Medicare

Dentists Chip Away at Uninsured Problem by Offering Patients Membership Plans

Nevada dentist David White has seen diseased and rotted teeth in the mouths of patients who routinely put off checkups and avoided minor procedures such as fillings. While dental phobia is a factor, White said, the overriding reason people avoid treatment is cost. To help patients lacking dental insurance, White in 2019 started offering a …

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KHN’s ‘What the Health?’: Much Ado About Drug Prices

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. Congressional Democrats are finding it harder to actually write legislation to lower drug prices than it is to make promises about it. But the drug price provisions of the $3.5 trillion social-spending bill …

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Older Americans Overwhelmingly Support Choose Home Care Act

The vast majority of older Americans want to age in place, several past surveys have found. Unsurprisingly, that desire has translated into overwhelming support for the Choose Home Care Act. Introduced in July by Sens. Debbie Stabenow (D-Mich.) and Todd Young (R-Ind.), Choose Home is legislation designed to give nursing home-eligible Medicare beneficiaries more options …

Older Americans Overwhelmingly Support Choose Home Care Act Read More »

Census: Insured Population Holds Steady, With a Slight Shift From Private to Public Coverage

Despite a pandemic-fueled recession, the number of uninsured Americans has increased only slightly since 2018, according to Census Bureau health insurance data released Tuesday. Twenty-eight million people, or 8.6% of Americans, were uninsured for all of 2020. In 2019, 8% of people were uninsured during the full year; in 2018, it was 8.5%. During a …

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Phony Diagnoses Hide High Rates of Drugging at Nursing Homes

At least 21 percent of nursing home residents are on antipsychotic drugs, a Times investigation found.

Justice Department Targets Data Mining in Medicare Advantage Fraud Case

The Justice Department has accused an upstate New York health insurance plan for seniors and its medical analytics company of cheating the government out of tens of millions of dollars. The civil complaint of fraud, filed late Monday, is the first by the federal government to target a data mining company for allegedly helping a …

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Potential Savings for Medicare Part D Enrollees Under Proposals to Add a Hard Cap on Out-of-Pocket Spending

Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides coverage above a catastrophic threshold for high out-of-pocket drug costs, but there is no cap on total out-of-pocket drug costs that beneficiaries pay each year. Recent legislative proposals would add a cap on out-of-pocket spending under Part D. This analysis focuses on the …

Potential Savings for Medicare Part D Enrollees Under Proposals to Add a Hard Cap on Out-of-Pocket Spending Read More »

2021 Medicare Trustees Report

The 2021 Medicare Trustees Report–formerly known as the “Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund“–had some grim news. Expenditures ($925.8 billion) exceeded revenues ($899.9 billion) in 2020. More worrying, the estimated depletion date for the Medicare (i.e., Hospital Insurance) trust …

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Report: Medicare trust fund still expected to run out by 2026

The latest report from the Medicare Board of Trustees shows that the health insurance trust fund, also known as Medicare Part A, will run out in a mere five years, which is in line with reports released in 2018, 2019 and 2020, indicating that the Covid-19 pandemic has not hastened the fund’s depletion.

Ochsner Health Launches Fall Prevention Pilot Program to Medicare Advantage Members

What You Should Know:  – Ochsner Health and innovationOchsner (iO) have partnered with Bold, an evidence-based, digital exercise platform for older adults aimed at reducing falls and improving health outcomes. – The Bold platform is one of five interventions in the Ochsner Connected Stability pilot fall prevention and monitoring programs focused on helping Medicare Advantage …

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Recent polling misrepresents public support for Medicare “negotiation”

Proponents of government price setting often misrepresent voters’ opinions on support for allowing the federal government to “negotiate” drug prices. This includes recent polling from advocacy firms like the Alliance for Retired Americans/Lake Research Partners that fails to reveal voters’ true health care priorities and concerns with government price setting, or so-called “negotiation.”

How CommonSpirit Reduced Medicare Spending by $136M

CommonSpirit Health carved out $136 million in savings to Medicare for 2020, while also improving overall outcomes for hundreds of thousands of beneficiaries, the company recently announced. CommonSpirit Health is a participant in the Medicare Shared Savings Program (MSSP), which began back in 2012 after being designed by the U.S. Centers for Medicare and Medicaid …

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Apple, Bose and Others Pump Up the Volume on Hearing Aid Options, Filling Void Left by FDA

Spurred by decades of complaints about the high cost of hearing aids, Congress passed a law in 2017 to allow over-the-counter sales, with hopes it would boost competition and lower prices. Four years later, federal regulators have yet to issue rules to implement the law. But changes in the industry are offering consumers relief. In …

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What they’re saying: Patient advocates want to protect Medicare from government interference

For seniors and people with disabilities, Medicare Parts B and D provide important access to lifesaving medicines. Unfortunately, some in Congress are proposing changes to Medicare under the guise of “negotiation,” meaning the government can set the price of medicines. But experts agree access to current and future medicines for Medicare beneficiaries is threatened when …

What they’re saying: Patient advocates want to protect Medicare from government interference Read More »

Impact of Medicare Pay-for-Performance Program for Surgical Procedures on Cost and Outcomes

In 2008, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital-Acquired Conditions Present on Admission (HAC-POA) program. The goal of this program was to reduce the frequency of high-cost complications among Medicare beneficiaries. The mandatory program penalized hospitals as it would no longer reimburse them for treating of preventable complications that developed during …

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Readers and Tweeters Ponder Vaccines and Points of Fairness

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names. Higher Insurance Rates for the Unvaccinated? Snuff Out That Idea This is about Dr. Elisabeth Rosenthal’s comments on “All In With Chris Hayes” (“Analysis: Don’t Want a Vaccine? Be Prepared to …

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Biden’s No-Jab-No-Job Order Creates Quandary for Nursing Homes

President Joe Biden’s edict that nursing homes must ensure their workers are vaccinated against covid-19 presents a challenge for an industry struggling to entice its lowest-paid workers to get shots without driving them to seek employment elsewhere. Although 83% of residents in the average nursing facility are vaccinated, only 61% of a home’s workers are …

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KHN’s ‘What the Health?’: Booster Time

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. As covid-19 cases in the U.S. continue to rise, the Biden administration is countering with new strategies. The latest efforts include preparing for vaccine boosters starting this …

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Study: Private consultancies can influence hospital participation in CMS bundled payments model 

Partnering with private consulting firms can spur greater hospital participation in the Bundled Payments for Care Improvement initiative Advanced Model, in which hospitals earn rewards for spending less than CMS-set benchmarks on an episode of care or pay penalties if they spend more.

Payments to Medicare Advantage Plans Boosted Medicare Spending by $7 Billion in 2019

The federal government spent $321 more per person for beneficiaries enrolled in Medicare Advantage plans than for those in traditional Medicare in 2019, a gap that amounted to $7 billion in additional spending on the increasingly popular private plans that year, finds a new KFF analysis. The Medicare Advantage spending includes the cost of extra…More

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges

This analysis finds that Medicare spending for Medicare Advantage enrollees was $321 higher per person in 2019 than if enrollees had instead been coverage by traditional Medicare, leading to an estimated $7 billion in additional spending in 2019. It also examines the implications of expected growth in Medicare Advantage enrollment and payments per enrollee from …

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges Read More »

KHN’s ‘What the Health?’: The Senate Acts

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The Senate has set the stage for a busy fall that will include debate on a broad array of health issues, such as prescription drug prices, Medicare …

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Myth vs. fact: Polling and Medicare “negotiation”

As some in Washington consider legislation related to prescription medicines and how to best help Americans manage health care costs, government “negotiation” of prescription medicines within Medicare continues to be debated. The concept of government-led negotiation is highly misleading – and there are other, more common-sense policy solutions that are in the better interest of …

Myth vs. fact: Polling and Medicare “negotiation” Read More »

How Would Drug Price Negotiation Affect Medicare Part D Premiums?

Proposals to allow the federal government to negotiate prescription drug prices, such as H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act, aim to lower out-of-pocket drug costs for Medicare beneficiaries and private plan enrollees and achieve savings for Medicare. This data note estimates average premium savings attributable to the negotiations provision of …

How Would Drug Price Negotiation Affect Medicare Part D Premiums? Read More »

US telemedicine company owner charged with $784m fraud

A jury in the US has charged a Florida man who owns multiple telemedicine companies in connection with a massive healthcare scam that involved a massive $784 million in fraudulent claims being submitted to Medicare. Creaghan Harry (53) is accused of conspiracy to commit health care fraud and wire fraud, and four counts of income …

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Why Doesn’t Medicare Cover Services So Many Seniors Need?

Sorry, Joe Namath. Despite what you keep saying in those TV ads, under Medicare, seniors are not “entitled to eliminate copays and get dental care, dentures, eyeglasses, prescription drug coverage, in-home aides, unlimited transportation and home-delivered meals, all at no additional cost.” But if Democratic lawmakers in Congress have their say, seniors could soon be …

Why Doesn’t Medicare Cover Services So Many Seniors Need? Read More »

2+2=? Senate Uses Murky Math as It Shelves Drug Pricing Rule to Fund Infrastructure

The Senate’s release of its bipartisan infrastructure plan signals that lawmakers are poised to throw former President Donald Trump’s belated bid to lower Medicare drug prices under the bus — not to mention trains, bridges, tunnels and broadband connections. That’s because the massive spending bill is the first of two likely to at least delay …

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Celebrating Medicare’s 56th anniversary

For 56 years, Medicare has helped pay for medical care for Americans over the age of 65, as well as younger Americans with certain medical needs. Today marks Medicare’s anniversary and to celebrate, we are reflecting on the history of the program that benefits more than 60 million Americans.

