A Profile of People in Medicare Advantage Plans – HealthMine’s Survey of “Digital Immigrants”

Health Populi

There are over 60 million enrollees in Medicare in 2019, and fully one-third are in Medicare Advantage plans. Medicare is adding 10,000 new beneficiaries every day in the U.S. Younger Medicare beneficiaries are more digitally engaged (connected) than their older peers.

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.

CMS finalizes Medicare Advantage and Part D Payment Policies

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. Under the rule, Medicare Advantage health plans will see a 2.53

Medicare Advantage Organizations Overturned 75% of Their Denials

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

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.

In Wednesday’s second Democratic debate, 7 of 10 candidates support Medicare for All

Henry Kotula

Seven support Medicare for All. Unlike many of his Democratic rivals, Biden does not support full Medicare for All. As in Medicare, costs would be reduced through negotiating for lower prices from hospitals and other providers. [link].

Patients Growing Health Consumer Muscles Expect Digital Services

Health Populi

One-half of patients in the Cedar study were frustrated about health care providers’ lack of digital administrative tools to help people pay bills online and/or access insurance information, for example.

Can you identify 7 qualities of a successful telehealth program?

South Central Telehealth Resource Center

For example, telehealth is being used in the management of chronic diseases and follow up/triage programs, which can reduce hospital readmissions and emergency department visits. For example, your community may have a large number of citizens who need diabetes or nutritional counseling.

The New Drug Companies Aren’t Drug Companies At All

Health Populi

Today’s example of this is Clover Health, which launched Clover Therapeutics this week. This research organization will develop medicines targeting older adults — which makes sense because Clover Health’s target consumer market is Medicare Advantage beneficiaries.

What $285,000 Can Buy You in America: Medical Costs for Retirees in 2019

Health Populi

That retirement cost gap is the sticker-shock assumption that Medicare is going to cover all health care expenses in retirement.

The Promise of Telehealth for Older People – the U-M National Poll on Healthy Aging

Health Populi

Health Populi’s Hot Points: I recently collaborated with HealthMine on a survey looking into Medicare Advantage members’ views of health and digital technology. The HealthMine study found folks largely unaware of patient portals, for example.

When Will Self-Service Come to Health Care?

Health Populi

At least one in three people who have tried out virtual health care have done so because they use technology in all aspects of life and want to do the same with their healthcare.

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.

Do Medicare providers located at a Distant Site have to be hospital-based to provide services?

South Central Telehealth Resource Center

Q: Per Medicare regulations, do the providers at a distant site have to be hospital-based or can they be in a private setting – for example, a group of pulmonologists who want to create a telehealth system on their own? Also, all telehealth services must meet the Medicare established set of criteria for reimbursement. Click here to visit the Medicare Eligibility Analyzer site. To review CCHP information on Medicare, go to: [link]. Medicare

Health/Care Everywhere – Re-Imagining Healthcare at ATA 2019

Health Populi

Cleveland Clinic is a prime example of a hospital system imagining and re-shaping what a hospital will be in the future. “ATA” is the new three-letter acronym for the American Telemedicine Association, meeting today through Tuesday at the Convention Center in New Orleans.

Costs, Consumerism, Cyber and Care, Everywhere – The 2019 Health Populi TrendCast

Health Populi

An example of legislation newly-crafted to hit the House floor in January 2019 comes from Elizabeth Warren (D-MA) in the form of the Affordable Drug Manufacturing Act. Today is Boxing Day and St.

Telehealth Payments Don’t Meet Medicare Requirements

BHM Healthcare Solutions

Payers are rapidly becoming educated in telehealth and are keen on closing telehealth gap, but need to be mindful of Medicare requirements. Almost a third of telemedicine claims sampled by HHS’ Office of Inspector General did not meet Medicare requirements, resulting in an estimated $3.7

Prescription Drug Costs In America Through the Patient Lens, via IQVIA, GoodRx and a New $2 Million Therapy

Health Populi

In 2018, we saw more incentives to inspire adherence to prescription drug regimens, particularly in Medicare Part D along with increasing focus by pharmacists and providers. For people enrolled in Medicare Part D, 20% faced over $500 in OOP costs. Americans consumed 17.6

Heart Health at #CES2019 – Food and Tech as Medicine

Health Populi

An important example of this self-care approach is the evidence-based Ornish food regimen which is reimbursed by Medicare (as a form of cardiac rehabilitation). Self-care is the new health care as patients, now consumers at greater financial risk for medical spending, are learning.

Will Foot Ulcer Treatment Survive Medicare Rollback?

Insulin Nation

A state-of-the-art wound therapy that prevents amputations is under threat from proposed cuts in Medicare reimbursement rates, according to regenerative medicine experts. to 26.3%) as traditional wound care in closing diabetic foot ulcer wounds during a 12-week test period, for example.

Can you identify 7 qualities of a successful telehealth program?

South Central Telehealth Resource Center

For example, telehealth is being used in the management of chronic diseases and follow up/triage programs, which can reduce hospital readmissions and emergency department visits. For example, your community may have a large number of citizens who need diabetes or nutritional counseling.

AMA Report: 6 Ways States Combat Opioid Epidemic

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.

Facility Fees & Telehealth Reimbursement

Telebehavioral Health Institute

For example, “facility fees” are often reimbursable. Blog Center For Medicare And Medicaid Cpt Codes Telehealth ReimbursementProperly identifying facilities that rely upon reimbursable services can also point the way for additional fees that are exclusive to telehealth. They are the U.S. government’s way of supporting the technology infrastructure costs … Read more. The post Facility Fees & Telehealth Reimbursement appeared first on TBH Institute Blog.

Rising Drug Prices Immune to Market Forces

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. For example, if a rebate accounted for half of a drug’s price rise, it could double over time without affecting what consumers actually pay.

