Examining the Effect of CMMI Value-Based Care
The Association of American Medical Colleges (AAMC) released an issue brief that details the impact of Centers for Medicare and Medicaid Innovation (CMMI) value-based care on patient outcomes and healthcare costs. The AAMC notes that although these value-based care payment models have helped patients, better data collection practices are needed to advance health equity.
US CMS Passes Rule Targeting Misleading Ads for Medicare Advantage Programs
The US Centers for Medicare and Medicaid Services (CMS) has implemented a new rule to limit misleading advertisements for Medicare Advantage programs. The rule would ban companies from producing advertising that would lead consumers to believe they are official government messaging. In addition, it would force companies to name the specific plans in their advertising.
Defragmenting Community Health to Improve Outcomes
Fragmentation of care delivery systems results in patients falling through gaps in care, imperiling health outcomes and exacerbating health disparities. In a new Stat News article, Chris Dodd of the University of Washington School of Public Health and CMO of Emcara Health talks about how the Sea Mar Community Health Centers created an integrated approach to care that alleviated barriers to access for many patients.
Longitudinal Study Finds Racial and Ethnic Inequalities in Wealth and Health Relationship
Wealth is associated with better health outcomes, but a recently published study finds that this relationship differs significantly between racial and ethnic groups. The results, taken from the Longitudinal Survey of Youth 1997, found that wealth was strongly associated with wealth in white and Hispanic people, but was only associated with better outcomes in the wealthiest of Black young people.
28 US States Will See Medicaid Enrollment Drop to Near Pre-Pandemic Levels
Just as US states begin the Medicaid redetermination process, a new report by Moody’s Investors Services finds that 28 states will see enrollment drop to numbers equivalent to pre-pandemic levels. Some states, the report notes, will settle on enrollment levels higher than those seen before the pandemic-era Medicaid redetermination pause.
Home Medical Equipment and Value-Based Care
Although value-based care models have become increasingly prevalent in recent years, they have yet to be implemented in several areas of care, including home medical equipment (HME). Speakers at a Medtrade panel session discussed the importance of moving to such models and what that entails for the HME industry.
FDA Clears Robotic Bassinet as Medical Device
Happiest Baby’s Snoo robotic bassinet was granted medical device approval by the US Food and Drug Administration (FDA). Snoo rocks infants with a built-in motor system and helps soothe babies with calming sounds, all while keeping them on their back. The device is intended to reduce sudden infant death syndrome (SIDS), which kills over 3,500 infants in the US each year.
Reducing the Financial Impact of Tuberculosis in India
Despite concerted efforts like the END TB Strategy, India faces the highest disease and economic burden for tuberculosis. A newly published study in PLOS Global Public Health, explores the financial burden and consequences for patients with TB in the nation. Regardless of the free diagnostic and treatment provided by the state, patients spent significant funds on care.
Biden Administration Appeals Texas District Court Loss in ACA Preventative Care Case
A US District Court’s decision on preventative care recommendations under the ACA has been appealed by the Biden administration. A Texas judge ruled that the federal government cannot make states follow preventative care recommendations under the ACA. The move sends the case to the 5th Circuit Court of Appeals for future litigation.
More SDoH Data Needed to Investigate Cardiovascular Health Equity
A recently published study in AJPM Focus found that data regarding the social determinants of health (SDoH) that impact cardiovascular disease outcomes is sorely lacking. Interviews with several healthcare leaders across New York City revealed that health systems are prioritizing SDoH, but several barriers stand in the way of implementation efforts.
State Level Look at Who’s About to Lose Medicaid Coverage
With the imminent end to the COVID-19 public health emergency looming large, pandemic-era Medicaid expansions are set to kick millions off the program in the US. A newly published report from the Urban Institute and Robert Wood Johnson Foundation predicts that up to 18 million people are set to be dropped from Medicaid in the coming weeks and months. Examine this at the state-by-state level in a new Becker’s Payer Issues article.
UnitedHealthcare Drops 20% of Prior Authorizations and Introduces Gold-Card Program
The payer giant UnitedHealthcare announced plans to cut down on prior authorizations by introducing a new gold-card program. The gold-card program would be implemented nationwide and would cut the number of prior authorizations by 20%. Once implemented, the program will relieve a significant work burden for the provider groups involved.
The Growing Impact of Health Economics
The field of health economics has existed for decades but has been brought to new prominence with recent policy decisions and the COVID-19 pandemic. In a new Health Tech Zone article, learn about the basics of health economics, how different stakeholders are leveraging it, and the growing impact the field has on the US healthcare system.