Pfizer Court Fight Could Legalize Medicare Copays and Unleash ‘Gold Rush’ in Sales

Three years ago, pharma giant Pfizer paid $24 million to settle federal allegations that it was paying kickbacks and inflating sales by reimbursing Medicare patients for out-of-pocket medication costs. By making prohibitively expensive medicine essentially free for patients, the company induced them to use Pfizer drugs even as the price of one of those medicines, …

Pfizer Court Fight Could Legalize Medicare Copays and Unleash ‘Gold Rush’ in Sales Read More »

Medicare vaccine coverage (including how the COVID-19 vaccines are covered)

How does Medicare cover vaccines? Are the paid for by Medicare Part B or Part D? MedPAC’s June 2021 report provides a nice overview. Medicare covers vaccines under Part B and Part D. Part B covers vaccines for influenza, pneumococcal disease, hepatitis B (for patients at high or intermediate risk), and coronavirus disease 2019 (COVID-19), …

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Medicare Enrollment Starting to Accelerate, as Number of Home Health Agencies Continues to Decline

Enrollment in fee-for-service (FFS) Medicare has started to accelerate in recent years, as more members of the baby-boom generation age into the program. At the same time, the number of individual home health agencies in the U.S. continues to decline. That’s according to the Medicare Payment Advisory Commission (MedPAC), which reported on emerging Medicare trends …

Medicare Enrollment Starting to Accelerate, as Number of Home Health Agencies Continues to Decline Read More »

Lacking Dental Coverage, Many People on Medicare Forgo Dental Care, Especially Beneficiaries of Color

Many people enrolled in Medicare go without dental care, especially beneficiaries of color, according to a new KFF analysis of dental coverage and costs for people with Medicare. Almost half of all Medicare beneficiaries (47%) did not have a dental visit within the past year as of 2018, the analysis finds, with rates higher among…More

Medicare and Dental Coverage: A Closer Look

Medicare does not cover routine dental care and about half of Medicare beneficiaries do not have dental coverage. Some beneficiaries have dental coverage through other sources, including Medicare Advantage, but 47% of all beneficiaries have not been to the dentist in the past year and many older adults face high out-of-pocket costs for needed dental …

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Success at a glance: Turning incomplete patient data from COVID-19 testing and vaccinations into valid reimbursable claims

“Experian Health’s speed and ability to speak our business language definitely impressed us,” said ACS president, Tim Anderson. “Some of the claims were valid for only a few more weeks, and we were able to submit them in plenty of time. This is the best, fastest platform we’ve seen to reconcile duplicate and data-deficient records. …

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Despite Formidable Challenges, PACE Leaders Keep Expansion Dreams Alive

The Program of All-Inclusive Care for the Elderly (PACE) concept has gained significant business and policy momentum over the past several months, with recent research also highlighting just how successful programs were at avoiding COVID-19 deaths compared to other care settings. Despite that traction and the model’s clear benefits, PACE still faces a long list …

Despite Formidable Challenges, PACE Leaders Keep Expansion Dreams Alive Read More »

Government “negotiation” could have devastating consequences for Medicare enrollees

Some members of Congress are considering significant changes to Medicare that could have a devastating effect on millions of Americans. Proponents call these changes government “negotiation,” but what they are actually proposing is anything but that. These politicians want to repeal a key provision of the Medicare Part D program that protects robust coverage and …

Government “negotiation” could have devastating consequences for Medicare enrollees Read More »

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Costs High Enough to Exceed the Catastrophic Threshold Over Time

Nearly 3 million Medicare Part D enrollees had out-of-pocket drug spending above the catastrophic threshold in a recent five-year period, finds a new KFF analysis that takes a comprehensive look at how many people on Medicare have drug expenses high enough to push them above that limit. While the Part D drug benefit has helped…More

What’s the Latest on Medicare Drug Price Negotiations?

In response to prescription drug spending growth and heightened attention to drug prices, some policymakers have proposed allowing the federal government to negotiate the price of prescription drugs for Medicare and private payers. This brief describes the current status of drug price negotiation proposals, looks back at the history of proposals to give the federal …

What’s the Latest on Medicare Drug Price Negotiations? Read More »

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time

Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides catastrophic coverage for high out-of-pocket drug costs, but there is no limit on the total amount that beneficiaries have to pay out of pocket each year. Policymakers on both sides of the aisle support proposals to modify the design of the Part D …

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time Read More »

Protecting Medicare from government interference

For more than a decade, Medicare Part D has provided seniors and people with disabilities with affordable and comprehensive prescription medicine coverage. Several surveys show that more than 9 in 10 Part D enrollees are satisfied with their coverage, helping tens of millions of patients manage a number of chronic and life-threatening conditions, including diabetes, …

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Though Millions Are at Risk for Diabetes, Medicare Struggles to Expand Prevention Program

Damon Diessner tried for years to slim down from his weight of more than 400 pounds, partly because his size embarrassed his wife but even more because his doctors told him he was at risk of developing Type 2 diabetes. His hemoglobin A1c level, a blood sugar marker, was 6.3%, just below the diabetes range …

Though Millions Are at Risk for Diabetes, Medicare Struggles to Expand Prevention Program Read More »

Sen. Wyden: $3.5T Budget May Have to Trim but It Can Set a Path to ‘Ambitious Goals’

Exactly what American health care will look like if Democrats can pass their $3.5 trillion spending plan is unclear, but the senator negotiating its health-related provisions hopes what emerges will be dramatic: the first complete health care system for older Americans and significantly reduced costs for everyone else. “We are setting very, very ambitious goals,” …

Sen. Wyden: $3.5T Budget May Have to Trim but It Can Set a Path to ‘Ambitious Goals’ Read More »

California Makes It Easier for Low-Income Residents to Get and Keep Free Health Coverage

SACRAMENTO, Calif. — Getting clean drinking water cost Ignacio Padilla his health insurance. The World War II veteran needed to repay the loan for the water pump installed on his 1-acre property in rural Tulare County, the only source of water to his mobile home. He carefully socked away a few thousand dollars so he …

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Data shows voters strongly support protecting access to their medicines

In our current health care system, the Medicare Part D program helps ensure seniors and people with disabilities have access to the prescription medicines they need. While more than 90% of seniors are very satisfied with their Part D prescription drug coverage and want to protect it, we also must tackle rising out-of-pocket costs for …

Data shows voters strongly support protecting access to their medicines Read More »

KHN’s ‘What the Health?’: Here Comes Reconciliation

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The expansion of health benefits is a major piece of the tentative budget deal reached this week by Democrats in Congress. They plan to press ahead — …

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Senate Democrats’ Plan Boosts Spending on Medicare, ACA Subsidies, Long-Term Care

The budget package Democrats are assembling in Congress would likely provide the biggest jolt to the American health care system since the passage of the Affordable Care Act in 2010, according to sources familiar with work on the plan. Democrats in the Senate announced Tuesday night that they had reached a framework for a $3.5 …

Senate Democrats’ Plan Boosts Spending on Medicare, ACA Subsidies, Long-Term Care Read More »

CMS proposes to cover mental health virtual visits through 2022

In the 1,747-page rule, which will be finalized later this year, CMS proposes expanding access to telehealth for behavioral healthcare, including for the first time allowing Medicare to pay for mental health virtual visits when they are provided by rural health clinics and federally qualified health centers and letting providers offer audio-only telehealth visits for …

CMS proposes to cover mental health virtual visits through 2022 Read More »

As Congress Wrestles With Plans to Expand Medicare, Becerra Says Any One Will Do

The Biden administration will support whatever expansions to Medicare Congress is willing to make, Health and Human Services Secretary Xavier Becerra said Tuesday. Democratic lawmakers on Capitol Hill are working on plans both to add benefits to the health program for seniors and to lower its eligibility age from 65 to 60. But the efforts …

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KHN’s ‘What the Health?’: Becerra Urges Congress to Expand Medicare, Address Rx Prices

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The Biden administration stands ready to work with Congress to address drug prices and expand Medicare, Health and Human Services Secretary Xavier Becerra said in a wide-ranging …

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US starts review of Aduhelm coverage amid fears of Medicare hit

The US government has started a review of how Biogen and Eisai’s pricey new Alzheimer’s disease therapy Aduhelm will be covered by Medicare, to see if a national strategy needs to be adopted. At the moment, the coverage for $56,000-a-year Aduhelm (aducanumab) is currently determined at the local level by Medicare administrative contractors representing 12 …

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Drugmakers’ Spending on Stock, Dividends and Executive Pay Exceeds Research, Democrats Say

The largest drug companies are far more interested in enriching themselves and investors than in developing new drugs, according to a House committee report released Thursday that argues the industry can afford to charge Medicare less for prescriptions. The report by the House Oversight and Reform Committee says that contrary to pharmaceutical industry arguments that …

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MedPAC report on alternative payment models

In 2021, CMS expects to operate 12 alternative payment models (APMs) offering 25 distinct tracks for providers to choose from that involve different payment options and risk arrangement… providers serving about 20 percent of Medicare beneficiaries participate in this APM That is a quote from a June 2021 MedPAC report on CMS APM’s serving Medicare …

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Paying Billions for Controversial Alzheimer’s Drug? How About Funding This Instead?

If you could invest $56 billion each year in improving health care for older adults, how would you spend it? On a hugely expensive medication with questionable efficacy — or something else? This isn’t an abstract question. Aduhelm, a new Alzheimer’s drug approved by the Food and Drug Administration last month, could be prescribed to …

Paying Billions for Controversial Alzheimer’s Drug? How About Funding This Instead? Read More »

Hospital Prices Must Now Be Transparent. For Many Consumers, They’re Still Anyone’s Guess.

