Healthcare reform in the United States

Statewide Survey Finds Broad, Bipartisan Support for Medicare Dental Coverage in West Virginia

Retrieved on: 
Wednesday, August 4, 2021
Regions of the United States, Geography of the United States, United States, Mid-Atlantic states, Southern United States, States of the United States, Federal assistance in the United States, Healthcare reform in the United States, Medicare, Sharps, Virginia

A new YouGov survey found that an overwhelming majority of likely midterm voters in West Virginiaincluding 73% of conservative votersfavor adding dental benefits to Medicare.

Key Points: 
  • A new YouGov survey found that an overwhelming majority of likely midterm voters in West Virginiaincluding 73% of conservative votersfavor adding dental benefits to Medicare.
  • Almost eight in 10 West Virginia voters surveyed in July support adding dental coverage to Medicare as proposed in the $3.5 trillion budget plan introduced in the Senate.
  • A further 67% of Republicans and 90% of Democrats in West Virginia believe their legislators should prioritize Medicare dental coverage.
  • West Virginians pride ourselves on knowing whats best for our community,said West Virginia Oral Health Coalition Coordinator Gina Sharps.

G1 Therapeutics Granted New Technology Add-On Payment (NTAP) for COSELA™ (Trilaciclib) by Centers for Medicare & Medicaid Services (CMS)

Retrieved on: 
Wednesday, August 4, 2021
Organic compounds, Chemical compounds, Chemistry, Medical terminology, Healthcare reform in the United States, Diagnosis-related group, G1 Therapeutics, Trilaciclib, Medicare, G1, Garbage-first collector

An NTAP provides additional payment to hospitals above the standard Medicare Severity Diagnosis-Related Group (MS-DRG) payment amount.

Key Points: 
  • An NTAP provides additional payment to hospitals above the standard Medicare Severity Diagnosis-Related Group (MS-DRG) payment amount.
  • As such, beginning on October 1, 2021, CMS will provide an additional maximum payment of$5,526.30for COSELA when used in the inpatient hospital setting for fiscal year 2022.
  • G1 Therapeutics is based in Research Triangle Park, N.C. For additional information, please visit www.g1therapeutics.com and follow us on Twitter @G1Therapeutics .
  • G1 Therapeutics and the G1 Therapeutics logo and COSELA and the COSELA logo are trademarks of G1 Therapeutics, Inc.

Sana Announces Results of 2021 State of Employer Health Insurance Report

Retrieved on: 
Wednesday, August 4, 2021
Mental Health, Technology, Insurance, Human Resources, Professional Services, Software, Small Business, Managed Care, Health, Data Management, Healthcare reform in the United States, Health insurance, Health economics, Healthcare reform debate in the United States, Health insurance marketplace

Sana , a health care company that provides Fortune 500-level health benefits to small businesses at affordable prices, has announced the release of its 2021 State of Employer Health Insurance Report , a survey of health insurance decision-makers at small and medium businesses.

Key Points: 
  • Sana , a health care company that provides Fortune 500-level health benefits to small businesses at affordable prices, has announced the release of its 2021 State of Employer Health Insurance Report , a survey of health insurance decision-makers at small and medium businesses.
  • The inaugural Sana survey engaged over 1,000 health insurance decision-makers at small and medium sized businesses.
  • 87% of health care decision-makers think they are locked into their health insurance contract when it is very rarely the case.
  • To access the full 2021 State of Employer Health Insurance Report, click here .

Centauri Health Solutions Introduces Stars Quality Solution for Medicare Advantage Health Plans

Retrieved on: 
Tuesday, August 3, 2021
Professional services, Data management, Health, Technology, Insurance, Software, General Health, Healthcare reform in the United States, Federal assistance in the United States, Presidency of Lyndon B. Johnson, Managed care, Child poverty, Medicaid, Medicare, Health, United States, Carenet Health, National Research Corporation

Centauri Health Solutions, Inc. (Centauri), an innovative healthcare technology services company, has extended its industry-leading quality solution suite with a Stars solution for Medicare Advantage and Part D health plans and providers.

