September 11, 2023
Payers | Tea Leaves
  • According to a study in JAMA Health Forum, Medicare Advantage (MA) plans should obtain feedback from beneficiaries concerning how much post-acute care helped them recover after being hospitalized. Researchers with Vanderbilt University Medical Center found that MA beneficiaries overall used fewer post-acute care services than enrollees in traditional Medicare and also reported less favorable outcomes, something that policymakers should keep in mind as MA keeps growing and the health insurers who run such plans attempt to cut back on what they might perceive as inefficient use of post-acute care services. The study noted that fee-for-service Medicare spent about $57 billion on post-acute care services in 2020. (Article here)
  • The Centers for Medicare & Medicaid Services (CMS) released new draft guidance Monday on how it plans to roll out a program allowing Medicare members to spread monthly payments for prescription drug purchases. The cost-sharing option must be offered beginning in 2025 and comes on the heels of President Joe Biden etching the Inflation Reduction Act (IRA) into law. Federal agencies believe the plan could help customers avoid large, upfront out-of-pocket drug costs. Sponsors and pharmacies are expected to use the draft guidance to see which enrollees benefit from the program and to understand the required opt-in process and data collection. It also includes requirements for Part D sponsors to reimburse pharmacies and how they should handle monthly billing. (Article here; Draft guidance here)
  • Minnesota authorities are investigating Allina Health over reports that the nonprofit provider refused to treat some patients who owed medical debts. In June, the New York Times reported that Minneapolis-based Allina Health denied non-urgent treatments to patients with unpaid bills from previous care. Following the publication of that article, the health system said it paused the policy in question. But Minnesota Attorney General Keith Ellison, who has focused on medical billing, has launched a probe, saying, “With recent reports in the media and from consumers that problems continue, we’re taking several steps to renew our focus on this longstanding concern.” (Articles here and here)