A colonoscopy might cost you or your insurer a few hundred dollars — or several thousand, depending on which hospital or insurer you use. Long hidden, such price variations are supposed to be available in stark black and white under a Trump administration price transparency rule that took effect at the start of this year. …

Hospital Prices Must Now Be Transparent. For Many Consumers, They’re Still Anyone’s Guess. Read More »

KHN’s ‘What the Health?’: Un-Trumping the ACA

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The Biden administration this week proposed a series of changes aimed at boosting insurance enrollment under the Affordable Care Act, undoing changes made by the Trump administration …

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‘Extensive’ Proposed Rule Sets Stage for Value-Based Purchasing, PDGM Adjustments

The U.S. Centers for Medicare & Medicaid Services (CMS) released its FY 2020 home health proposed payment rule on Monday, while simultaneously announcing plans for the nationwide expansion of the industry’s value-based purchasing demo. While just a few days have gone by, home health stakeholders have already started to zero-in on several key areas — …

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Medicare “negotiation” proposals threaten Americans’ access to medicines

While more than 90% of seniors and people with disabilities report that they are very satisfied with their Medicare Part D prescription drug coverage, they also acknowledge concerns with rising out-of-pocket costs. It is no surprise that this has been a recurring discussion on Capitol Hill with many putting forth proposals aimed at lowering the …

Medicare “negotiation” proposals threaten Americans’ access to medicines Read More »

Former CMMI director’s new company will focus on value-based rural healthcare

Main Street Health, launched by former Center for Medicare & Medicaid Innovation Director Brad Smith, aims to provide value-based care solutions in rural America. The company’s first step will be to partner with primary care clinics, urgent care centers and independent pharmacies to implement a program that will coordinate care for seniors.

KHN’s ‘What the Health?’: The ACA Lives

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. For the third time in nine years, the Affordable Care Act has survived a constitutional challenge at the Supreme Court. In a 7-2 decision, the court ruled …

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HHS Issues New Reporting Requirements, Deadlines for Provider Relief Fund Recipients

Home health providers may have some additional financial aid in the not-too-distant future, as the federal government reportedly inches closer toward disbursing another round of CARES Act funds. As they wait for details, home health providers and other Medicare-reimbursed organizations on Friday received new reporting requirements and deadlines for the COVID-19 relief dollars they received …

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Innovaccer Unveils Health Plan Analytics Tool to Give a Comprehensive View of Over 700 Medicare Advantage Plans

What You Should Know:  –Innovaccer Inc., a leading healthcare technology company, recently launched its Health Plan Analytics tool, which provides a comprehensive view of health plan performance across the country.  –With this tool, payers can identify the quality parameters where they lag and determine the performance threshold to attain satisfactory ratings and enrollment. In addition, …

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FDA’s Approval of Biogen’s New Alzheimer’s Drug Has Huge Cost Implications for Medicare and Beneficiaries

The question of what would happen when a new, expensive prescription drug comes to market for a disease like Alzheimer’s that afflicts millions of people has loomed large in discussions over drug prices in the U.S. This brief analyzes the cost implications for Medicare and beneficiaries associated with Biogen’s new FDA-approved Alzheimer’s drug, which will …

FDA’s Approval of Biogen’s New Alzheimer’s Drug Has Huge Cost Implications for Medicare and Beneficiaries Read More »

Clover Health Announces In-Home Primary Care Expansion, Becomes New Target for Reddit Traders

Clover Health (Nasdaq: CLOV) announced Wednesday that it plans to scale its in-home primary care program, “Clover Home Care,” through the new direct-contracting model from the U.S. Centers for Medicare & Medicaid Services (CMS). The announcement came as Reddit’s investor community also targeted the health care company as its most recent cause. Headquartered in Nashville, …

Clover Health Announces In-Home Primary Care Expansion, Becomes New Target for Reddit Traders Read More »

CMS ups Medicare payment for at-home vaccinations to about $75 per dose

CMS is increasing the payment for administering at-home Covid-19 vaccinations from around $40 to $75 per dose. The move comes amid the Biden administration’s push to boost vaccinations nationwide, including among older adults who may not be able to access vaccine sites.

Medicare Advantage vs. Medicare FFS: A Systematic Review

Medicare Advantage has grown over time. In 2020, nearly four in ten (39%) of all Medicare beneficiaries – 24.1 million people out of 62.0 million Medicare beneficiaries overall – were enrolled in Medicare Advantage (MA) plans. With MA enrollment growing, a key question is who provides higher quality care: Medicare fee-for-service (FFS) or MA? Who …

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Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2021

The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans, including stand-alone drug plans and Medicare Advantage drug plans. This analysis provides the latest data about Part D enrollment, premiums, and cost sharing in 2021 and trends over time.

Study: Poor care access, higher costs more likely with private than public insurance

People with private insurance report poorer access to care, higher costs and lower satisfaction as compared to those with public insurance plans, a new study shows. As the debate over health insurance reform continues, policymakers should consider efforts that expand Medicare and increase protections for those with private insurance.

Expanding Insurance Coverage Is Top Priority for New Medicare-Medicaid Chief

The new head of the federal agency that oversees health benefits for nearly 150 million Americans and $1 trillion in federal spending said in one of her first interviews that her top priorities will be broadening insurance coverage and ensuring health equity. Use Our Content It can be republished for free. “We’ve seen through the …

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Addus Focused on Sourcing New Home Health Acquisitions, Improving Applicant-Conversion Rates

The COVID-19 public health emergency has solidified the home as a viable and effective care setting. That, in turn, has led to meaningful opportunities for home-based care providers, especially those with diversified service lines. Addus HomeCare Corporation (Nasdaq: ADUS) is a prime example. The company’s leadership team discussed the pandemic and its lasting impacts during …

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Readers and Tweeters React to Racism, Inequities in Health Care

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names. A Harrowing Tale of Racism I liked the article “The Making of Reluctant Activists: A Police Shooting in a Hospital Forces One Family to Rethink American Justice” (May 10). As a …

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Caring for an Aging Nation

USE OUR CONTENT This story can republished for free. Please contact KHNweb@kff.org for embed codes. Table of Contents A Variety of Services Booming Number of Seniors The Cost of Long-Term Care Services The Physical – and Financial – Burden The $61 Billion Price Tag Health care for the nation’s seniors looms large as the baby-boom …

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KHN’s ‘What the Health?’: The Return of the Public Option

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The “public option” is back — both in Washington, D.C., and the states. President Joe Biden as a candidate supported the idea of a government-run or heavily regulated insurance …

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Expanding Medicare to Adults at Age 60 Years—Medicare-for-More?

In this column for the JAMA Health Forum, Larry Levitt examines the implications of lowering Medicare’s age of eligibility, which is emerging as a potential pathway toward Medicare-for-all or a public option among single-payer advocates. He explores the implications for costs, industry, people and broader reform efforts.

Broad Coalition of Democrats Presses Biden to Expand Medicare

Over 150 House Democrats are pushing the president to include a plan in his infrastructure package to lower the eligibility age, expand benefits and negotiate drug prices.

Medicare Expansion: Broad Coalition of Democrats Press President Biden on Plan

Over 150 House Democrats are pushing the president to include a plan in his infrastructure package to lower the eligibility age, expand benefits and negotiate drug prices.

Impact of COVID-19 on CMS’ value-based programs

Many Medicare payment initiatives aim to link reimbursement to value. Value includes both cost and quality of care. However, measuring quality of care during a pandemic is problematic. Further, most of CMS’ value-based purchasing programs–such as Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program (HRRP) and the Hospital-Acquired Condition (HAC) Reduction Program all …

Impact of COVID-19 on CMS’ value-based programs Read More »

KHN Journalists Comment on Abortion Case, Wasted Covid Doses

KHN chief Washington correspondent Julie Rovner discussed the Supreme Court’s decision to hear a challenge in an abortion case from Mississippi on Newsy on Tuesday. Click here to watch Rovner on Newsy KHN freelancer Sara Reardon discussed allegations by a rail company that a clinic in Libby, Montana, is defrauding Medicare by overdiagnosing asbestos-related diseases on …

KHN Journalists Comment on Abortion Case, Wasted Covid Doses Read More »

Lowering the Age of Medicare Eligibility to 60 Could Reduce the Cost of Health Care and Have a Modest Effect on the Number of People Who Are Uninsured

A new KFF analysis shows that lowering the age of Medicare eligibility to 60 could improve the affordability of coverage for people who are already insured and expand coverage to over a million of the nation’s 30 million uninsured. Such a policy could provide a path to Medicare coverage for up to 11.7 million people…More

As Pandemic Eases, Many Seniors Have Lost Strength, May Need Rehabilitative Services

Ronald Lindquist, 87, has been active all his life. So, he wasn’t prepared for what happened when he stopped going out during the coronavirus pandemic and spent most of his time, inactive, at home. Use Our Content It can be republished for free. “I found it hard to get up and get out of bed,” …

As Pandemic Eases, Many Seniors Have Lost Strength, May Need Rehabilitative Services Read More »

Zing Health Acquires Medicare Advantage Plan Provider Lasso Healthcare

What You Should Know: – Zing Health Enterprises, a physician-founded and led provider of Medicare Advantage health plans, has signed definitive documents to acquire Harrisburg, PA-based Lasso Healthcare Insurance Co. – Lasso Healthcare offers Medicare Advantage (MA) plans in 34 states and the District of Columbia. Its insurance offerings currently cover over 6,000 members. Lasso …

Zing Health Acquires Medicare Advantage Plan Provider Lasso Healthcare Read More »

More Than 1 in 4 Medicare Beneficiaries Had a Telehealth Visit Between the Summer and Fall of 2020

As the coronavirus pandemic kept people home last year, just over 1 in 4 Medicare beneficiaries had a telehealth visit with a doctor or other health professional between the summer and fall of 2020, a new KFF analysis finds. Once limited to beneficiaries living in rural areas, coverage of telehealth services by traditional Medicare has…More

Medicare and Telehealth: Coverage and Use During the COVID-19 Pandemic and Options for the Future

This brief provides an overview of changes in coverage of telehealth under traditional Medicare before the coronavirus pandemic, and estimates changes in use of telehealth services using survey data from the Medicare Current Beneficiary Survey (MCBS) during the pandemic. The analysis also discusses issues and questions related to extending telehealth coverage under traditional Medicare beyond …

Medicare and Telehealth: Coverage and Use During the COVID-19 Pandemic and Options for the Future Read More »

Limitations of CMS’s Hospital Star Ratings System

Is your hospital high quality? Well, this depends on what quality means. Does it have low readmission rates? Low rates of mortality? Do they follow clinical guidelines? Are patients satisfied? Are they good at cardiology care? What about cancer treatment? Combining all these different dimensions of quality is a complex task. The Centers for Medicare …

Limitations of CMS’s Hospital Star Ratings System Read More »

CMS’ rule granting speedy coverage to FDA-designated ‘breakthrough’ devices delayed again

CMS delayed the start date of its rule that would provide expedited Medicare coverage for products the FDA deems “breakthrough devices” from May 15 to Dec. 15. CMS wants more time to examine concerns expressed about the rule, including that devices may gain coverage despite limited evidence of their use among seniors.

