Payers
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Report: Weight Loss Drugs Cost Significantly More for Americans than Peer Countries
A new KFF analysis compared list prices for Ozempic, Wegovy, Rybelsus and Mounjaro. It found that the U.S. has much higher list prices for these drugs than other peer countries while also having the highest rate of obesity.
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Why Blue Shield of California Is Shaking Up its Prescription Drug Model
Blue Shield of California is cutting many of its ties with CVS Caremark (though not all) and adding four additional partners for its prescription drug benefits. These partners include Mark Cuban Cost Plus Drug Company and Amazon Pharmacy. The changes are needed to disrupt the current broken system, said Salina Wong, senior director of clinical pharmacy programs at Blue Shield of California.
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Payer’s Place: Dawn Maroney
Dawn Maroney, President, Markets of Alignment Health and CEO of Alignment Health Plan, to discuss how they are using technology to provide better service and care to consumers.
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Congressman Launches Investigation into Medicaid Prior Authorization Denials
U.S. Representative Frank Pallone, Jr. (D-New Jersey) announced that he is looking into high prior authorization denial rates by Medicaid managed care health plans. It follows a report by the Office of Inspector General that found that Medicaid MCOs denied one out of every eight prior authorization requests in 2019.
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Evernorth: 3 Actionable Insights To Help Health Plans Improve Cancer Care
Immune checkpoint inhibitors are effective cancer treatments, but are expensive. Understanding the least-costly settings for administering treatments, leveraging genomic testing and following evidence-based guidelines can help health plans optimize cancer care, according to Evernorth Research Institute.
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MedArrive, Heartbeat Health Team Up To Offer In-home Cardio Care
In-home provider MedArrive can now connect members of its payer customers, particularly Medicaid plans, to Heartbeat Health for virtual cardiovascular services, the companies announced Tuesday.
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74% of Medicare Beneficiaries Concerned About Medicare’s Long-term Sustainability
About 20% of Medicare beneficiaries are “very worried” about the long-term sustainability of Medicare, 54% are “somewhat worried” and 25% are “not at all worried,” according to an eHealth survey.
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MedCity Influencers, Payers, Physicians
Cancer Moonshot: Would It Even Be Possible in Today’s Fee-For-Service World?
CMS’ Enhancing Oncology Model and Cancer Moonshot are the forcing functions to achieve value-based care in oncology. In the spirit of working together to improve lives, this is a MUST for physicians to consider–before they get left behind.
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Survey: Only 44% of MA Beneficiaries Fully Understand Their Plan
Only 44% of Medicare Advantage enrollees said they “fully understand” their plan, while 50% said they “somewhat understand” it and 6% said they don’t understand it, according to a recent survey.
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Marketplace Premiums Could Increase by 6% in 2024, Report Shows
ACA Marketplace insurers are proposing an average 6% premium hike for 2024, with inflation being a driving factor, according to an analysis by KFF.
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Payer’s Place: Don Antonucci
The CEO of Providence Health Plan visits the Payer’s Place and addresses the future of payment models.
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Payer’s Place: Peter Long, Blue Shield of California
Peter Long of Blue Shield of California discusses how they focus on member experience and ways to improve their overall healthcare needs.
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Report: Black, Latino, Asian Americans Are More Likely To Choose MA Plans Over Traditional
About 27% of Medicare Advantage enrollees are Black, Latino or Asian, versus 17% of traditional Medicare enrollees, according to a report conducted by ATI Advisory and commissioned by the Better Medicare Alliance.
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Report: Fewer Adults Are Interested in Weight Loss Drugs If Not Covered by Insurance
About half of adults, or 45%, said they are at least somewhat interested in taking a “safe, effective weight-loss drug,” according to a new survey by KFF. However, just 16% of adults are still interested in taking weight-loss drugs if they’re not covered by insurance.
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35% of Medicaid Beneficiaries Say Their Health Plan Hasn’t Reached Out About Renewing Coverage
Many Medicaid enrollees are not receiving the information they need from health plans during the return to Medicaid renewals, a new survey shows. Older Medicaid enrollees are especially struggling.
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Signify Health Unveils Chronic Kidney Disease Evaluation
Home care company Signify Health announced Tuesday that it added an in-home kidney health evaluation to its platform. Based on the results of the evaluation, the company can refer patients to their primary care physician or a specialist if they’re in need of further treatment.
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MedCity Influencers, Consumer / Employer, Payers
What We Can Learn From Health Systems Around the World
I am a practicing UK general practitioner and in this article, I take a magnifying glass to quality indicators including access, affordability, healthcare inequalities and population health, staffing and equipment, and patient and provider experience to discuss how we can shape up.
