Medicare Advantage AI Tools Stripping Care from Older Adults
Medicare Advantage insurers, like many payers, are increasingly relying on artificial intelligence (AI) to make reimbursement decisions, resulting in some older adults being denied access to adequate care. The tools are used to determine exactly when the plan can stop paying for care, often long before it is medically advisable to pull back.
US Veteran’s Administration to Cover Alzheimer’s Drug Leqembi
The US Veteran’s Administration has decided that it will cover Leqembi, Eisai and Biogen’s new therapeutic for Alzheimer’s disease. The announcement comes just weeks after the Centers for Medicare and Medicaid Services (CMS) decided not to expand coverage of the drug to patients outside of clinical trials, a restriction put in place after last year’s approval and failed market release of Aduhelm.
Language Barriers Worsen Asthma Care and Outcomes
English second language (ESL) Hispanic patients face significant barriers to adequate care, worsening health outcomes. Research presented at this year’s American Academy of Allergy, Asthma & Immunology meeting shows these health disparities are present for Hispanic people with Asthma, especially those who speak Spanish primarily.
Michigan Minds Podcast: Addressing Health Disparities through Health Policy Research
Social determinants of health (SDoH) are a driving factor in health disparities, especially those faced by marginalized and rural populations. In the latest episode of the Michigan Minds Podcast, University of Michigan professor Paula Lantz, PhD talks about SDoH, birth rates, and how public policies can be used to address health disparities on the population level.
Biden, the GOP, and the Future of Medicare
As the US Congress deliberates over the Biden administration’s recently released budget proposal, uncertainty looms over the future of Medicare funding. President Biden and most Republicans have pledged not to cut funding from the program, but some outliers within the GOP are pushing for cuts. These potential cuts could take one of a three different forms, according to Kaiser Health News correspondent Julie Rovner in a new NPR interview.
Proposed US DEA Rules Necessitate In-Person Visits For Certain Drugs Prescribed Via Telehealth
New rules proposed by the US Drug Enforcement Agency (DEA) will require patients to have in-person visits when prescribing certain controlled drugs to patients who primarily receive care via telehealth. While many controlled drugs are targeted, the rules are an expansion to access for buprenorphine treatment for patients with opioid use disorder.
Talking Remote Care and Reimbursement with Bronwyn Spira of Force Therapeutics
The US Centers for Medicare and Medicaid Services (CMS) introduced new CPT codes last year, reducing barriers via remote care. In a new video by Managed Healthcare Executive, Force Therapeutics’ Bronwyn Spira talks about how these new codes affected outcomes and why outcomes-based reimbursement models may help support these efforts going forward.
Real-World Data Study Identifies Negative Health Outcomes in Long COVID Patients One Year Out
A newly published study in JAMA Health Outcomes found several adverse health outcomes in people living with long COVID one year after their initial infection. The researchers analyzed data from 13,435 people with long COVID symptoms and nearly 27,000 without it, finding that those with long COVID had increased care utilization and higher rates of a litany of cardiovascular symptoms.
Vertical Integration Has Negative Impacts on Patient Outcomes
Although many health systems are moving toward vertical integration by acquiring private practices, the strategy may be hurting the bottom line and patients. A newly published study examined how vertical integration impacts patients undergoing colonoscopies and their subsequent healthcare costs using data from over 2.6 million visits.
Medicare Advantage Insurer’s Margins on the Rise
An analysis from the Kaiser Family Foundation shows that insurers in Medicare Advantage saw strong margins in 2021, twice that of other markers. This is leading many insurers to enter into the market and many others to redouble their efforts, Humana which announced it is pivoting away from the commercial market.
Supporting Comprehensive Care at Safety-Net Providers Through Value-Based Pricing
Although safety-net care systems are essential for providing healthcare to under- and uninsured people, often from marginalized backgrounds, comprehensive care is often out of reach due to a dearth of funding. One way to help address this care disparity, according to a newly published article in Health Affairs, is to implement value-based care pricing models.
Understanding the Impact of New EU Cybersecurity Directive on Medical Device Industry
As implementation of medical devices is on the rise, cybersecurity threats have become a pressing concern. In a Med Device Online guest column by John Giantsidis, President of CyberActa, discusses a recent EU directive that is set to change the cybersecurity landscape of the medical device industry, Directive (EU) 2022/2555 (NIS2).