Clover halves membership projections for direct contracting

When it planned to go public through a SPAC merger, insurance startup Clover Health told investors that it already had 200,000 direct contracting lives under contract for 2021. But in new guidance shared on Monday, the company now plans to end the year just 70,000 to 100,000 covered lives from direct contracting. 

Medicare-Covered Older Adults Are Satisfied with Their Coverage, Have Similar Access to Care as Privately-Insured Adults Ages 50 to 64, And Fewer Report Cost-Related Problems

This brief analyzes current experiences of Medicare beneficiaries ages 65 and older with respect to satisfaction and access measures and examines whether privately-insured adults ages 50 to 64 report access or cost problems at higher or lower rates than Medicare beneficiaries 65 and older.

The ABCs (and Ds) of Medicare

For nearly 60 years, Medicare has helped pay for medical care for Americans over the age of 65, as well as younger Americans with certain medical needs. Medicare has many different programs, all named with different letters of the alphabet, so it can often feel confusing. With Medicare increasingly in the news, clarity around how …

The ABCs (and Ds) of Medicare Read More »

You’ve Added Your Kids to Your Health Plan. What About Mom?

SACRAMENTO — When Laura Chavez’s 74-year-old mom needed eye surgery last month, Chavez paid cash for the procedure. This story also ran on Los Angeles Times. It can be republished for free. The cost? $15,000 — and that was for just one eye. She couldn’t afford both. Her mom, Esperanza Chavez, doesn’t qualify for Medicare …

You’ve Added Your Kids to Your Health Plan. What About Mom? Read More »

32 hospitals in non-Medicaid expansion states sue HHS over payments for low-income patients

The hospitals are pushing HHS to recognize patients eligible for Medicaid under the ACA as “low-income” when calculating Medicare disproportionate share hospital payments in states that did not expand Medicaid. The agency’s refusal to do so resulted in the hospitals receiving lower reimbursements for three years, the lawsuit claims.

InnovAge CEO: ‘We Have a Couple of Irons in the Fire’

Even though InnovAge (Nasdaq: INNV) is already one of the largest Program of All-Inclusive Care for Elderly (PACE) providers in the U.S., the company has plans to go after an even bigger piece of the pie. Maureen Hewitt, president and CEO of InnovAge, talked about the company’s multi-pronged growth strategy on Monday during a conference …

InnovAge CEO: ‘We Have a Couple of Irons in the Fire’ Read More »

Covered California Says Health Insurance Just Got Too Cheap to Ignore

If you are uninsured because health coverage seemed too expensive the last time you looked, it’s time to look again. Use Our Content It can be republished for free. A new federal law could make it a whole lot cheaper to buy your own insurance if you don’t get coverage through an employer or a …

Covered California Says Health Insurance Just Got Too Cheap to Ignore Read More »

Shorter SNF Stays Could Mean More Room for Home-Based Care

Patients recovering at a skilled nursing facility (SNF) can often be discharged home much sooner than they typically are without resulting in a negative health outcome, new research suggests. And if that were to happen more frequently, it could potentially save the U.S. health care system millions of dollars in post-acute care spending while setting …

Shorter SNF Stays Could Mean More Room for Home-Based Care Read More »

Hoping to Age in Place, Americans Want Long-Term Care Help from Medicare

Given a choice, the vast majority of U.S. adults would still prefer to receive long-term care in their own homes instead of moving into a nursing facility or senior living community, according to a new study from The AP-NORC Center for Public Affairs Research. But while nearly everyone wants to age in place, few actually …

Hoping to Age in Place, Americans Want Long-Term Care Help from Medicare Read More »

Health Insurer Financial Performance in 2020

This analysis examines insurers’ financial data across markets through the end of 2020. It finds that average margins remained relatively high compared to recent years, suggesting many insurers remained profitable even as health spending rebounded and COVID-19 cases surged in the fall and winter.

CMS Medicare Provider Enrollment Requirements Could Drive Home Health Agencies Out of Business

Changes to the requirements for Medicare provider enrollment could have major consequences for home health providers down the line. Under provider enrollment requirements, the U.S. Centers for Medicare & Medicaid Services (CMS) has the authority to rescind providers’ Medicare enrollment if they are associated with “bad actors” and are at risk for fraud due to …

CMS Medicare Provider Enrollment Requirements Could Drive Home Health Agencies Out of Business Read More »

CMS proposes putting $2.5B into hospitals’ coffers, eliminating part of price transparency rule

CMS has released its proposed inpatient payment rule for fiscal year 2022, which includes a payment bump that could increase reimbursement for hospitals by $2.5 billion. Further, in a win for hospitals, the proposal aims to repeal a part of the price transparency rule related to Medicare Advantage plans.

Lowering the Age of Medicare Eligibility Would Likely Reduce Health Spending for Employers, But Raise Costs for the Federal Government by Covering More People in Medicare

Two new KFF analyses find that lowering the age of Medicare eligibility from 65 to 60 could significantly reduce health spending for employers, who could potentially pass savings to employees in the form of lower premiums or higher wages. Additionally, per person health spending for older adults who move from employer coverage on to Medicare…More

Health Spending for 60-64 Year Olds Would Be Lower Under Medicare Than Under Large Employer Plans

During the presidential campaign, President Biden proposed to lower the age of Medicare eligibility from 65 to 60. This analysis uses claims data for covered medical services from both large employer plans and traditional Medicare to illustrate the potential spending effects of using Medicare payment rates in lieu of higher rates paid by employer plans …

Health Spending for 60-64 Year Olds Would Be Lower Under Medicare Than Under Large Employer Plans Read More »

Time to Say Goodbye to Some Insurers’ Waivers for Covid Treatment Fees

Just as other industries are rolling back some consumer-friendly changes made early in the pandemic — think empty middle seats on airplanes — so, too, are health insurers. Many voluntarily waived  all deductibles, copayments and other costs for insured patients who fell ill with covid-19 and needed hospital care, doctor visits, medications or other treatment. …

Time to Say Goodbye to Some Insurers’ Waivers for Covid Treatment Fees Read More »

Humana Health Plan Overcharged Medicare by Nearly $200 Million, Federal Audit Finds

A Humana Inc. health plan for seniors in Florida improperly collected nearly $200 million in 2015 by overstating how sick some patients were, according to a new federal audit, which seeks to claw back the money. This story also ran on NPR. It can be republished for free. The Health and Human Services Office of …

Humana Health Plan Overcharged Medicare by Nearly $200 Million, Federal Audit Finds Read More »

3 Strategies to Up-Level Medicare Advantage Enrollment Before it is Too Late

Trey Keller, VP of Product Management at Edifecs Aaron Fulner, Sr. Director at Edifecs With a new administration looking to reshape healthcare policy and additional special enrollment periods already underway, now is the time to ensure Medicare enrollment systems are ready for the unpredictability, and potential opportunities, ahead. While Medicare is the fastest growing segment …

3 Strategies to Up-Level Medicare Advantage Enrollment Before it is Too Late Read More »

Analysis Finds That a Relatively Small Number of Drugs Account for the Majority of Medicare Prescription Drug Spending

A new KFF analysis finds that a relatively small share of drugs, mainly those without generic or biosimilar competitors, accounted for a disproportionate share of prescription drug spending in Medicare in 2019. This finding suggests that recent proposals that focus on prices for a limited number of high-cost drugs could achieve significant savings. The 250…More

Relatively Few Drugs Account for a Large Share of Medicare Prescription Drug Spending

As policymakers focus attention on proposals to lower prescription drug costs by allowing price negotiation or international reference pricing for a limited number of drugs, this analysis measures the share of total Medicare Part D and Part B prescription drug spending accounted for by top-selling drugs covered under each part.

KHN’s ‘What the Health?’: Pause and Effect on Covid Vaccines

Can’t see the audio player? Click here to listen on SoundCloud. The effort to vaccinate Americans against covid-19 took a hit this week. The Centers for Disease Control and Prevention and the Food and Drug Administration jointly called for a pause in use of the vaccine made by Johnson & Johnson while experts try to figure …

KHN’s ‘What the Health?’: Pause and Effect on Covid Vaccines Read More »

New Research Highlights ‘Surprising’ Findings About COVID-19’s Impact on Mortality in Community, Long-Term Care Settings

Since last spring, there has been a consistent — and justifiable — narrative that long-term care residents are particularly vulnerable to the deadly COVID-19 virus. New research, however, suggests it’s not so simple. A team of researchers from the Cleveland Clinic and Health Data Analytics Institute (HDAI) explored how the COVID-19 virus affects actual versus …

New Research Highlights ‘Surprising’ Findings About COVID-19’s Impact on Mortality in Community, Long-Term Care Settings Read More »

Navigating the complexities of health coverage and reimbursement beyond the pandemic

Product featured in this article: Coverage Discovery As of the end of March 2021, more than 53 million Americans have been fully vaccinated, allowing for cautious optimism as we prepare for the next phase of the COVID-19 journey. Unfortunately for pharmacists, the vaccination program has compounded many of the challenges of the last 12 months. …

Navigating the complexities of health coverage and reimbursement beyond the pandemic Read More »

Q1 2021 Health IT/Digital Health PC/VE, M&A, IPOs/ SPACs Activity

The first quarter of 2021 has been one of investor optimism as the vaccine rollout continues ahead of expectations and economic activity begins to accelerate in response.  Within the Health IT industry, the already strong investment and M&A trends seen in 2020 have only accelerated.  Over the course of the quarter, we observed $7 billion in private …

Q1 2021 Health IT/Digital Health PC/VE, M&A, IPOs/ SPACs Activity Read More »

Biden Seeks $400 Billion to Buttress Long-Term Care. A Look at What’s at Stake.

