Two studies highlight the role of health plans in driving up out-of-pocket prescription drug costs for 2019 individual Affordable Care Act (ACA) exchange enrollees, while insurers continue to file lawsuits against the federal government for unpaid cost-sharing reduction payments (CSRs).
Multiple insurers filed status reports in...Arizona News
Prescription drug spending and pricing data for 2017 was added to the Centers for Medicare and Medicaid Services' (CMS), updated drug dashboards to indicate spending per dosage of prescription drugs under Medicaid and Medicare Parts B and D. The data is tracked by changes in the average spending per dose.
In its first update since...Arizona News
The Centers for Medicare and Medicaid Services (CMS) announced the release of updated hospital performance data on the Hospital Compare website and data.medicare.gov. The agency also announced on Feb. 28 that it would post potential changes to the star rating methodology for public comment and feedback in attempts to improve the way...Arizona News
Various insurers, hospitals, and state regulators are encouraging the Centers for Medicare and Medicaid Services to continue a practice dubbed "silver loading" in fear that ending the rule would destabilize Affordable Care Act (ACA) exchanges.
Health insurers typically raise premiums on silver-level exchange plans to recover the...Arizona News
A new study from Milliman suggests that 577 Medicare Advantage plans are offering at least one or more supplementary benefits offered by long-term care insurance policies. CMS is encouraging Medicare Advantage plans to provide coverage with added benefits that can be seen as an alternative to traditional fee-for-service Medicare...Arizona News
Under the Affordable Care Act (ACA), statistics on healthcare coverage noted a closure of the gap in the number of people of various races and ethnicity who have health insurance, but a Kaiser Family Foundation brief has highlighted trends indicating that between 2016 and 2017, some groups of color have experienced a stagnation in health...Arizona News
On Friday, Feb. 15, The Centers for Medicare and Medicaid Services (CMS) published a proposal that would require Medicare to offer coverage for CAR-T cell therapy and could take form as a national coverage determination (NCD). The cancer treatment uses a patient's immune system to fight off the illness and currently, local Medicare...National News
Over 60 healthcare legislatures joined in sending a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma regarding an interpretation of National Coverage Determination (NCD) for next-generation sequencing (NGS) that would limit accessibility to certain testing.
The Jan. 31 letter expressed explicit...National News
Blue Cross and Blue Shield of North Carolina (BCBSNC) announced last month its Blue Premier program, a value-based model of healthcare that binds performance directly to payment. BCBSNC and five other health systems are responsible for fostering better outcomes with a lower cost.
The health systems include:
Cone Health
...Arizona News
The Centers for Medicare and Medicaid Services (CMS) announces its consideration to add coverage for acupuncture under the Medicare program for chronic lower back pain. The consideration for acupuncture comes in light of the opioid epidemic spreading across the country and the evidence behind effectiveness for non-drug treatments of a...National News
Health insurers are tasked with the job of sending the government detailed cost forecasts for the following year to provide prescription drug benefits to millions of Medicare beneficiaries across the country. A Wall Street Journal investigation uncovered that the same insurers reeled in $9.1 billion thanks to discrepancies between...Arizona News
A study by the American Journal of Medical Care (AJMC) highlighted the hospital grades the Centers for Medicare and Medicaid Services (CMS) posted on Hospital Compare for heart failure (HF) and acute myocardial infarction (AMI) readmissions are inconsistent with the scores used to set penalties under the Hospitals Readmissions Reduction...Arizona News
The Centers for Medicare and Medicaid Services (CMS) still has $1.6 billion to collect in Medicaid overpayments, news revealed through Office of Inspector General (OIG) audits. A new December OIG report explains that CMS's timely recovery of overpayments helps to confirm that federal funds are being used effectively and...Arizona News
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to lower prescription drug costs for beneficiaries by making changes to Medicare Part D. The proposal could give insurers negotiating powers on drug prices by offering an expectation that plans would implement broader use of prior authorization (PA)...National News
For the first time in eight years, the 2018 Medicare fee-for-service improper payment rate has seen a decline of over $4.5 billion and a drop in home health improper payments is a big contributor to the lower rate.
The rate was at 9.51 percent in 2017 and is now at 8.12 percent. This is the lowest the improper payment rate has...Arizona News
Last week, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma released an update to her Merit-based Incentive Payment System (MIPS) original performance evaluation published in May. The November 8 blog post revealed 93 percent of participants merited a positive payment adjustment for their 2017...National News
According to a state audit released this past week, California’s Medicaid program, Medi-Cal, spent $4 billion between 2014 and 2017 on coverage for beneficiaries that may have been ineligible for Medicaid.
California’s $100B Medicaid program covers 13.1 million residents of the state (one-third of the state) and eligibility is...Arizona News
Anthem individual insurance plans bid goodbye to Affordable Care Act (ACA) markets across the nation to focus on the growth of its Medicare Advantage business, an experience more sweet than bitter; the insurance giant's third quarter profits were up 29 percent, year over year.
Enrollment in Anthem's insurance plans may have taken...National News
A proposal to lift a prohibition on allowing companies to take advantage of health reimbursement arrangements (HRA) dating back to the Obama administration is slated to reshape employee-based healthcare.
Announced Tuesday, the expansion of HRAs would enable employers to use them to pay for health insurance premiums, allowing...National News
The America's Physician Group (APG) recently launched a new initiative aimed at developing advanced alternative payment models (APMs). Dubbed "the Risk Evaluation Task Force," its inception was a result of a learning collaborative looking to move volume to value.
There is no lack of interest in APMs in the physician world, but...
