Monthly Archives: September 2018


CMS strengthens decentralization push, gives states more Medicaid authority

Aiming to cut down on regulatory burdens and give more power to states, the Centers for Medicare & Medicaid Services is making notable changes to the Medicaid program, the biggest source of payment for nursing homes. CMS issued a bulletin late Thursday, outlining “significant improvements” for streamlining Medicaid review processes and reducing approval times. The […]
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As federal Medicaid expansion funding share declines, states consider ways to pick up their increasing costs

“Of the states that have expanded Medicaid, a third are funding expansion with fees on hospitals or insurance companies or taxes on cigarettes or liquor.  ‘The bottom line is that the majority are using general revenues’” Read More Here  

Drug prices expected to rise almost 5% next year

Though possibly a signal that drug spending could be on the decline in the future, a report from Vizient says health systems will face even higher pharmaceutical prices in 2019, due largely to drugs that have no competition and therapeutics accounting for those that have the biggest share of spending. According to the 2018 Drug Price […]
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Drug company rebates don’t have that much impact on costs

The blame game continues regarding the escalating cost of drugs, with AHIP this time brandishing a study by Milliman that AHIP commissioned and that says that the rebates pharmaceutical companies offer for certain drugs don’t really have that much of an impact on costs. The drugs that generated the biggest rebates for insurers and PBMs represented only 10% […]
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Nurses in D.C.’s 9-1-1 center reduce some unnecessary ambulance runs, but not most

Nurses in D.C.’s 9-1-1 center reduce some unnecessary ambulance runs, but not most “Fire and EMS officials found positive signs in the first 90 days of a $1 million nursing phone line at the 9-1-1 call center, but have yet to see big dividends” Read More Here  

AI could save insurers billions in administrative costs

Dive Brief: U.S. insurers can unlock $7 billion in total value — 10-15% of operating expenses — in 18 months by using artificial intelligence to automate certain core administrative functions, according to a new study from Accenture. The savings could stem from streamlining core functions for payers across the board, including customer service, billing, enrollment, claims and quality […]
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Managed care opportunity demands new mindset, tech in senior living

Managed care opportunity demands new mindset, tech in senior living “Managed care plans are seeking ways to expand their enrollment, reduce health care spending among their beneficiary population, and keep health outcomes and customer satisfaction high. Working with senior living providers can help them achieve all those goals” Read More Here  
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States take action to preserve access to health coverage

The Trump administration has been working to weaken Obamacare, while the GOP-run Congress continues to look for ways to defang or undo the controversial health care law entirely. But while the battle rages in the political arenas, states are taking a more practical approach, writing their own rules to expand health care to their constituents. […]
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Government health care is a growing part of insurers’ revenues

Adapted from Lane et al., 2018, “Best’s Market Segment Report: U.S. Government-Related Health Insurance Business Continues to Grow Despite Risks“; Chart: Axios Visuals Health insurance companies used to collect a majority of their premium dollars from people who had coverage through their jobs, but their growing stake in running government health care programs has consumed a […]
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How retail mental health could be medicine’s next frontier

Throughout his residency and his last three years as a physician in psychiatry training at Mather Hospital in New York, Dr. Tamir Aldad saw upfront how thousands of mental health patients each year were sent home from the emergency room knowing they might not get follow-up treatment for several weeks. Despite the urgency of care needed amid […]
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