ACOs saved Medicare $755M from 2013 to 2017, new analysis finds


Accountable care organizations lowered Medicare spending by $755 million from 2013 to 2017, a new analysis found

Health Care and the Democratic Debates – Round 2 – Battle Royale for M4All vs Medicare for All Who Want It – What It Means for Industry

Health Populi

Sanders, noting his call for big new government benefits like universal health care through Medicare for All and free college tuition. Senator Harris, too, mentioned government benefits like free college and Medicare for All as her health plan preference.

A look at 4 ways to grow dental coverage in Medicare


Expanding options for dental care in Medicare is a popular idea, but policymakers could take several avenues toward this goal, according to a new analysis

ACOs saved Medicare $2.7B to date, outpacing CMS estimates


Accountable care organizations in the Medicare Shared Savings Programs have saved Medicare $2.7 billion to date, including $859 million in 2016, according to a new analysis commissioned by NAACOS.

Most U.S. Voters Support Building on the ACA, Not Medicare For All, As Fewer Americans Have Insurance Coverage

Health Populi

There’s another major finding the Democratic Presidential candidates should keep in mind: only 14% of Democrats and Democratic-leaning Independents would only vote for a candidate who would replace the ACA with Medicare for All.

Medicare Advantage Plans Grow With Star Ratings

BHM Healthcare Solutions

Editor’s Note: Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government. Financial Medicare and Medicaid Medicaid Medicare payment models Value Based Payments

Medicare Opens the Door to Reimbursement for Remote Patient Monitoring

Digital Health Today

When CMS unveiled the first standalone reimbursement for Remote Patient Monitoring (“RPM”) by “unbundling” CPT Code 99091 in the 2018 Medicare Physician Fee Schedule , it opened the door to the widespread use of RPM services for patients and promised there was more to come.

Medicare charges spike for specialties most associated with surprise bills


Average list prices for emergency medicine and anesthesiology, the most common sources of surprise billing, outpaced annual growth compared to all other specialties, a new analysis finds

Medicare Drug Prices Up Despite Decrease in Prescriptions

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. ” Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries.

KFF: Small share of Medicare Advantage and Part D enrollees switched up plans


Only a small share of Medicare Advantage and Part D beneficiaries switched their health plans during the 2016 and 2017 open enrollment, even though plan options have expanded, a new analysis finds

#IBMWoW cognitive solutions for cyber threat analysis and collaboration

The Healthcare Guys

Given how hard cybersecurity threat comprehension happens to be from a single company viewpoint, I’m eager to learn how we’ll be able to use next generation cognitive type tools for cyber threat analysis across firms or within logical groupings of firms.

Analysis shows frequent prescribers of opioids receive larger payments from pharma


Doctors who write the most opioid prescriptions get paid the most money from the pharmaceutical companies that manufacture the drugs, an analysis by CNN and researchers at Harvard University found. Using government databases, the report found that 54% of doctors who wrote prescriptions to Medicare patients in 2014 and 2015 for opioids received a payment from pharmaceutical companies that make the drugs

National Health Spending Will Reach Nearly 20% of U.S. GDP By 2027

Health Populi

every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth , published yesterday by Health Affairs.

Some payers and providers could thrive under ‘Medicare for All.’ But only if they’re willing to adapt 


Most of the legacy health organizations—both payer and provider—would stand to lose substantially under a ‘Medicare for All’ system, but a select few could thrive, according to a new analysis.

Medicare Told to Cover CGMs in Ruling

Insulin Nation

Medicare doesn’t typically provide coverage for continuous glucose monitors (CGMs), as insurors who oversee Medicare coverage have long argued that CGMs are a “precautionary” device rather than a “medically necessary” one. The Medicare-insuring contractor denied the claim.

Thinking About Health Care One Year From the 2020 Presidential Election

Health Populi

Last week, the Fed cut interest rates by 25 basis points for the third time this year,” the FT-Peterson Center analysis observed. has “the best health care system in the world,” compared with 21% of people who favor Medicare-for-All and 29% who want to improve the ACA.

Medicare Advantage beats fee-for-service in utilization, outcomes


A new analysis from Avalere shows Medicare Advantage patients have fewer inpatient stays, ER visits and avoidable hospitalizations than fee-for-service beneficiaries, despite higher rates of social and economic risk factors

2019 Medicare Physician Fee Schedule Could Expand RPM Reimbursement

care innovations

Just as it did for the 2018 calendar year , the Centers for Medicare & Medicaid Services (CMS) is seeking to further expand reimbursement for remote patient monitoring, virtual visits and other telehealth services as part of its proposed 2019 Medicare physician fee schedule.

Clinical Alarm Management Market – Global Industry Analysis, Size and Forecast, 2017 to 2027

Healthcare Guys

In its recent report titled, ‘Clinical Alarm Management Market: Global Industry Analysis (2012-2016) and Opportunity Assessment (2017-2027)’, Future Market Insights has conducted a thorough analysis of the global clinical alarm management market. Medicare and Medicaid service centres are striving to achieve greater cancer care consistency and cost predictability with the adoption of clinical decision tools. clinical alarm management market.

Technology, Aging and Obesity Drive Healthcare Spending, BEA Finds

Health Populi

Financial health Health Consumers Health costs Health Economics Health policy Heart health Medicare Medicines Mental health Money and health Obesity Personal health finance Pharmaceutical Prescription drugs Prevention Public health Specialty drugs TransparencyThe U.S.