Key Points: 
  • Centauri Health Solutions, Inc. (Centauri), an innovative healthcare technology services company, has extended its industry-leading quality solution suite with a Stars solution for Medicare Advantage and Part D health plans and providers.
  • The Centauri Stars solution provides insight into improvement opportunities which support optimal Medicare Star Ratings, improve member health outcomes, and support member retention and engagement.
  • The Centers for Medicare and Medicaid Services uses the 5-star rating system to measure the quality of care and service provided to Medicare members.
  • Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange.

Cerus Corporation Announces CMS Has Granted New Technology Add-On Payment for INTERCEPT Fibrinogen Complex

Retrieved on: 
Tuesday, August 3, 2021
Biotechnology, General Health, Health, Medical Supplies, Blood, Proteins, Branches of biology, Coagulation system, Acute-phase proteins, Blood proteins, Federal assistance in the United States, Healthcare reform in the United States, Cerus Corporation, Fibrinogen, Prospective payment system, Factor I deficiency

Cerus Corporation (Nasdaq: CERS) today announced that the U.S. Centers for Medicare & Medicaid Services (CMS) has granted a new technology add-on payment (NTAP) for INTERCEPT Fibrinogen Complex within the Medicare Hospital Inpatient Prospective Payment System (IPPS).

Key Points: 
  • Cerus Corporation (Nasdaq: CERS) today announced that the U.S. Centers for Medicare & Medicaid Services (CMS) has granted a new technology add-on payment (NTAP) for INTERCEPT Fibrinogen Complex within the Medicare Hospital Inpatient Prospective Payment System (IPPS).
  • The NTAP was granted under CMS alternative NTAP pathway, which recognizes the transformative nature of products granted Breakthrough Device designation by the U.S. Food and Drug Administration (FDA).
  • The U.S. FDA granted approval of the INTERCEPT Blood System for Cryoprecipitation, which is used to produce INTERCEPT Fibrinogen Complex for the treatment and control of bleeding, including massive hemorrhage, associated with fibrinogen deficiency, in November 2020.
  • INTERCEPT and the INTERCEPT Blood System are trademarks of Cerus Corporation.

GoHealth and GoodRx Announce Exclusive Medicare Agreement

Retrieved on: 
Monday, August 2, 2021
GoHealth, GoodRx, Healthcare reform in the United States, Health, Medicare, Companies

CHICAGOand SANTA MONICA, Calif., Aug. 2, 2021 /PRNewswire/ -- GoHealth, Inc. (GoHealth) (NASDAQ: GOCO), a leading health insurance marketplace and Medicare-focused digital health company, and GoodRx, Inc. (NASDAQ: GDRX), America's leading resource for healthcare savings, today announced an exclusive agreement to bring GoHealth's Medicare enrollment and engagement solutions directly to GoodRx users on the GoodRx platform.

Key Points: 
  • CHICAGOand SANTA MONICA, Calif., Aug. 2, 2021 /PRNewswire/ -- GoHealth, Inc. (GoHealth) (NASDAQ: GOCO), a leading health insurance marketplace and Medicare-focused digital health company, and GoodRx, Inc. (NASDAQ: GDRX), America's leading resource for healthcare savings, today announced an exclusive agreement to bring GoHealth's Medicare enrollment and engagement solutions directly to GoodRx users on the GoodRx platform.
  • GoodRx consumers who want to explore Medicare coverage options and understand potential benefits or savings will be able to access information about GoHealth's market-leading Medicare plan selection solutions.
  • Those who enroll in a Medicare plan through GoHealth have access to a suite of healthcare services to further improve health outcomes.
  • GoHealth consumers will also have access to GoodRx prescription discounts on GoHealth's Encompass platform.

