March 28th 2024
CMS released a final rule to help patients obtain Children’s Health Insurance Program (CHIP) coverage and issued a proposed rule to update Medicare payment policies and rates for inpatient rehabilitation facilities; debate over if gift card incentives are acceptable in health care marketing.
What We’re Reading: Health Insurance Premiums; Drug Price Hikes; Postpartum Depression Pill Access
January 17th 2024Families with workplace health insurance may have missed out on $125,000 in earnings over the past 3 decades due to rising premiums; so far, there have been about 600 drug price hikes in January; experts worry that minority and low-income people will not have easy access to zuranolone, the first FDA-approved postpartum depression pill.
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What We’re Reading: ACA Enrollment Increase; Adult ADHD Surge; High Rent Health Effects
January 11th 2024Health insurance enrollment through the Affordable Care Act (ACA) insurance marketplace has broken a record for the third consecutive year; attention-deficit/hyperactivity disorder (ADHD) treatment prescriptions for adults surged during the COVID-19 pandemic, contributing to lingering shortages; paying high rent can shorten your lifespan.
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What We’re Reading: Rising Hospital Care Costs; New Antibiotic; Disenrolled Medicaid Beneficiaries
January 4th 2024The average direct cost for hospital treatment for patients with COVID-19 in the United States rose by 26% from 2020 to 2022; scientists have developed a new type of antibiotic to treat a deadly bacteria resistant to most current antibiotics; a survey conducted for Utah state officials gave some clues as to why millions of Americans lost Medicaid coverage last year.
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Top 5 Most Popular Reimbursement Content of 2023
December 31st 2023The most popular reimbursement content of 2023 included coverage of the shift from the Oncology Care Model to the Enhancing Oncology Model, reactions to the 2024 Medicare Physician Fee Schedule, and concerns around denial of services in Medicare Advantage plans.
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Health Plan Design: Employers as the Architects of Health Equity
December 22nd 2023Employers, recognized as pivotal contributors to health equity, are urged to prioritize equitable benefits, address the complexity of health plans, and engage in education, data-driven interventions, and systematic measurements to comprehensively improve outcomes for diverse employee populations.
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What We’re Reading: Health Data Breaches; Medicaid Grassroots Groups; PCP Shortage Impact
December 22nd 2023As many as 116 million patients were impacted by large health data breaches this year; grassroots groups have begun leading the push to re-enroll patients denied Medicare coverage for bureaucratic reasons; a nationwide shortage of primary care clinicians is causing more distrust in the health care system.
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More than 15.3 million Americans enrolled in health insurance under the Affordable Care Act for 2024, which is a 33% increase from last year; emergency contraception sales in the United States may spike by around 10% in the new year; top Biden administration officials met with prominent civil rights and public health leaders on Tuesday amid the decision to delay the menthol cigarette ban.
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Understanding the Social Risk Factor Adjustment’s Effect on Star Ratings
This article examines how CMS’ adjustment for social risk factors affects the Medicare Advantage Star Ratings and the type of contracts affected by the adjustment.
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Higher Survival Rates Found in Male Hispanic, API Patients With Early Breast Cancer
December 18th 2023These findings suggest that addressing socioeconomic disparities and inequities that impact access to health care and services may help improve survival outcomes across racial/ethnic groups of male patients with early breast cancer.
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What We’re Reading: Inflation Penalties; Melanoma Vaccine; Respiratory Vaccine Coverage
December 15th 2023A vaccine is showing promising results in treating melanoma; the Biden administration will implement inflation penalties on dozens of drugmakers to reduce out-of-pocket costs for Medicare recipients; the CDC issued an alert urging health care providers to increase immunization coverage for influenza, COVID-19, and respiratory syncytial virus (RSV).
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AHIP Report Touts Medicare Advantage’s Quality Edge, but Hospital Concerns Persist
December 14th 2023A new report from AHIP shows that Medicare Advantage outperformed traditional Medicare on several clinical quality measures, including preventive screenings. However, debate continues over these plans’ cost efficiency and impact on the financial sustainability of rural hospitals.
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What We’re Reading: Childhood Obesity Counseling; Humana Lawsuit; AI Use Concern
December 13th 2023The US Preventive Services Task Force (USPSTF) recommended that children with obesity receive intensive counseling at age 6 to promote healthy diet and exercise habits; a new survey found that the majority of American patients are wary of their doctors using artificial intelligence (AI); a class-action lawsuit was filed Tuesday against health insurer Humana for using an AI algorithm that systemically denies seniors rehabilitation care recommended by their doctors.
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What We’re Reading: RSV Vaccine Demand; Permanent Contraception; Drug Negotiation Impact
December 8th 2023The Biden administration recently met with manufacturers of respiratory syncytial virus (RSV) immunizations to encourage them to increase access to the vaccine; since the Dobbs v Jackson decision, many patients have been seeking more permanent reproductive health care solutions; a Mathematica analysis showed that Medicare prescription drug price negotiations could have cut seniors’ out-of-pocket costs by nearly a quarter had the program been in effect in 2021.
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Data analysis showed that 40% of patients who filled a prescription for Wegovy in 2021 or 2022 were still taking it a year later; both Democrats and reproductive rights organizations are pressuring the Biden administration to ensure health insurers fully cover contraception; CMS implemented Medicare changes in March that limited access to blood tests that help transplant recipients ensure their organs remain healthy.
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The Impact of Nurse Practitioner Attribution in Medicare Shared Savings ACOs
December 5th 2023Allowing nurse practitioners to serve as attribution-eligible providers for Medicare Shared Savings Program accountable care organizations leads to no change in hierarchical condition category risk scores and modest growth in attributed beneficiaries.
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HMO and EPO Insurance Plans More Likely to Promote Use of Biosimilars
November 21st 2023Health plan type highly influences the likelihood of biosimilar uptake, with low-flexibility insurance plans more likely to have patients who either switched to a biosimilar or were initiated on a biosimilar.
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What We’re Reading: UnitedHealth Lawsuit; Fentanyl Crackdown; Global Heat Deaths Increase
November 15th 2023A class action lawsuit was filed against UnitedHealth Group and a subsidiary for allegedly using an algorithm to deny rehabilitation coverage for seriously ill patients; US and China officials are finalizing an agreement to crack down on fentanyl; a study published Tuesday projected global heat deaths to increase by 370% if no action is taken against global warming.
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Therapists’ Perspectives on Access to Telemental Health Among Medicaid-Enrolled Youth
This qualitative study elucidates therapists’ perspectives on barriers to and facilitators of access to telemental health among Medicaid-enrolled youth served by a large safety-net organization.
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Journey to Anticoagulant Access Following Payer Rejection of Apixaban
Formulary restrictions can create treatment barriers for patients with atrial fibrillation, including unnecessary delays in treatment and prescription abandonment, with vulnerable populations at greater risk.
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Many sleep experts want to permanently stay in the standard time zone; Medicare will cover mental health counselors and marriage and family therapists beginning in January; a new Minnesota law requires hospitals to check if patients are eligible for financial assistance before referring medical debt for collections.
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