Industry Voices—Attention Medicare Advantage plans: It’s not too late to meet year-end goals

FierceHealthIT

Medicare Advantage plans still have time to meet their year-end goals

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

Health Care and the Democratic Debates – Part 1 – Medicare For All, Rx Prices, Guns and Mental Health

Health Populi

Elizabeth Warren assertively and transparently backed Bernie Sander’s Medicare for All proposal. Let’s take on pharma, allow negotiations of prices under Medicare.

Talk to Me About My Health, Medicare Advantage Beneficiaries Tell J.D. Power

Health Populi

Cost is the major reason why Medicare Advantage plan beneficiaries switch plans, but people who switch also tend to have lower satisfaction scores based on non-cost factors. Power’s 2019 Medicare Advantage Plan Study.

Tweets at Lunch with Paul Krugman – Health IT Meets Economics

Health Populi

I greatly appreciated the opportunity today to attend a luncheon at the HX360 meeting which convened as part of the 2018 HIMSS Conference. The post Tweets at Lunch with Paul Krugman – Health IT Meets Economics appeared first on HealthPopuli.com.

Medicare: Cover CGMs Now!

Insulin Nation

Unfortunately, Medicare policy hasn’t kept up with evolving diabetes technology, and policymakers have left out CGMs from the list of reimbursable diabetes devices. There have been several petitions circulating to pressure lawmakers to make Medicare cover CGMs.

Patients Growing Health Consumer Muscles Expect Digital Services

Health Populi

Do not assume that older people, and especially “younger older” Medicare members between 65 and 74 don’t increasingly feel this way.

When Will Self-Service Come to Health Care?

Health Populi

A common theme at health care meetings these days is how and when health care will meet its Amazon, Apple, or Uber moment?

Anthem pushes back on Medicare Advantage fraud probe, cites 11 attempts to meet with DOJ

FierceHealthIT

Weeks after federal prosecutors asked a court to force Anthem to turn over testimony on retrospective chart reviews, the insurer told the court it tried nearly a dozen times to meet with the DOJ to resolve the issue

The New Drug Companies Aren’t Drug Companies At All

Health Populi

This research organization will develop medicines targeting older adults — which makes sense because Clover Health’s target consumer market is Medicare Advantage beneficiaries.

MedPAC debates what form a Medicare without fee-for-service payment might take

FierceHealthIT

MedPAC plans to focus heavily on value-based payment in the coming months, and at its meeting Thursday the commissioners weighed what a Medicare without fee-for-service might look like.

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.

Health Insurer Growth Plans Held Back By Tech And Infrastructure Limitations

Healthcare IT Today

Health plans are eager to grow their Medicare business but may not be able to meet their goals unless they build out their tech and administrative infrastructure further, according to results from a survey backed by health plan technology vendor HealthEdge.

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.

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

Talking “HealthConsuming” on the MM&M Podcast

Health Populi

We’d been trying to schedule meeting up to do a live podcast since February, and we finally got our mutual acts together on 6th August 2019. Marc Iskowitz, Executive Editor of MM&M, warmly welcomed me to the Haymarket Media soundproof studio in New York City yesterday.

Thinking About Health Care One Year From the 2020 Presidential Election

Health Populi

Americans are roughly split — and/or equally confused — about the differences between three major health reform approaches: Medicare -for-All, improving the existing Affordable Care Act, or replacing the ACA with state-run health plans.

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

Health Populi

“ATA” is the new three-letter acronym for the American Telemedicine Association, meeting today through Tuesday at the Convention Center in New Orleans.

CMS’ Rural Health Strategy Could Expand Medicare Telehealth Reimbursement

care innovations

Congress and the Centers for Medicare & Medicaid Services (CMS) have generated hope among health plans, insurers, providers and patients that Medicare telehealth reimbursement is set to expand significantly in the year ahead. A series of moves in recent months by the U.S.

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

Health Populi

As I finalize my meeting agenda for CES 2019, I see more invites to developers of techs for adult “toys” (a growing category of sexual health and wellness), mental health and mindfulness, addiction and substance use, and consumer breathalyzers. Today is Boxing Day and St.

Will Health Consumers Morph Into Health Citizens? HealthConsuming Explains, Part 5

Health Populi

This was equally true for people whether enrolled in Medicare, Medicaid, or covered by private insurance. The last chapter (8) of HealthConsuming considers whether Americans can become “health citizens.”

