A Look at How Medicare Advantage Affects Providers
Although Medicare Advantage (MA) has been greatly beneficial for participating payer organizations, the picture is less rosy for providers, according to an analysis from the Kaiser Family Foundation (KFF). Providers must deal with a more complex policy framework when working with MA plans, resulting in an increased administrative burden and higher costs.
Better Employee Health Through Specialty Rx Carve-Outs
Specialty Rx carve-outs allow for dedicated management of high-cost specialty medications by bypassing traditional pharmacy benefit managers (PBMs). Doing so, according to a new article in Corporate Wellness Magazine, can help improve employee health by applying specialized expertise to coverage decisions, better coordinating care management, and reducing costs.
Working with Pharma to Advance NHS Health Equity Efforts
A key priority in the UK’s National Health Service (NHS) Operational Planning Guidance 2023/2024 is improving health outcomes for the poorest 20% of patients in the nation. Partnerships between NHS systems and the pharmaceutical industry represent one way to help address health disparities. Doing so, however, requires understanding the problem at hand and acting precisely.
Targeting Health Equity at the Neighborhood-Level
A person’s living environment is an important social determinant of health (SODH), affecting access to care and employment, exposure to environmental hazards, and financial pressures. As a result, health equity efforts need to zoom down to the neighborhood level to improve health outcomes. In a new Health Affairs article, learn more about addressing health equity efforts by analyzing SODH from a neighborhood-focused perspective.
Addressing Barriers to Care in Rural America
Rural US residents face significant barriers to care that significantly worsen health outcomes. Addressing these barriers is a complex task due to the underlying reasons behind them. In a new Becker’s Hospital Review article, Karen Joynt-Maddox, MD, MPH, associate professor at the Washington University School of Medicine talks about the importance of hospitals in rural areas and how providers can work to improve rural health outcomes.
Over 500,000 Disenrolled from Medicaid After COVID-19 PHE Ends
Shortly following the end of the COVID-19 public health emergency, pandemic-era restrictions on Medicaid redetermination ended. In that time, over 500,000 people have been disenrolled, interrupting their coverage and impacting their access to healthcare. Some states have kicked off more beneficiaries than others, with Florida taking the lead.
Incorporating Value-Based Care into Nursing Homes with the Payvider Model
As nursing homes increasingly look for ways to incorporate value-based care into their practices, some are moving towards payvider models, wherein they partner with a Medicare Advantage insurer and play the roles of payer and provider together. A panel of experts spoke about this strategy in a recently broadcast webinar by NetSmart Technologies.
Real World Data Study Finds Comprehensive Genomic Profiling Improves Cancer Outcomees
Real-world data (RWD) to be presented at this year’s upcoming American Society of Clinical Oncology’s Annual Meeting shows that comprehensive genomic profiling (CGP) improves cancer patients’ outcomes. The study, which covered 1,423 advanced cancer patients who received CGP from 2019 to 2021, showed that CGP was associated with improved survival.
Patients Turning to Illegal Pharmacies for Essential Medications
US patients are increasingly turning to illegal pharmacies due to high prescription drug prices and shortages of essential medications. The issue has grown in recent years, catching the eyes of officials at the US Food and Drug Administration. It is especially concerning for the attention deficit hyperactivity disorder drug Adderall, which is currently difficult to impossible to find at many legal pharmacies.
Expiration of Temporary Provisions Set to Change Up Insurance Coverage for People Under 65
COVID-era policies expanded access to Medicaid and Marketplace plans for millions of people in the US, resulting in the lowest rates of uninsured status ever. However, these policies are set to expire soon, resulting in many people under 65 losing their coverage. In a new Health Affairs article, learn more about the state of insurance coverage of people under 65 years of age and how it’s set to change in the coming decade.
Data Book Podcast: Collecting Better Data on LGBTQ+ Patients to Improve Health Outcomes
LGBTQ+ patients experience significant discrimination in healthcare settings and face disproportionate barriers to care, worsening health outcomes. In the latest episode of the Data Book podcast by Chief Healthcare Executive, C.K. Wang of COTA talks about issues facing LGBTQ+ patients in healthcare and how fostering patient trust can help advance health equity efforts and data collection for this population.
Transgender Adults Stripped of Transition Care in Florida
Florida governor Ron DeSantis recently signed a bill into law that, at least for now, strips transgender adults of their right to access gender transition care, including all hormones, gender transition appointments, and surgical operations. The law only allows adults to maintain their transition care if they fill out an informed consent form that the state has yet to publish or give any intimation of when it will be released. The law also allows any care provider to turn away LGBTQ patients for any reason without recourse.