There’s widespread agreement that it’s important to help older adults and people with disabilities remain independent as long as possible. But are we prepared to do what’s necessary, as a nation, to make this possible? This story also ran on NPR. It can be republished for free. That’s the challenge President Joe Biden has put …

Biden Seeks $400 Billion to Buttress Long-Term Care. A Look at What’s at Stake. Read More »

Time and Goals Should Drive Your Post-COVID-19 Care Management Strategy

Jessica Scruton, BSN, RN, CCM, VP of Clinical Transformation for Lightbeam Health Solutions COVID-19 forced many health systems to reassess and reconfigure their care management processes and staffing models so that clinicians could better manage more of their acute, complex, and otherwise healthy patients remotely to limit in-person care.  During this time, health systems likely …

Time and Goals Should Drive Your Post-COVID-19 Care Management Strategy Read More »

How a Virtual Care Mindset Leads to Greater Patient Acceptance and Sustainable Telehealth Growth

Sandeep Pulim, MD, Chief Medical Officer at Bluestream Health There’s no question that the demand for telehealth and virtual care has grown exponentially over the last twelve months. With that growth has come a fundamental shift in the attitude toward virtual care. No longer do patients and providers take a “let’s try it” approach—now, it’s …

How a Virtual Care Mindset Leads to Greater Patient Acceptance and Sustainable Telehealth Growth Read More »

Highlights from MedPAC’s Spring 2021 Report

Here are a few highlight’s from the March 2021 report on Medicare Payment Policy from the Medicare Payment Advisory Commission (MedPAC). Leading causes of death The leading cause of death are heart disease, cancer, and respiratory disease. Note that these figures are from 2018. MedPAC notes that the 3rd leading cause of death in 2020 …

Highlights from MedPAC’s Spring 2021 Report Read More »

Medicare eats the world

In 2020, Medicare premiums and cost sharing were estimated to consume 24 percent of the average Social Security benefit, up from 14 percent in 2000. The Medicare Trustees estimate that in another 20 years, these costs will consume 31 percent of the average Social Security benefit. Medicare Payment Advisory Committee (MedPAC), March 2021 report

Time to Reboot “Medicare-For-All”

By MIKE MAGEE In the fog of the Covid pandemic, many are wondering what ever happened to prior vocal support for universal coverage and Medicare-for-All. Expect those issues to regain prominence in the coming months. A bit of recent history helps explain why. The January 6th insurrection, followed by the past weeks two mass shootings, …

Time to Reboot “Medicare-For-All” Read More »

KHN’s ‘What the Health?’: Planning for Round Two

Can’t see the audio player? Click here to listen on SoundCloud. Congress is out of session, but that hasn’t stopped Democrats from planning their next round of health legislation. Together with President Joe Biden, they are looking at a broad array of possibilities, from allowing Medicare to negotiate drug prices to adding more benefits to the …

KHN’s ‘What the Health?’: Planning for Round Two Read More »

Boost Operational, Clinical and Financial Performance with Good Data

Peter Nelson, VP & General Manager, Global Alliances at GHX There’s an old adage that every challenge is merely an opportunity in disguise. COVID-19 highlighted the healthcare industry’s ongoing challenge with producing clean, standardized data. As the industry looks to rebound from the severe financial impact of the pandemic, there’s a renewed urgency among hospitals …

Boost Operational, Clinical and Financial Performance with Good Data Read More »

What Home Health Providers Need to Know About Medicare Loan Recoupment

It has been six months since the U.S. Centers for Medicare & Medicaid Services (CMS) gave home health agencies and other Medicare providers a reprieve from having to pay back advance and accelerated payment loans. But recoupment for these loans is just around the corner. To avoid future financial headaches, providers must be prepared to …

What Home Health Providers Need to Know About Medicare Loan Recoupment Read More »

Effort underway to help hospitals by suspending Medicare sequestration

Medicare sequestration is making headlines this week, as legislation to pause the 2% payment cuts moves through Congress. Here is a recap of what the sequester cuts are, why hospitals want it gone and how lawmakers are working to make that happen.

How the Pandemic is Accelerating the Shift to Alternative Care Delivery Models

Mark Prather MD, MBA, CEO & Co-founder at DispatchHealth The COVID-19 pandemic has transformed how we interact with one another, with businesses, and with the world around us. From social distancing to hand sanitation to remote working, its impact on society is immense. And among the various industries that are experiencing significant change as a …

How the Pandemic is Accelerating the Shift to Alternative Care Delivery Models Read More »

Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap.

When Democrats pushed through a two-year expansion of the Affordable Care Act in the covid-relief bill this month, many people celebrated the part that will make health insurance more affordable for more Americans. This story also ran on NPR. It can be republished for free. But health care researchers consider this move a short-term fix …

Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap. Read More »

Will Medicare beneficiaries pay more for outpatient vs. inpatient surgeries?

Let’s say you need a surgery. Let’s say that it’s a serious surgery. There are a number of choices that you (or your doctor) may make. The surgery could be done in a hospital where you are admitted as an inpatient. On the other hand, you could get the procedure at a hospital, but perhaps …

Will Medicare beneficiaries pay more for outpatient vs. inpatient surgeries? Read More »

Democrats Eye Medicare Negotiations to Lower Drug Prices

Democrats, newly in control of Congress and the White House, are united behind an idea that Republican lawmakers and major drugmakers fiercely oppose: empowering the Department of Health and Human Services to negotiate the prices of brand-name drugs covered by Medicare. This story also ran on Fortune. It can be republished for free. But they …

Democrats Eye Medicare Negotiations to Lower Drug Prices Read More »

Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill

A cost-saving change in Medicare launched in the final days of the Trump administration will cut payments to hospitals for some surgical procedures while potentially raising costs and confusion for patients. This story also ran on The Washington Post. It can be republished for free. For years, the Centers for Medicare & Medicaid Services classified …

Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill Read More »

SNF-at-Home Concept Earning ‘Very Positive Feedback’ in Congress, Among Special Interest Groups

An innovative care concept designed to keep patients at home and out of skilled nursing facilities (SNFs) is reportedly gaining ground in Congress and among special interest groups. The concept — known as “Choose Home” — is a type of SNF-at-home model that leverages both medical and non-medical home care services for certain patients. LHC …

SNF-at-Home Concept Earning ‘Very Positive Feedback’ in Congress, Among Special Interest Groups Read More »

Strive Health Raises $140M for Value-Based Kidney Care Platform

What You Should Know: – Strive Health, a Denver-based provider of value-based kidney care today announced $140 million in Series B funding with Alphabet’s independent growth fund, CapitalG, as the lead investor. Strive has more than doubled its presence in regional markets and grown its employee base by more than 600% in the last year. This funding will further increase that momentum.  …

Strive Health Raises $140M for Value-Based Kidney Care Platform Read More »

Unite Us Nabs $150M, Reaching $1.6B Valuation to Address Social Determinants of Health

What You Should Know: –   Unite Us, the tech company creating coordinated care networks nationwide, has just announced a $150M Series C round of funding led by ICONIQ Capital, bringing its valuation at $1.65 billion.   – Unite Us is leading the care transformation movement towards whole-person health with its core product, Unite Us Platform, an outcome-focused coordination software sconnecting community-based …

Unite Us Nabs $150M, Reaching $1.6B Valuation to Address Social Determinants of Health Read More »

Home Health Profit Margins Projected to Remain Strong in 2021

Margins for Medicare-certified home health agencies are projected to remain strong in 2021, despite ongoing challenges tied to the COVID-19 pandemic and the shift to the Patient-Driven Groupings Model (PDGM). Margins are anticipated to be so robust, in fact, that Congress should reduce the 2021 Medicare base payment rate for home health agencies by 5% …

Home Health Profit Margins Projected to Remain Strong in 2021 Read More »

Quality Virtual Care Matters for Patients – Even More Than Telehealth

Rick Halton, Vice President of Marketing, Lumeon The COVID-19 pandemic made healthcare visits over video or phone the norm, likely turning telehealth into a permanent fixture within the U.S. healthcare system. In fact, the majority of patient access leaders at large hospitals believe 20-30 percent of appointments will happen over video in 2021, according to …

Quality Virtual Care Matters for Patients – Even More Than Telehealth Read More »

CMS Could Target LUPAs, Functional Impairment in Future PDGM Adjustments

Despite the once-in-a-generation COVID-19 pandemic, the home health industry’s transition to the Patient-Driven Groupings Model (PDGM) was pretty seamless. Looking into the not-too-distant future, the U.S. Centers for Medicare & Medicaid Services (CMS) will now likely attempt to make modest tweaks to a handful of key areas, payment experts believe. The agency will do so …

CMS Could Target LUPAs, Functional Impairment in Future PDGM Adjustments Read More »

How much does the U.S. federal government pay for pharmaceuticals?

A number of different federal agencies buy prescription drugs. However, the price at which these pharmaceuticals are purchased varies dramatically. To quantify this variation, a 2021 report from the Congressional Budget Office examines the following prices: Medicare Part D: the prescription drug program for Medicare beneficiaries. Prices are set when private insurers (or pharmacy benefit …

How much does the U.S. federal government pay for pharmaceuticals? Read More »

How U.S. Ratings of Nursing Homes Mislead the Public

Nursing homes have manipulated the influential star system in ways that have masked deep problems — and left them unprepared for Covid-19.

