizona and nationally, efforts are being made to ramp-up rollout and distribution. At time of publication, Arizona has received 570,000 doses of vaccine...
National News

CMMI Year in Review: How VBP Is Shaping Up for 2021

This week, the Centers for Medicare and Medicaid Services published its 2020 Year in Review for the Center for Medicare and Medicaid Innovation (CMMI), which enumerates the models and modifications launched to advance value-based care initiatives through CMS. CMMI launched four new models, implemented three previously announced models...
Arizona News

National & Local Medicaid News Update: Tennessee Approved for Block Grant, AHCCCS Submits 1115 Waiver

The Arizona Health Care Cost Containment System (AHCCCS) released its 2020 Year in Review this week, enumerating the efforts by the agency to innovate improvements in service delivery and its overall response to the COVID-19 pandemic. AHCCCS announced that over 60% of the agency’s staff is now run through a virtual work environment,...
Arizona News

Direct Contracting Entity Apricus Health Network Launches in Arizona

The Apricus Health Network, an Arizona-based Direct Contracting Entity (DCE), is busy signing up providers and offering patients continuous care augmented by health monitoring technology and telemedicine.  Direct Contracting is a set of new payment models that are designed to allow organizations to take on more risk, and to save...

Healthcare Outlook for the Incoming Biden Administration and Democratic Congressional Majority

A recently study shows that the Affordable Care Act reduced income inequality by 10% in the United States ahead of the potential for a Supreme Court opinion that could overturn the entire law. The incoming administration under President-elect Joe Biden has articulated every intention of strengthening and building on the ACA, but how much...

Mercy Gilbert Campus Will Add 80,000-square-foot Medical Office Space

Medical office experts in the Phoenix office of JLL were chosen to market 80,000 square feet of new medical office space planned for one of the last Val Vista Drive-fronting parcels surrounding Dignity Health’s Mercy Gilbert Medical Center.  The 80,000-square-foot medical office project, Mercy Medical Center, is being directed...

Blue Cross Blue Shield of Arizona To Award Up To $500,000 for Substance Use Disorder

Blue Cross Blue Shield of Arizona is awarding up to $500,000 in grants to assist organizations fighting the opioid epidemic and substance use disorder by increasing access to life-saving services. Arizona nonprofit organizations, academic institutions, and government entities that are seeking resources to further their work related...
January Newsletter is Here!

January Newsletter is Here!

We begin 2021 with a look back on the most important stories of 2020 complemented by relevant Arizona data and market insight along with a full page of local healthcare Comings & Goings.     JANUARY NEWSLETTER SPONSOR ...

COVID-19 Update January 7th, 2021

Arizona currently has the highest rate of COVID-19 infections in the world. Hospitals continue to be overwhelmed as Governor Doug Ducey continues to take no statewide action to curb the outbreak, including heeding pleas from State Superintendent of Schools Kathy Hoffman to close schools for a few weeks. Health care providers and workers...

Centene Buys Magellan Health, Molina Closes on Magellan Medicaid Plans Deal

Back in April of 2020, Molina announced plans to buy Magellan Complete Care, Magellan's Medicaid managed care plan division.  That deal closed on December 31, 2020, see Market Watch for that story and the transition plan from AHCCCS.  On January 4, 2021, Centene announced plans to buy Magellan Health behavioral health and specialty...

Incoming Biden Administration Facing Urgent Requests from Stakeholders; Trump Administration Rules

The Trump administration is still full-steam ahead on its end-of-term plans for health care policy. On December 31, President Trump extended pandemic-related ban on green cards and work visas to any applicants through March 31 and a federal appeals court upheld the rule that dictates any incoming immigrants must prove that they have...

Increasing ACA Tax Credits Expands Coverage More Than Base Medicare Buy-In

In a new analysis, the Urban Institute found that coupling a Medicare buy-in with enhanced ACA tax credits would lead to the largest coverage gains. Without the enhanced credits, a buy-in would not dramatically expand coverage or reduce costs, although it would help some people and could lower overall spending since payment rates...
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