HHS Awards $65 Million in Funding to Fight Maternal Mortality
Despite spending the most on healthcare per capita in the world, the US has much higher maternal mortality rates than other wealthy nations, especially among Black and Indigenous patients. To address this long-standing problem, the US Department of Health and Human Services (HHS) and its Health Resources and Services Administration (HRSA) has announced it has awarded over $65 million to 35 care centers.
Older US Adults Skipping Meds Because of Price
A recently published study in JAMA Network OPEN found that at least 20% of adults 65 and up skipped their medication, cut back their dose, or took drugs intended for other patients due to financial reasons in 2022. The figure is a jump from 2016, when one in seven older patients reported skipping medications for the same reason. Many of those who did maintain their drug regimen faced significant financial hardships.
Federal Appeals Court Keeps ACA Preventative Care Rules in Place
A US Federal appeals court has issued a stay on a lower court’s ruling that would gut the preventative care requirements in the Affordable Care Act. If not paused, the lower court’s ruling would end the requirements for payers to cover preventative care services like physicals, Pap tests, cancer screenings, and pre-exposure prophylaxis (PrEP) for HIV.
Monica Bertagnolli Nominated for Director of NIH
The Biden administration has nominated Monica Bertagnolli for the next director of the US National Institutes of Health (NIH). Bertagnolli formerly worked as the chief of surgical oncology at the Dana-Farber Brigham Cancer Center and is currently the director of the National Cancer Institute (NCI). Her appointment is expected to make it through the narrowly Democratic-leaning senate some time later this year.
Physicians Pushing Back Against Private Equity Firm Buyouts
Private equity firms are increasingly taking over small medical groups and nabbing hospital contracts in the process. To fight back against this growing trend, a group of providers formed the Association for Independent Medicine (AIM). AIM argues that practices like rolling smaller groups into larger companies or the sale-leaseback model are hurting providers and patients.
Promoting Health Equity and Community Health with Medicaid Reinvestment Requirements
Several states have adopted policies that make Medicaid managed care plans put money back into local communities to promote health equity and community health by targeting social determinants of health (SDoH) associated with poor health outcomes. In a new Health Affairs Forefront article, learn about the challenges blocking the full realization of these policies’ potential and best practices in developing them.
New Proposed CMS Medicaid and CHIP Managed Care Rule Targets Access, Quality, and Payment Rates
A newly released proposed rule by the US Centers for Medicare and Medicaid Services (CMS) targets transparency, quality, care access, and payment rates for Medicaid and Children’s Health Insurance Program (CHIP) managed care. States would need to provide an annual payment analysis of all managed cares payment rates for a variety of services. In addition, states will need to develop a quality rating system for Medicaid and CHIP plans.
Real-World Data Study Finds Sickle Cell Decreases Life Expectancy by 32 Years in Brazil
A recently published real-world data (RWD) study in Blood Advances found that sickle cell disease (SCD) is associated with a 32 year decrease in life expectancy in Brazil. SCD has a significant impact on health outcomes worldwide, causing a 22-year drop in the US, for example. This study examined healthcare data collected between 2015 and 2019.
Medicare Advantage Programs Not Helping with US Healthcare Spending
Medicare Advantage is a program set up by the US federal government to allow private plans to provide government-funded healthcare services to older adults. Although the goal was to offset spending per Medicare beneficiary, it’s done the opposite, with Medicare Advantage plans often costing much more per member than Medicare Parts A and B.
WHO: The COVID-19 Pandemic Is Over
The World Health Organization (WHO) has announced the end of the COVID-19 public health emergency (PHE). The move comes after reported deaths and hospitalizations for the disease have plummeted in recent months. PHE status as declared by the WHO won’t immediately rescind healthcare policy changes in all nations, but countries are already set to end their own PHEs, triggering massive changes to Medicare enrollment in the US.
FDA On the Fence About OTC Birth Control
The US Food and Drug Administration (FDA) recently met to discuss whether to approve Opill, Perrigo’s hormonal contraceptive, for over-the-counter (OTC) use. Although reproductive rights advocates contend that the move would expand access to contraceptives to people who don’t have a primary care clinician, some religious advocates and committee members argued against it.
Addressing Asthma Care Gaps with Patient Assistance Programs
The majority of Americans living with asthma sit firmly in the poverty range, making it difficult or impossible to get lifesaving care. Fortunately, nonprofit patient assistance programs (PAP) are stepping up, connecting uninsured or underinsured low-income patients access asthma care. However, the programs don’t just offer care, according to Accessia Health CEO Gwen Cooper.
The CARE Act Is Improving Patient Health Outcomes
A total of 42 states have adopted laws called the Caregiver Advise, Record, and Enable (CARE) Act, which promotes increased clinician communication with patients and caregivers during care delivery and at the point of discharge from care centers. A newly published paper in JAMA Network Open finds that these policies are having positive real-world impacts on patient health outcomes.