How U.S. Ratings of Nursing Homes Mislead the Public

Nursing homes have manipulated the influential star system in ways that have masked deep problems — and left them unprepared for Covid-19.

How U.S. Ratings of Nursing Homes Mislead the Public

Nursing homes have manipulated the influential star system in ways that have masked deep problems — and left them unprepared for Covid-19.

How U.S. Ratings of Nursing Homes Mislead the Public

Nursing homes have manipulated the influential star system in ways that have masked deep problems — and left them unprepared for Covid-19.

How U.S. Ratings of Nursing Homes Mislead the Public

Nursing homes have manipulated the influential star system in ways that have masked deep problems — and left them unprepared for Covid-19.

ICYMI: Bipartisan lawmakers urge new administration to oppose changes to six protected classes policy

On January 19, 2021 – the last full day of the Trump administration – CMS released a Part D Payment Modernization Model Request for Applications (RFA) for calendar year 2022. This model would provide “formulary flexibility” by exempting participating Part D plans from some of Part D’s formulary coverage requirements. These requirements include rules for …

ICYMI: Bipartisan lawmakers urge new administration to oppose changes to six protected classes policy Read More »

Payers Struggle with Provider Data Management Too

Eric Demers, CEO of Madaket Health Provider data management is usually discussed from the provider perspective: the busy staff, the needless paperwork amid a pandemic, the faxing, emailing and uploading of data. In these scenarios, the health plans are often painted as the villains for their bureaucratic processes and unique requirements. But the reality is …

Payers Struggle with Provider Data Management Too Read More »

2% Cut to Home Health Agencies, Other Medicare Providers Nearing Unwanted Return

Among its many provisions, last year’s Coronavirus Aid, Relief and Economic Security (CARES) Act pressed pause on the government’s 2% payment cut to all Medicare-reimbursed health care providers. The “sequestration holiday” was immediately seen as a common-sense lifeline for cash-strapped home health providers on the front lines of the COVID-19 pandemic, many of whom had …

2% Cut to Home Health Agencies, Other Medicare Providers Nearing Unwanted Return Read More »

Analysis: Spending on Health Care Would Drop by an Estimated $352 Billion in 2021 if Private Insurance Used Medicare Rates to Reimburse Hospitals and Other Health Care Providers

Total health care spending for people with private health insurance would be an estimated $352 billion lower in 2021 if private insurers used Medicare rates to pay hospitals and other health care providers, rather than the substantially higher rates they currently pay, a new KFF analysis finds. That would represent a 41 percent decrease from…More

Limiting Private Insurance Reimbursement to Medicare Rates Would Reduce Health Spending by About $350 Billion in 2021

This analysis estimates the total annual reduction in health care spending by employers and privately insured individuals that would result from having private insurers reimburse hospitals and other health care providers at Medicare rates. In total, we estimate spending for the privately insured population would be an estimated $352 billion lower in 2021 if employers …

Limiting Private Insurance Reimbursement to Medicare Rates Would Reduce Health Spending by About $350 Billion in 2021 Read More »

States Have Made Progress in Vaccinating Older Adults Against COVID-19 in Recent Weeks, But No State Has Vaccinated At Least Half of its Older Population

Twenty-two states and the District of Columbia have vaccinated at least one-third of their residents who are 65 and older against COVID-19, an updated KFF analysis finds, but no state has crossed the threshold of vaccinating 50 percent or more of its older population. The share of adults 65 and older who have received at least…More

3 Ways to Boost Patient Confidence with Real-Time Contactless Communication

Ford Blakely, SVP & GM, Medallia Zingle Although the vaccine’s rollout is slowly underway, Covid cases worldwide are continuing to reach all-time highs as new mutations make the virus even more contagious than ever before. Not surprisingly, patients’ concerns about visiting their healthcare providers in the midst of this global pandemic persist, pushing demand for …

3 Ways to Boost Patient Confidence with Real-Time Contactless Communication Read More »

Webinar: Improving value-based care through data-driven insights—lessons from Florida Blue Medicare

It’s clear that rewarding providers for value, not volume, of services reduces unnecessary and costly care, but transitioning from the traditional fee-for-service model is challenging. Providers respond best to a transparent, data-driven approach in which “value” is clearly and objectively defined. But how can health plans achieve this? For answers to this question and more, …

Webinar: Improving value-based care through data-driven insights—lessons from Florida Blue Medicare Read More »

Countless Homebound Patients Still Wait for Covid Vaccine Despite Seniors’ Priority

This story also ran on CNN. It can be republished for free. Opening another front in the nation’s response to the pandemic, medical centers and other health organizations have begun sending doctors and nurses to apartment buildings and private homes to vaccinate homebound seniors. Boston Medical Center, which runs the oldest in-home medical service in …

Countless Homebound Patients Still Wait for Covid Vaccine Despite Seniors’ Priority Read More »

Key excerpts: PhRMA submits comments to keep the six protected classes protected

Earlier this month, PhRMA submitted comments to CMS regarding the Part D Payment Modernization Model Request for Applications (RFA) for calendar year 2022. This RFA was released on January 19, 2021 – the last full day of the Trump Administration. Since the inception of the Medicare Part D program, PhRMA has supported the Part D …

Key excerpts: PhRMA submits comments to keep the six protected classes protected Read More »

Medicare Cuts Payment to 774 Hospitals Over Patient Complications

Use Our Content It can be republished for free. The federal government has penalized 774 hospitals for having the highest rates of patient infections or other potentially avoidable medical complications. Those hospitals, which include some of the nation’s marquee medical centers, will lose 1% of their Medicare payments over 12 months. The penalties, based on …

Medicare Cuts Payment to 774 Hospitals Over Patient Complications Read More »

Montana’s Health Policy MVP Takes Her Playbook on the Road

Use Our Content It can be republished for free. Marilyn Bartlett might be the closest thing health policy has to a folk hero. A certified public accountant who barely tops 5 feet, Bartlett bears zero resemblance to Paul Bunyan. But she did take an ax to Montana’s hospital prices in 2016, stopping the state’s employee …

Montana’s Health Policy MVP Takes Her Playbook on the Road Read More »

Home Health Experts Offer Update on Transition to No-Pay RAPs

It’s been 48 days since the start of “no-pay RAPs” in home health care. During this time, providers have had to navigate a sea of challenges and unexpected speed bumps while adjusting to the new process. The U.S. Centers for Medicare & Medicaid Services (CMS) kicked off no-pay RAPs on Jan. 1 of this year. …

Home Health Experts Offer Update on Transition to No-Pay RAPs Read More »

Vytalize Health Acquires Patient Financial Experience Platform MedPilot

What You Should Know: – Vytalize Health acquires patient financial experience platform MedPilot to accelerate data-driven engagement technology to its ACO’s Medicare population. – An alumnus of the Cedars-Sinai Accelerator, MedPilot’s platform has already helped over 1 million patients to date and boasts a 97% patient satisfaction score.   Vytalize Health, a leading provider of value-based …

Vytalize Health Acquires Patient Financial Experience Platform MedPilot Read More »

The COVID-19 Pandemic Has Hit People of Color the Hardest, Including Among People With Medicare

The COVID-19 pandemic has underscored the stark racial and ethnic health inequities in the U.S., including among Medicare beneficiaries. Among this group, people of color, including older adults and others on Medicare, account for disproportionate shares of COVID-19 cases, hospitalizations and deaths, according to data presented in a new KFF report about racial and ethnic…More

Does Education Narrow the Gap in Wealth Among Older Adults, by Race and Ethnicity?

Differences in median per capita income among White, Black, and Hispanic adults ages 65 and older are narrower when comparing people with similar levels of education, although among college graduates, the gap in income continues to be wide between Hispanic and White seniors. The gaps in savings and home equity remain wide, and are particularly …

Does Education Narrow the Gap in Wealth Among Older Adults, by Race and Ethnicity? Read More »

Signify Health Shares Soar More Than 33% in IPO, Valuing Company at Over $7.12B

What You Should Know: – Shares of Signify Health, a value-based care billing platform for in-home and bundled health services jumped more than 33% in its initial public offering (IPO), valuing the company at over $7.12B. – Today, Signify Health’s CEO Kyle Armbrester will also join the ranks among the youngest CEOs to ever take …

Signify Health Shares Soar More Than 33% in IPO, Valuing Company at Over $7.12B Read More »

A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration

This brief provides a status update on prescription drug final rules advanced by the Trump Administration in its final months related to Medicare, importation, and 340B pricing for insulin and epinephrine, and an overview of key drug pricing proposals related to Medicare and prescription drug prices generally that were voted on but not enacted in …

A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration Read More »

In-Home Care Providers ConcertoHealth, Perfect Health Merge to Form ‘ConcertoCare’

Two in-home care providers — ConcertoHealth and Perfect Health — announced Wednesday that their organizations have merged. Together, the companies will operate under the name “ConcertoCare.” Aliso Viejo, California-based ConcertoHealth is a value-based care provider organization that delivers a variety of home-based care services. The company’s teams consist of complex care physicians, complex care nurses, …

In-Home Care Providers ConcertoHealth, Perfect Health Merge to Form ‘ConcertoCare’ Read More »

What providers need to know about OIG’s plans to audit telehealth services

The Office of the Inspector General will audit Medicare Part B telehealth services to detect potential vulnerabilities and ensure compliance with regulatory requirements. To prepare, providers must first take stock of their programs and conduct audits of their own, experts say.

Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan

What You Should Know: – Anthem, Inc. has entered into an agreement with InnovaCare Health, L.P., to acquire its Puerto Rico-based subsidiaries, including MMM Holdings, LLC (“MMM”) and its Medicare Advantage (MA) plan MMM Healthcare, LLC as well as affiliated companies and Medicaid plan.   – MMM is Puerto Rico’s largest MA plan and one …

Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan Read More »

Action needed to preserve the six protected classes

In the final hours of the previous Administration’s time in office, the Center for Medicare & Medicaid Innovation (the Innovation Center) (CMMI) announced new changes for CY 2022 to an existing five-year Part D Payment Modernization Model. This model would provide “formulary flexibility” by exempting Part D plans in the Model from some of Part …

Action needed to preserve the six protected classes Read More »

Humana Taps DispatchHealth to Power Hospital-Level Care in the Home

What You Should Know: – Humana Inc. and DispatchHealth, a provider of in-home medical care, today announced an agreement to provide Humana members with access to an advanced level of care in the home – to help enhance patients’ experience and health outcomes. The Dispatch-Humana agreement is believed to be the country’s first program to …

Humana Taps DispatchHealth to Power Hospital-Level Care in the Home Read More »

4 Vital Health Issues — Not Tied to Covid — That Congress Addressed in Massive Spending Bill

This story also ran on NPR. It can be republished for free. Late last month, before President Joe Biden took office and proposed his pandemic relief plan, Congress passed a nearly 5,600-page legislative package that provided some pandemic relief along with its more general allocations to fund the government in 2021. While the $900 billion that lawmakers included for …

4 Vital Health Issues — Not Tied to Covid — That Congress Addressed in Massive Spending Bill Read More »

Addressing the Risk of Medicare Trust Fund Insolvency

In this Viewpoint for the Journal of the American Medical Association (JAMA), KFF’s Tricia Neuman and co-author Richard G. Frank of Harvard Medical School explain that the looming 2024 insolvency of the Medicare Hospital Insurance Trust Fund cannot be ignored for long.

Why CMS Will Lead the 2021 Kidney Care Revolution

Chris Riopelle, CEO of Strive Health After an unprecedented year, kidney care providers, including nephrologists, dialysis facilities, and care extenders are expecting 2021 to follow suit. We will see an overhaul in reimbursement and major industry shifts, partly led by CMS, that will require providers to advance their capabilities in a way that will usher …

Why CMS Will Lead the 2021 Kidney Care Revolution Read More »

Hurdle Secures $5M for Digital Mental Health Platform for People of Color

What You Should Know: – Washington, D.C.-based Hurdle raises $5M in seed funding to accelerate its digital mental health platform for people of color. – Hurdle aims to provide an innovative teletherapy solution for employers and insurers; aims to remove barriers to mental health care for People of Color by rooting its services in evidence-based …

Hurdle Secures $5M for Digital Mental Health Platform for People of Color Read More »

MACs Report Processing Glitches for No-Pay RAPs

Among payment-related policy changes for the home health industry in 2021 is the elimination of traditional Requests for Anticipated Payment (RAPs) — and the introduction of the “no-pay RAP.” While the change is a potentially costly one for home health agencies, they’re not the only ones struggling to keep up. Medicare Administrative Contractors (MACs) have …

MACs Report Processing Glitches for No-Pay RAPs Read More »

Biden administration – What can the healthcare industry expect?

As Joe Biden takes the reins at the White House, pharmaphorum asks experts how his presidential tenure may influence the global healthcare industry. “I think the Biden administration will have only an incremental impact on the healthcare industry as a whole,” said Maxim Jacobs, CFA, managing partner and director of research at Edison Group. “With …

Biden administration – What can the healthcare industry expect? Read More »

Trump’s Pardons Included Health Care Execs Behind Massive Frauds

At the last minute, President Donald Trump granted pardons to several individuals convicted in huge Medicare swindles that prosecutors alleged often harmed or endangered elderly and infirm patients while fleecing taxpayers. “These aren’t just technical financial crimes. These were major, major crimes,” said Louis Saccoccio, chief executive officer of the National Health Care Anti-Fraud Association, …

Trump’s Pardons Included Health Care Execs Behind Massive Frauds Read More »

After a Decade of Lobbying, ALS Patients Gain Faster Access to Disability Payments

Anita Baron first noticed something was wrong in August 2018, when she began to drool. Her dentist chalked it up to a problem with her jaw. Then her speech became slurred. She managed to keep her company, which offers financing to small businesses, going, but work became increasingly difficult as her speech worsened. Finally, nine …

After a Decade of Lobbying, ALS Patients Gain Faster Access to Disability Payments Read More »

Aledade Secures $100M for Value-Based Primary Care, Reaching $2.1B Valuation

What You Should Know: – Aledade raises $100 Million in Series D funding to help more primary care practices thrive in value-based care. – The new funding will power the growth of a nationwide network of more than one million patients by further expanding into Medicare Advantage Contracts. Aledade, a Bethesda, MD-based provider of value-based …

Aledade Secures $100M for Value-Based Primary Care, Reaching $2.1B Valuation Read More »

CVS Health Launches Senior Medical Alert System, Symphony

What You Should Know: – Today, CVS Health announced Symphony, a medical alert system designed to keep seniors safe and connected at home. – Symphony consists of a collection of in-home and wearable devices that offer a new at-home experience by connecting a suite of sensors that can monitor for falls, motion, and room temperature …

CVS Health Launches Senior Medical Alert System, Symphony Read More »

Provider Strategies for Mitigating Telehealth Fraud & Abuse in 2021

Dr. Gary Call, Chief Medical Officer at HMS As healthcare spending continues to rise, so too does the inherent risk for bad actors to take advantage. Today, the United States is estimated to spend nearly 18 percent of its GDP, or $3.6 trillion, on healthcare, and is expected to increase to one-fifth of GDP within …

Provider Strategies for Mitigating Telehealth Fraud & Abuse in 2021 Read More »

New CMS rule to enable immediate coverage for FDA-designated ‘breakthrough’ devices

The agency has finalized a rule that allows it to provide immediate Medicare coverage for FDA-approved products that are deemed “breakthrough devices.” The new coverage process would enable seniors to get access to these devices more quickly, but some provider and payer groups are concerned that this could cause patient harm.

A Dozen Facts About Medicare Advantage in 2020

Medicare Advantage enrollment has grown rapidly over the past decade, and Medicare Advantage plans have taken on a larger role in the Medicare program. More than 24 million Medicare beneficiaries (36%) are enrolled in Medicare Advantage plans in 2020. This data analysis provides updated information about Medicare Advantage enrollment trends, premiums, and out-of-pocket limits. It …

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Net Health Acquires Post-Acute Analytics Platform PointRight – M&A

What You Should Know: –  Net Health acquires post-acute market analytics platform PointRight to deepen the company’s analytics capabilities, post-acute presence, and support for SNF networks. Net Health, a provider of cloud-based software for specialty medical providers across the continuum of care, today announced that it has acquired PointRight Inc., a leading provider of analytics …

Net Health Acquires Post-Acute Analytics Platform PointRight – M&A Read More »

One Ambulance Ride Leads to Another When Packed Hospitals Cannot Handle Non-Covid Patients

This story also ran on U.S. News & World Report. It can be republished for free. Keely Connolly thought she would be safe once the ambulance arrived at Hutchinson Regional Medical Center in Kansas. She was having difficulty breathing because she’d had to miss a kidney dialysis treatment a few days earlier for lack of …

One Ambulance Ride Leads to Another When Packed Hospitals Cannot Handle Non-Covid Patients Read More »

Illinois, primer estado en ofrecer cobertura médica a adultos mayores indocumentados

Como jefa de enfermería en uno de los hospitales más concurridos de la red de seguridad de atención médica de Chicago, Raquel Prendkowski ha sido testigo del devastador número de víctimas que COVID-19 ha causado entre los residentes más vulnerables de la ciudad, incluyendo a personas que no tienen seguro médico por su estatus migratorio. …

Illinois, primer estado en ofrecer cobertura médica a adultos mayores indocumentados Read More »

Illinois Is First in the Nation to Extend Health Coverage to Undocumented Seniors

As a nurse manager for one of Chicago’s busiest safety-net hospitals, Raquel Prendkowski has witnessed covid-19’s devastating toll on many of the city’s most vulnerable residents — including people who lack health insurance because of their immigration status. Some come in so sick they go right to intensive care. Some don’t survive. “We’re in a …

Illinois Is First in the Nation to Extend Health Coverage to Undocumented Seniors Read More »

January 14 Web Event: A Shot in the Arm For Long-Term Care Facilities? Early Lessons from the COVID-19 Vaccine Rollout to High Priority Populations

With the pandemic taking a heavy toll among older Americans, the Centers for Disease Control and Prevention and most states have placed a high priority on vaccinating residents and staff of long-term care facilities. People in nursing homes and other long-term care settings account for 8 percent of cases but 40 percent of deaths from…More

Many Health Plans Now Must Cover Full Cost of Expensive HIV Prevention Drugs

Ted Howard started taking Truvada a few years ago because he wanted to protect himself against HIV, the virus that causes AIDS. But the daily pill was so pricey he was seriously thinking about giving it up. Under his insurance plan, the former flight attendant and customer service instructor owed $500 in copayments every month …

Many Health Plans Now Must Cover Full Cost of Expensive HIV Prevention Drugs Read More »

12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup

Dr. Paul Hain, Chief Medical Officer of GoHealth Telehealth is Here to Stay in 2021 Prior to the pandemic, telehealth was a limited ad-hoc service with geographic and provider restrictions. However, with both the pandemic restrictions on face to face interactions and a relaxation of governmental regulations, telehealth utilization has significantly increased from thousands of …

12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup Read More »

Seniors Face Crushing Drug Costs as Congress Stalls on Capping Medicare Out-Of-Pockets

This story also ran on Fortune. It can be republished for free. Sharon Clark is able to get her life-sustaining cancer drug, Pomalyst — priced at more than $18,000 for a 28-day supply — only because of the generosity of patient assistance foundations. Clark, 57, a former insurance agent who lives in Bixby, Oklahoma, had …