CMS BLOG: Medicare for All? Just another name for a government-run, single payer system

CMS.gov

CMS BLOG: Medicare for All? Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? When listening to those advocating ‘Medicare for All’ it’s good to be skeptical about their promises. As head of the agency that serves over 58 million Medicare beneficiaries, I deal first-hand with the challenges of government run healthcare. Medicare for All’ is Obamacare on steroids.

Modernizing Medicare to Take Advantage of the Latest Technologies

CMS.gov

Modernizing Medicare to Take Advantage of the Latest Technologies. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies. Today we are announcing a revision of Medicare’s local coverage determination process, which will pave the way to expanded access to new technologies. However, while medical technology is developing at a rapid pace, Medicare’s payment systems haven’t always been as quick to change.

“Pathways to Success,” an Overhaul of Medicare’s ACO Program

CMS.gov

“Pathways to Success,” an Overhaul of Medicare’s ACO Program. Administrator, Centers for Medicare & Medicaid Services. Medicare Parts A & B. Pathways to Success,” an Overhaul of Medicare’s ACO Program. Today the Trump Administration announced our overhaul of the program for Accountable Care Organizations, or “ACOs,” in Medicare. ACOs serve a large number of Medicare beneficiaries – over 10.4 Jeremy.Booth@c…. Fri, 12/21/2018 - 13:09. Seema Verma.

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

He also partners with journalists (like the folks at ProPublica , for example) — to get data out to the public in a useful manner. Fred’s efforts sometimes help the government better understand its own inner workings, and sometimes allow one agency to better understand another; for example, it was easier for the FTC to get a dataset from Fred than to get it from CMS.

Proposed Changes to Lower Drug Prices in Medicare Advantage and Part D

CMS.gov

Proposed Changes to Lower Drug Prices in Medicare Advantage and Part D. Medicare Part D. Proposed Changes to Lower Drug Prices in Medicare Advantage and Part D. Today the Centers for Medicare & Medicaid Services (CMS) announced proposed changes to Medicare Part D to lower prescription drug costs for beneficiaries. The changes we are proposing bring tools to Medicare that are widely used in private plans.

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

He also partners with journalists (like the folks at ProPublica , for example) — to get data out to the public in a useful manner. For example: ransomware attacks, and the manipulation of stock prices by releasing cybersecurity vulnerabilities in an irresponsible way.

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

He also partners with journalists (like the folks at ProPublica , for example) — to get data out to the public in a useful manner. For example: ransomware attacks, and the manipulation of stock prices by releasing cybersecurity vulnerabilities in an irresponsible way.

Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report

CMS.gov

Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Director, Medicare-Medicaid Coordination Office, Topic. Medicare Parts A & B. Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Today, the Centers for Medicare & Medicaid Services (CMS) released a report that demonstrates how empowering states can help reduce costs.

Payer, provider groups weigh in on CMS' planned Medicare Advantage policy changes

FierceHealthIT

The Alliance of Community Health Plans, for example, said CMS should further modify its MA star ratings to focus on sustained performance rather than year-over-year improvement Healthcare industry groups that responded to CMS' 2019 advance notice are optimistic about some of the proposed changes but have reservations about others.

Nonprofit Hospital Consolidation to Continue in 2019

Henry Kotula

The report cites ProMedica’s acquisition of HCR Manorcare and Tower Health’s purchase of five for-profit acute care hospitals as examples of nonprofit systems taking a short-term credit hit to gain stable long-term positioning for the organization. [link].

The The Five Biggest Areas of Opportunity for Digital Health

The Digital Health Corner

Examples are Treatment Diaries, patientslikeme , and WEGOHEALTH. digitalhealth clinical trials digital health digital health technology EHR healthcare economics Healthcare IT healthcare reform informatics mHealth mobile health patient engagement remote patient monitoring smartphone apps technology telehealth ACOs government IT healthcare healthcare IT HHS hospitals Medicare medicine S4PMDigital health is unquestionably becoming part of healthcare lexicon and fabric.

Privacy Issues with Patient Portals

BHM Healthcare Solutions

“For example, a user could tag a diagnosis of chlamydia on a problem list so that it would not be transmitted to another site or populate the summary of care record without the patient’s consent,” Dr. Galvin wrote. Healthcare IT Medicare and Medicaid Services Data hack Healthcare Data Breaches Healthcare Data Protection MedicaidEditor’s Note: Payers stay informed with information security trends to protect their patients’ data.

EHR 40

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

He also partners with journalists (like the folks at ProPublica , for example) — to get data out to the public in a useful manner. Fred’s efforts sometimes help the government better understand its own inner workings, and sometimes allow one agency to better understand another; for example, it was easier for the FTC to get a dataset from Fred than to get it from CMS.

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

He also partners with journalists (like the folks at ProPublica , for example) — to get data out to the public in a useful manner. Fred’s efforts sometimes help the government better understand its own inner workings, and sometimes allow one agency to better understand another; for example, it was easier for the FTC to get a dataset from Fred than to get it from CMS.

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

He also partners with journalists (like the folks at ProPublica , for example) — to get data out to the public in a useful manner. Fred’s efforts sometimes help the government better understand its own inner workings, and sometimes allow one agency to better understand another; for example, it was easier for the FTC to get a dataset from Fred than to get it from CMS.

Five Ways a Good Digital Health Registry Addresses Healthcare System Needs

The Digital Health Corner

The Physician Quality Reporting System (PQRS) has been used since 2015 as a metric to determine negative Medicare payment adjustments to providers who do not meet quality standards. Examples are found in the implantable pacemaker and defibrillator and orthopedic device industries or long-term risk of certain medications (ex. Registries have traditionally been viewed as static repositories of data to be reviewed in a summary fashion after a predetermined time period.