Using Z Codes to Turn Social Determinants of Health Insights into Better Healthcare
Research in recent years has identified several non-medical factors that greatly influence health outcomes, referred to as social determinants of health (SDoH). However, health equity gains from these insights are held back, in part, by many providers not using the appropriate Z codes to record and track relevant SDoH data.
Study Finds Most Employers Provide Multiple Options for Health Insurance Plans
Results from Alight’s 2023 Benefits and Enrollment Trends report show that the vast majority of employers who provide health insurance give employees multiple options for plans. Over 90% offered more than one plan and three-quarters put money into employee health savings accounts for those with high-deductible plans.
NHS England Reveals Plan to Accelerate Diagnosis and Care for Rare Brain Disorders
NHS England has announced it is developing a new service to help fast-track diagnoses and care for people with a set of rare genetic brain diseases called inherited white matter disorders (IWMDs). Patients will be reviewed by a group of specialists and undergo genetic testing, getting referred to neurologists if an IWMD is expected.
Moving to Eliminate Health Inequities
Despite years of concerted efforts by providers and policy makers, patients from marginalized backgrounds still face significant health disparities. In a new Med Page Today article, Maulik S. Joshi, DrPH, lays out three ways that care systems can enact changes to make health inequity a “never event.” It begins with appropriate goal setting and a sea change in how health systems view care.
Provider Groups Call on US CMS for Hybrid Payment Model
Almost 30 provider groups have written a letter asking the US Centers for Medicare and Medicaid Services (CMS) to implement a hybrid system that mixes fee-for-service and prospective payments for primary care. According to the letter, doing so would incentivize primary care physicians (PCPs) to serve rural areas. The letter is, in part, in response to a push from the agency to get PCPs in rural and underserved areas to move to value-based care models.
AMCP 2023 Panel Argues for Patient-Centered Prior Authorization
Prior authorization is a complex, lengthy process that stands between patients and the drugs they need. In a panel at the Academy of Managed Care Pharmacy 2023, Heather Odem, PharmD, of UnitedHealthcare and Richard Ogletree, PharmD, of Alliant Health Solutions spoke about the need to shift measures used in prior authorization decision-making to benefit patients.
Value-Based Care as a Solution for Healthcare Workforce Shortages
Widespread healthcare workforce shortages and high employer-sponsored health insurance costs are impacting health systems and increasing healthcare costs. One potential solution for this problem is value-based care (VBC), which bases reimbursement on quality of care and patient outcomes. According to a new article in Benefits Pro, this can keep employees healthier and happier while reducing organizational health insurance costs.
Exploring the Systemic Causes of Maternal Mortality in the US
A 2022 report by the US Centers for Disease Control and Prevention (CDC) explored the underlying causes of high maternal mortality in the US. Over 75% of maternal deaths happen after returning from the hospital after delivery and 80% were preventable. A new article in Health Affairs, explains how the underlying design of our maternal care systems contributes to the problem
Using AI to Streamline Rare Disease Diagnosis
It can take years for patients with rare diseases to get a proper diagnosis, often worsening their condition in the process. Artificial Intelligence (AI) may represent a way to help streamline proper diagnoses of rare diseases, improving patient outcomes in the process. In a new pharmaphorum article by Dr. Peter Fish, learn more about how Mendelian’s Mendelscan technology can aid in diagnosis.
New Startup Launches Platform to Simplify Telehealth Insurance Verification Process
The new startup Opkit, formed by two former Brex software engineers, has launched a new platform to simplify the process [...]
Oncologists Skeptical of Enhancing Oncology Model
Despite being largely onboard with value-based care models, oncologists speaking at the Association of Community Cancer Centers (ACCC) 2023 meeting were skeptical of the upcoming Enhancing Oncology Model (EOM) developed by the US Centers for Medicare and Medicaid Services (CMS). The EOM replaces the previous Oncology Care Model (OCM).
Beneficiaries File Appeal Against UnitedHealth Victory in Mental Healthcare Coverage Case
A group of UnitedHealth members are filing an appeal to a recent court case against the company regarding its mental healthcare coverage practices. The class-action lawsuit alleged that United was basing its coverage decisions on patient claims based on the whims of the finance department, ignoring medical needs. The patient group had orgininally won their case in 2019 and 2020, but these wins were undone by court reversal last year.