Changes to Medicare Advantage Plans Could Allow for Expansion of RPM Services in Senior Care

care innovations

And that means that “senior living companies that double as Medicare Advantage insurers” will be given the opportunity for reimbursement for new modes of care targeting patient with chronic conditions. Changes to Medicare Advantage Plans Designed to Reduce Rehospitalizations.

New Study on Lowering Opioid Prescription Challenges

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries.

Part D catastrophic threshold to spike in 2020, hiking out-of-pocket costs: KFF report


Medicare Part D beneficiaries could see their out-of-pocket costs go up next year before they reach the catastrophic phase of the benefit, a new analysis shows.

Report: Axing protected drug classes in Medicare Part D may not substantially lower spending


Eliminating the protected classes of medications for Medicare Part D plans could give insurers more leverage to negotiate rebates but may have a limited financial payoff, according to a new analysis

Heart-Love – Omron’s Holy Grail of Blood Pressure Tracking on the Wrist

Health Populi

It’s February 1st, which marks the first of 28 days of American Heart Month – a time to get real, embrace, learn about, and engage with heart health. Heart disease kills 610,000 people in the U.S. every year, equal to 1 in 4 deaths in America.

AHIP: CMS must fix flaw in Medicare Advantage rate formula


As Medicare Advantage grows in popularity, America’s Health Insurance Plans says it is vital that the Centers for Medicare & Medicaid Services fix the flaws in its funding formula to maintain the program’s stability. AHIP’s assessment rests on a new legal analysis that shows CMS calculates current benchmarks for Medicare Advantage using data from patients who are not eligible to participate in the program

Medicare readmission rates offer incomplete picture of hospital quality


Condition-specific readmission rates do not offer a fair proxy for overall hospital quality, according to a new analysis of federal data. The authors of the study pointed to an imbalance between 30-day readmissions among Medicare patients and overall quality, concluding that broadening the scope of the program would eliminate penalties for 40% of hospitals

CMS Updates Opioid Mapping Tool

BHM Healthcare Solutions

CMS launched the tool in 2015, which featured Medicare Part D prescribing rates for 2013. Now, the updated tool also contains data on Medicaid opioid prescribing rates, along with an expanded look at Medicare data. percent and Medicare Part D prescribing rates ranged from 2.9

Combating Opioid Overprescription

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. The majority of the indictments reportedly stemmed from data analysis, which produces much more straightforward results in opioid investigations than in other potential cases of healthcare-related fraud. Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries.

Physician-led ACOs generated almost seven times more savings than hospital-led ACOs: Avalere


Physician-led accountable care organizations generated nearly seven times more savings for Medicare last year compared to more high-revenue ACOs typically led by hospitals, a new analysis finds

3 Big Healthcare Trends To Watch in 2015

BHM Healthcare Solutions

In 2013 The Centers for Medicare & Medicaid Services launched Bundled Payments for Care Improvement (BPCI) Initiative, which breaks down bundled payment in to four models of care to help target and hone in on the different types of bundled payments used by healthcare entities.


Altarum: Growth in spending on privately insured patients outpacing Medicaid, Medicare


A new analysis from the Altarum Institute found that spending and price growth among the privately insured sped up in 2017 and the first half of 2018 compared to public payers. It's a reversal from prior trends when private spending growth was near or below Medicare and Medicaid rates

Best Practices for Payer-Provider Partnerships

BHM Healthcare Solutions

CMS also analyzed data from the National Committee for Quality Assurance, Healthcare Effectiveness Data and Information Set, and CMS Medicare Advantage Star Ratings.

MA plans post higher gross margins than individual, group markets: KFF


Average gross margins for Medicare Advantage plans were double those of plans in the individual and commercial group markets, with MA plans buoyed by bonus payments, according to a new analysis

More Medicare Part D beneficiaries reaching catastrophic phase, likely setting up calls for reform


A new analysis from Avalere shows that more Part D enrollees are reaching their catastrophic phase, and the consulting group told FierceHealthcare such growth in spending is likely to lead to future reforms

Study: Hospital Prices Show ‘mind-boggling’ Variation

BHM Healthcare Solutions

The study provides the most comprehensive and detailed analysis of private health care spending in the United States and examines the real prices hospitals negotiate with private insurers for medical services.

KFF: MA plans per beneficiary to reach highest level in 2020 in a decade


The average number of Medicare Advantage plans per beneficiary will increase in 2020 to the highest level since 2010, according to a new analysis

New Opioids Bill Addresses Patient Brokering

BHM Healthcare Solutions

The kickback payments are already illegal under Medicare and Medicaid. Behavioral Health Integration Care Coordination Clinical Analysis Clinical Operations Improvement Strategic Planning Healthcare Payers Opioid Opioid Epidemic Payer Challenges

CBO: Pelosi drug plan saves $345B but could reduce flow of new drugs


House Speaker Nancy Pelosi’s drug prices plan would reduce Medicare spending by $345 billion over a seven-year period, according to an analysis from the Congressional Budget Office

Study Finds Flaws in Physician Performance Metrics

BHM Healthcare Solutions

The measures were part of the Medicare’s Merit-based Incentive Payment System/Quality Payment Program, a sweeping initiative to link physician performance – and patient outcomes – to reimbursement under the program.