Sanofi Launches “This is Rare” Campaign on Rare Disease Day
Sanofi is marking this year’s Rare Disease Day, February 28th, with its new “This is Rare” campaign, which will feature the voices of patients living with rare diseases. The campaign is part of a large push by the company and others to develop therapeutics for the rare disease community, which accounts for one in seventeen people in the UK.
Inflation Matters for Patients Considering Care Decisions
A recent survey of over 1,000 consumers found that 71% of participants said that inflation has affected their decision-making processes regarding healthcare. Results also show that one in ten people in the US owe at least 250 in medical debt. 43% of respondents said that the max amount they could comfortably spend on healthcare at the moment is just shy of that figure at $249.
High-deductible Insurance Plans Harm Patients
To cope with the cost of health insurance, over half of patients in the US with private insurance sign up for high-deductible plans that leave them paying list price for most of their medications and care. While some payer orgs tout the benefits of these plans, researchers are finding that these plans worsen health outcomes for members.
Most Healthcare Organizations Behind on SDoH Data
The American Health Information Management Association (AHIMA) has released a white paper detailing the state of social determinants of health (SDoH) data collection and usage. The authors surveyed 2,637 members, finding that the majority of healthcare organizations are collecting SDoH data but have issues analyzing and using it.
Harvard Study Finds LGB People Face Significant Barriers to Care and Poor Health Outcomes
Health equity received a boost of attention during the COVID-19 pandemic, bringing increased awareness of the health impact of social determinants of health (SDoH) like race and location. A recent study found that exposure risk was highly affected by a variety of SDoH. Likewise, access to care and quality of care are far from equally distributed.
Exploring the Intersection of Health Equity and Infectious Disease
Health equity received a boost of attention during the COVID-19 pandemic, bringing increased awareness of the health impact of social determinants of health (SDoH) like race and location. A recent study found that exposure risk was highly affected by a variety of SDoH. Likewise, access to care and quality of care are far from equally distributed.
Food Insecurity and Health Outcomes in Sub-Saharan African Nations
Several Sub-Saharan African (SSA) nations face significant levels of food insecurity, which is known to worsen health outcomes. A new study published in BMC Public health analyzes analyzed the effects of food insecurity on life expectancy and infant mortality in SSA nations and found that both were negatively impacted by food insecurity.
Children with Asthma Don’t Get Enough GP Visits
A set of studies published in the Archives of Disease in Childhood and the Journal of Asthma found that patients with childhood asthma benefit from regular general practitioner (GP) visits but unfortunately do not get enough of them. Only 20% saw their GP for a majority of their visits, with less than 40% seeing their GP in the week following a hospital discharge for asthma-related reasons.
Most Managed Care Plans Are Missing Medicaid Patient Contact Information
As the Medicare redeterminations and the end of the COVID PHE approach, many Medicaid managed care plans are ill-equipped to inform all their members about their status. A recent survey released by the Kaiser Family Foundation found that nearly a third of Medicaid plans have up-to-date contact information for 75% or more of their members.
Oppenheimer Analysts: Keep an Eye on Managed Care
A note to clients from Oppenheimer recommends that investors carefully watch managed care industry. Analysts say that a group of major managed care firms like Centene, Cigna, and UnitedHealth, have underperformed so far this year, in part because uncertainty surrounding the impending end of the COVID-19 public health emergency.
US GSA Launches AI Healthcare Challenge
The US General Services Administration (GSA) has announced the launch of a new competition to develop artificial intelligence (AI) solutions to improve health outcomes. The challenge, launched by the Centers of Excellence (CoE) and Challenge.gov, will focus on accessibility, oncology, logistics and safety, mental healthcare, and substance use disorders.
Preparing for the End of the COVID-19 PHE By Investing in Public Health
The COVID-19 public health emergency (PHE) is set to end this May, leaving many wondering about the financial impact on hospitals. In a new video shared by Managed Healthcare Executive, clinical associate professor Rich Priore, Sc.D., M.H.A. of Tulane University talks about how healthcare costs could be lowered if Americans invest in public health, wellness, and disease prevention.
5 Recommendations to Revamp Dementia Care Payment Models
Care for people living with Alzheimer’s and related dementias (ADRD) is emotionally taxing for caregivers and costly for Medicaid, which spent $146 billion on ADRD care in 2022 alone. In a newly published article in Health Affairs, authors give 5 recommendations to help revamp ADRD care payment models to reduce the burden on Medicaid and caregivers.
