During an interview at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum held Tuesday in Washington, D.C., CMS Administrator Chiquita Brooks-LaSure discussed CMS' key focus areas for 2023. This includes the end of the public health emergency, health equity and prescription drug costs.
For the first time ever, CMS is preparing to negotiate prices for drugs paid for by Medicare. This has sparked a huge debate — will the creation of this taxpayer-funded drug negotiation infrastructure be a failed experiment, or will it become the standard for the future of drug pricing in this country? Jason Borschow, president and CEO of Abarca Health, says it's the latter.
Gabby Everett, the site director for BioLabs Pegasus Park, offered a tour of the space and shared some examples of why early-stage life science companies should choose North Texas.
The U.S. Department of Health & Human Services announced three models Tuesday that will be tested by the CMS Innovation Center and aim to lower prescription drug costs. The models, which include access to $2 generic drugs, build on the Inflation Reduction Act of 2022.
The final rule calls for stricter audits on Medicare Advantage plans. AHIP president and CEO Matt Eyles referred to the rule as "unlawful and fatally flawed."
Pearl Health — a technology company that helps independent physician practices participate in value-based care models — just raised $75 million in Series B financing. Pearl’s platform leverages data science to help primary care providers focus on patients who are driving expenses and need care the most.
This year’s ACA Marketplace enrollment represents a 13% increase, or 1.8 million people, from last year, according to CMS. There were more than 12.7 million returning consumers and more than 3.6 million new consumers.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
By creating a marketplace that empowers consumers to choose the right health care coverage for their unique and individual needs, CMS will continue to put consumers first and strengthen Medicare Advantage, already the chosen program of America’s seniors.
About 11.5 million people have selected a health plan through the ACA Marketplace as of December 15. This is 1.8 million people more than the same period last year, representing an 18% increase, CMS said.
This represents a 17% increase in total ACA plan selections — both through HealthCare.gov and state-based Marketplaces — compared with last year, CMS said. Enrollment through the federal HealthCare.gov has especially seen a rise of 40% from the same period last year.
Intus Care, a predictive analytics platform designed to improve care outcomes among geriatric patients, recently closed a $14.1 million Series A funding round. The startup's mission is to improve the way PACE programs use their data so they can maintain and enhance the quality of care they provide to vulnerable seniors.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
The 2023 Physician Fee Schedule conversion factor — which calculates how much a physician is reimbursed by Medicare for services — changed to $33.06, a $1.55 decrease from 2022 at $34.61. The American Medical Association strongly opposes the cuts.
In a conference session on Friday in Chicago, CMS Administrator Chiquita Brooks-LaSure said that Congress has authorized the agency to reimburse telehealth through Medicare permanently - in other words, even beyond the pandemic.
The healthcare industry is still building software to can handle its complex and vast pricing data, so it still has a few more years to go before price transparency information actually becomes useful. Once software development cycle matures, this data can infiltrate the way providers and payers negotiate contracts and affect the way patients shop for care.
CMS is proposing a system in which it would collect information from providers that would go in a single national directory it maintains. AHIP is seeking a more collaborative directory between the government and private insurers.
There are 260 MA plans with Part D coverage that received four stars or more for 2023, a share of about 51%. This is a steep decline from 2022, when there were 322 plans with four stars or more, accounting for about 68% of plans.