Seniors Face Crushing Drug Costs as Congress Stalls on Capping Medicare Out-Of-Pockets Read More »

MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers

Under the Trump administration, federal health care policymakers have long been vocal about the ability of Medicare Advantage (MA) to lower costs and improve outcomes among vulnerable populations. A recent report from the Washington, D.C.-based Better Medicare Alliance (BMA) and consulting firm Avalere Health is now putting hard numbers on that claim, particularly around home …

MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers Read More »

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Teladoc Health and Livongo Merge The combination of Teladoc Health and Livongo creates a global leader in consumer-centered virtual care. The combined company is positioned to execute quantified opportunities to drive revenue synergies of $100 million by the end of the second year following the close, reaching $500 million on a run-rate basis by 2025. …

2020’s Top 20 Digital Health M&A Deals Totaled $50B Read More »

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021. Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various institutions, geographies, patient demographics, and medical scanners. The sensitivity and …

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021 Read More »

KHN’s ‘What the Health?’: 2020 in Review — It Wasn’t All COVID

Can’t see the audio player? Click here to listen on SoundCloud. COVID-19 was the dominant — but not the only — health policy story of 2020. In this special year-in-review episode of KHN’s “What the Health?” podcast, panelists look back at some of the biggest non-coronavirus stories. Those included Supreme Court cases on the Affordable Care …

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For Better Patient Care Coordination, We Need Seamless Digital Communications

Catherine Thomas: Co-Founder and VP, Customer Engagement, careMESH  Peter Tippett MD, PhD: Founder and CEO, careMESH A recent Advisory Board briefing examined the annual Centers for Medicare & Medicaid Services (CMS) Readmission penalties.  Of the 3,080 hospitals CMS evaluated, 83% received a penalty for payments to be made in 2021, based on expected outcomes for a …

For Better Patient Care Coordination, We Need Seamless Digital Communications Read More »

End of year Part D reading List

Happy Holidays, Part D readers, and thank you for following along this year as we explored the impact of Medicare Part D and the important role the program plays for seniors and those with disabilities.

American Academy of Home Care Medicine Urges CMS to Reconsider Rate Cut for Home-Based Primary Care

At the beginning of the month, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the 2021 Medicare Physician Fee Schedule. Since then, the rule has drawn criticism for the payment cuts CMS made to home-based primary care visits, a move that experts believe will jeopardize access to care for seniors …

American Academy of Home Care Medicine Urges CMS to Reconsider Rate Cut for Home-Based Primary Care Read More »

Health Insurer Financial Performance Through September 2020

In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related care returned in the summer and fall.

Who Didn’t Get a Second Shingrix Shot? Implications for Multidose COVID-19 Vaccines

As the U.S. prepares for nationwide distribution of vaccines to combat COVID-19, some are asking whether people who get the first of two doses will return to complete the series in order to be fully immunized. This analysis draws on Medicare Part D prescription drug claims data for the herpes zoster vaccine Shingrix, which also …

Who Didn’t Get a Second Shingrix Shot? Implications for Multidose COVID-19 Vaccines Read More »

As Telehealth Surges, Are Seniors Being Left Behind?

Anne Davis, Director of Quality Programs & Medicare Strategy at HMS A global health crisis has thrust us into a scenario in which lives quite literally depend on the ability to virtually connect. Telehealth has rapidly emerged as a vital tool, enabling continuity of care, allowing vulnerable individuals to access their physician from home, and …

As Telehealth Surges, Are Seniors Being Left Behind? Read More »

Despite COVID-19: Providers Should Not Lose Sight of MIPS Compliance

Courtney Tesvich, VP of Regulatory at Nextech When 2020 began, no one anticipated that complying with the Merit-based Incentive Payment System (MIPS)—the flagship payment model of the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP)—would look so different halfway through the year. Like many other things, the COVID-19 crisis has delayed, diverted, …

Despite COVID-19: Providers Should Not Lose Sight of MIPS Compliance Read More »

New analysis finds stark difference in coverage of breast cancer medicines for seniors in the United States and England

In the United States, seniors and people with disabilities enjoy broad coverage of physician-administered medicines under Medicare Part B because the program relies on market competition to balance access, innovation and cost control. But the same cannot be said for patients in other countries. In fact, a new analysis from Avalere underscores the dangers of …

New analysis finds stark difference in coverage of breast cancer medicines for seniors in the United States and England Read More »

Cityblock Health Reaches $1B Valuation, Raises $160M to Address Systemic Healthcare Inequity

What You Should Know: – Cityblock Health, a transformative, value-based healthcare provider focused on improving healthcare outcomes for marginalized communities, today announced a $160M Series C round, bringing its total raised to $300M. – Cityblock is a care delivery trailblazer working to right the injustices of a healthcare system that cycles vulnerable communities through frequent …

Cityblock Health Reaches $1B Valuation, Raises $160M to Address Systemic Healthcare Inequity Read More »

Elation Health Nabs $40M for Clinical-First Solution to Power Independent Primary Care

What You Should Know: – Elation Health, which provides an easy-to-use and affordable clinical technology platform for more than 7 million independent primary care clinicians serving 14M+ patients – including an EHR raises $40M in Series C funding from Al Gore’s sustainable investment firm, Generation Investment Management. – Elation’s API-enabled platform also allows organizations to …

Elation Health Nabs $40M for Clinical-First Solution to Power Independent Primary Care Read More »

CMS’ new Geo care delivery model: 5 things to know

The new Geographic Direct Contracting Model aims to improve quality of care and slash costs for Medicare beneficiaries across an entire region. It involves setting up risk-sharing arrangements where participants will be responsible for the total cost of care for beneficiaries in the region.

Pair Team Emerges Out of Stealth with $2.7M to Automate Primary Care Operations

What You Should Know: – San Francisco-based digital health startup Pair Team emerges out of stealth with $2.7M in seed funding backed by Kleiner Perkins, Craft Ventures, & YC. – Pair Team provides both a remote team and AI that automates workflows, provides infrastructure & improves medical practices — efficiencies and billing as you’d expect, …

Pair Team Emerges Out of Stealth with $2.7M to Automate Primary Care Operations Read More »

Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense

Don Godbee Don Godbee, Mobile Solutions Architect at Stratix Don Godbee Telehealth and virtual care are not brand-new phenomena suddenly cobbled together as a rapid response to the onset of the COVID-19 pandemic, but the average US patient could be forgiven for thinking that it is. Indeed, virtual visits to care providers and remote patient …

Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense Read More »

Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond

Medicare provides significant health and financial protections to more than 60 million Americans, but there are gaps in coverage and high cost-sharing requirements that can make health care difficult to afford. This report analyzes several policy options that could help make health care more affordable for people covered by Medicare: adding an out-of-pocket limit to …

Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond Read More »

Potential Health Policy Administrative Actions Under President Biden

This brief outlines the potential health policy actions that President Biden could take using executive authority, based on campaign pledges, and actions that would reverse or modify regulations or guidance issued by the Trump Administration.

House Bill Looks to Keep Medicare Sequestration ‘Holiday’ in Place for Home Health Agencies, Others

U.S. Representatives Brad Schneider (D-Ill.) and David McKinley (R-W.Va.) introduced the Medicare Sequester COVID Moratorium Act last week. If passed, the bill would extend the temporary suspension of Medicare sequestration payment reductions, giving home health agencies and other providers more financial flexibility headed into an uncertain 2021. Since 2014, the U.S. Centers for Medicare & …

House Bill Looks to Keep Medicare Sequestration ‘Holiday’ in Place for Home Health Agencies, Others Read More »

5 Steps for Interoperability Excellence for Healthcare Providers

Shanti Wilson, Consultant, Freed Associates  As if 2020 couldn’t be any more challenging for healthcare providers, new federal rules on interoperability and patient access, granting patients direct access to their healthcare data, begin taking effect this November and continue into 2022. These rules, while ultimately beneficial to patients, bring an additional level of operational complexity to …

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MedPAC: ‘Dynamic’ Home Health Industry Is Evolving into ‘Multiple Types of Care’

The home health industry is in a “dynamic state” and evolving into “multiple types of care,” according to the Medicare Payment Advisory Commission (MedPAC). As a result, health care policymakers should start thinking about how to redesign the traditional home health benefit to make it more nimble, perhaps by breaking it up into pre-acute and …

MedPAC: ‘Dynamic’ Home Health Industry Is Evolving into ‘Multiple Types of Care’ Read More »

CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status

What You Should Know: – CommonHealth has connected to 230 health systems in the United States, allowing patients to gather, manage and share their health and test data, including COVID test and vaccination status. By the end of this month, CommonHealth will connect to more than 340 health systems – CommonHealth extends the health data …

CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status Read More »

5 Myth-Busting New Hospital ADT Notification Requirements

 Claudia Williams, CEO of Manifest MedEx When doctors know their patients have been to the hospital, they can act fast to provide needed support. Widespread use of hospital event notifications is associated with all kinds of health benefits, including a 10 percent decrease in readmissions for Medicare beneficiaries. These event notifications are one of the …

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SCAN Group Takes on Telehealth’s ‘Digital Divide,’ Moves Further into the Home

As mission-driven organizations, SCAN Group and SCAN Health Plan have leaned into trying to solve some of health care’s biggest problems. In particular, keeping seniors independent and healthy at home has been a major area of focus. SCAN Group is a nonprofit organization focused on helping older adults age in place. Founded in 1977, Long …

SCAN Group Takes on Telehealth’s ‘Digital Divide,’ Moves Further into the Home Read More »

Final rebate rule represents right way to change Medicare

As Washington policymakers look to make changes to Medicare and our health care system overall, there are right ways and wrong ways to address the challenges that seniors and patients face. Indeed, as part of the 2020 election, voters made it clear what they want Washington policymakers to focus on: Addressing COVID-19 and concerns around …

Final rebate rule represents right way to change Medicare Read More »