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What We’re Reading: Unauthorized ACA Plan Switching; Private Equity in Emergency Care; MA Payments Cut
Insurance plan members find themselves involuntarily switched between plans; the Senate investigates patient safety concerns resulting from private equity practices; base payments to Medicare Advantage (MA) plans will decrease in 2025.
ACA Enrollees Encounter Unauthorized Plan Switching
Affordable Care Act (ACA) enrollees are experiencing unauthorized plan-switching disruptions to their coverage, driven by rogue agents exploiting vulnerabilities in federal marketplace security, according to Kaiser Health News. Despite record enrollment, complaints have surged, prompting regulatory actions from CMS, yet the efficacy of these measures remains uncertain. Additionally, brokers have reported ongoing concerns amidst new consent rules, highlighting the urgent need for enhanced safeguards to protect consumers and maintain ACA integrity.
Senate Committee Probes Private-Equity Firms' Impact on ED Care
Senator Gary Peters (D, Michigan) is heading a Senate inquiry into private-equity firms' management of hospital emergency departments, prompted by reports of patient safety and care issues, according to NBC News. Requests for information targeted Apollo Global Management, the Blackstone Group, and KKR, along with affiliated companies, aiming to assess the impact of private-equity practices on health care quality and physician autonomy. As private-equity firms increasingly dominate the health care sector, concerns continue to mount over cost-saving measures that potentially compromise patient safety, which have prompted calls for transparency and accountability from industry stakeholders.
Biden Administration Cuts MA Payments
The Biden administration's decision to reduce base payments to Medicare Advantage (MA) plans by an average of 0.16% has triggered a market downturn for major insurers like UnitedHealth, CVS Health, Humana, and Centene, amidst fears of ongoing financial challenges, according to Axios. While risk-adjusted payments may mitigate the impact, insurers expressed worries over continued pressure on seniors' benefits and potential benefit reductions due to rising costs and policy changes. With MA enrollment surging, concerns persist over overpayment and cost escalation.
USPSTF Lowers Age for Biennial Mammograms to 40, Citing Early Detection Benefit
April 30th 2024The USPSTF lowered the recommended starting age for mammograms from 50 to 40 years, citing moderate benefits for early detection in this age group. Disparities persist, especially for Black women, highlighting the need for improved access to health care and social support.
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Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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Makers of medical tests will have about 4 years to show the FDA that their new offerings deliver accurate results; after previously decreasing for 27 years, US tuberculosis (TB) cases increased every year since 2020; a US district judge rejected a challenge by Bristol Myers Squibb and Johnson & Johnson to the Medicare drug price negotiation program.
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Just as it is important for retail analysts to understand the choices their customers make and why they may choose not to purchase a specific item, so is it important for the specialty pharmacy industry to understand the actions of prescribers and how the often inefficient prior authorization process affects patient outcomes.
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