Prescription drug costs, Medicare for All debate take center stage as Pelosi, McConnell address hospitals

FierceHealthIT

Hospital leaders were treated to opposing healthcare arguments from the nation's top congressional leaders headed to the AHA's annual meeting Tuesday

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.

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.

CMS’s Price Transparency Initiatives for 2020

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. Here are 10 takeaways from the proposed rules: Medicare Outpatient Prospective Payment System. Medicare Physician Fee Schedule.

How Walmart Could Bolster Healthcare in the Community

Health Populi

Here’s one description about the chain’s plans to use $200 mm to expand in Florida (THINK: the state will be home to 4,5 million people age 65 and over in 2020, potential candidates for Humana’s Medicare programs. Walmart has been a health/care destination for many years.

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

Health Populi

” I’m glad to report that we’ll be there before the end of the year, based on my meet-up with Omron Healthcare at #CES2018.

Farzad Mostashari: CMS should look to Medicare Advantage to improve accountable care

FierceHealthIT

To help meet that goal and support accountable care organizations, he should look to Medicare Advantage for inspiration, say Farzad Mostashari, M.D., HHS Secretary Alex Azar has made it clear that the transition to value-based care is one of his priorities. and Travis Broome

AMA says yes to strengthening ACA, no to ending opposition to 'Medicare-for-All' single-payer reform

FierceHealthIT

At its annual meeting in Chicago this week, the American Medical Association’s delegates voted to adopt a new policy that boosts its push for universal coverage by improving the Affordable Care Act

MACRA: Medicare’s Opportunity to Finally Embrace Connected Health Technology

ConnectedHealth

The nation’s healthcare system is in the middle of a major transition – one that, if done well, will have an incredible impact on the lives of millions Americans who rely on Medicare. For a long time, Medicare has had a reputation for being bureaucratic, lethargic, wasteful, and outdated. Further, the Center for Medicare and Medicaid Services (CMS), which administers Medicare, has been slow to incorporate advances in advanced health technology in the program.

How Skilled Nursing Facilities Need To Prepare For Value-Based Care

Electronic Health Reporter

The resources required to meet the care needs of […]. Editorial long-term care Medicare fee-for-service skilled nursingThis article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited.

GAO: CMS must do better job monitoring quality programs, funding

FierceHealthIT

A government watchdog found the Centers for Medicare & Medicaid Services hasn't done a good job of tracking quality program funding or whether quality measures meet goals

“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.

Texting patient information – The latest from CMS

Health Blawg

We are now back to the status quo ante, at least with respect to the question of whether and how texting may be used in hospitals subject to the Medicare Conditions of Participation (i.e., So, when you’re shopping for your next CPOE tool, remember this: Any smartphone-based tool for CPOE must meet the CMS requirements outlined above as well as all HIPAA requirements. CMS has a communications problem.

HIE 95

Blockchain in Healthcare: A Vehicle Towards Digital Health 2.0?

The Digital Health Corner

The blockchain rubber meeting Wall Street’s road is already here. digitalhealth clinical trials digital health digital health technology drug addiction FDA healthcare economics Healthcare IT IT security medical apps medical devices patient engagement patient safety pharma technology #hcldr blockchain cybersecurity EHR healthcare IT hospitals Medicare telehealthI would like to apologize to the readers of this site for the long hiatus.

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

Fred notes that the DocGraph dataset of Medicare physician relationships with patients is the largest graph dataset — i.e. a dataset organized with nodes and edges — using real-name data out there, and is one of the few “people” graphs that are open. ” And every fear voiced in those meetings was realized over the course of the next year.

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 program is driven by market competition: Plans compete for beneficiaries’ business, and enrollees choose the plan that best meets their needs.

Texting patient information – The latest from CMS

Health Blawg

We are now back to the status quo ante, at least with respect to the question of whether and how texting may be used in hospitals subject to the Medicare Conditions of Participation (i.e., CMS has a communications problem.

HIE 78

Texting patient information – The latest from CMS

Health Blawg

We are now back to the status quo ante, at least with respect to the question of whether and how texting may be used in hospitals subject to the Medicare Conditions of Participation (i.e., CMS has a communications problem.

HIE 78

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

Fred notes that the DocGraph dataset of Medicare physician relationships with patients is the largest graph dataset — i.e. a dataset organized with nodes and edges — using real-name data out there, and is one of the few “people” graphs that are open.