Texas Adds Endari® to Latest Preferred Drug List

Retrieved on: 
Monday, August 2, 2021
Healthcare reform in the United States, Health sciences, Pharmaceuticals policy, Health, Federal assistance in the United States, Presidency of Lyndon B. Johnson, Child poverty, Medicaid, Formulary

According to the THHS website, preferred drugs are medications recommended by the Texas Drug Utilization Review Board for their efficaciousness, clinical significance, cost effectiveness, and safety.

Key Points: 
  • According to the THHS website, preferred drugs are medications recommended by the Texas Drug Utilization Review Board for their efficaciousness, clinical significance, cost effectiveness, and safety.
  • The Texas Medicaid Formulary contains all products, including those on the preferred drug list, available to people enrolled in Medicaid.
  • With this recent revision, Texas joins many other states in improving access to Endari for the treatment of sickle cell disease in Medicaid patients.
  • "We greatly appreciate that Texas Health and Human Services has eliminated the prior authorization criteria for Endari.

Constantine Cannon LLP: US Justice Department Intervenes in Whistleblower Suits Against Kaiser Permanente Alleging Extensive Fraud in Its Multi-Billion-Dollar Medicare Advantage Business

Retrieved on: 
Monday, August 2, 2021
Healthcare in the United States, Healthcare reform in the United States, Managed care, Medicare Advantage, UnitedHealth Group, Medicare, False Claims Act, UHG, Health in the United States, Health

CMS risk-adjusted payments for members with certain conditions under Medicare Advantage (also known as Medicare "Part C") average roughly $3,000 per year per condition.

Key Points: 
  • CMS risk-adjusted payments for members with certain conditions under Medicare Advantage (also known as Medicare "Part C") average roughly $3,000 per year per condition.
  • The government's intervention focuses on unsupported diagnosis codes that Kaiser allegedly improperly added through addenda to patients' medical records.
  • Similar one-way chart reviews are at the core of the United States' massive lawsuit against UnitedHealth Group (UHG), in which Constantine Cannon represents the whistleblower.
  • Constantine Cannon also represents Kathy Ormsby in a False Claims Act suit against Sutter Health and its affiliates over similar claims of Medicare Advantage fraud.

Centene Affiliate Wellcare Of North Carolina To Partner With Selected Behavioral Health I/DD Tailored Plans

Retrieved on: 
Monday, August 2, 2021
Healthcare in the United States, Health care, Health, WellCare, Centene Corporation, Managed care, Federal assistance in the United States, Healthcare reform in the United States, Medicaid managed care, Medicaid, North Carolina Department of Health and Human Services

ST. LOUIS, Aug. 2, 2021 /PRNewswire/ -- Centene Corporation (NYSE: CNC) announced today its North Carolina subsidiary, WellCare of North Carolina, will help coordinate physical health services for multiple Local Management Entities/Managed Care Organizations (LME/MCOs) for the state's Behavioral Health and Intellectual/Developmental Disability Tailored Plans (Behavioral Health I/DD Tailored Plans).

Key Points: 
  • ST. LOUIS, Aug. 2, 2021 /PRNewswire/ -- Centene Corporation (NYSE: CNC) announced today its North Carolina subsidiary, WellCare of North Carolina, will help coordinate physical health services for multiple Local Management Entities/Managed Care Organizations (LME/MCOs) for the state's Behavioral Health and Intellectual/Developmental Disability Tailored Plans (Behavioral Health I/DD Tailored Plans).
  • The North Carolina Department of Health and Human Services announced that awardees are anticipated to begin operating as Tailored Plans on July 1, 2022.
  • WellCare of North Carolina began operations for DHHS' Medicaid Managed Care program as a Standard Plan on July 1, 2021.
  • With the implementation of North Carolina's Behavioral Health I/DD Tailored Plans, WellCare of North Carolina will contract withits LME/MCO partners as a Standard Plan partner.

NEW STUDY: MEDICARE BUNDLED PAYMENT INITIATIVE MAINTAINED PATIENT HEALTH OUTCOMES; PRIOR EVIDENCE ALSO FOUND LOWER COSTS

Retrieved on: 
Thursday, July 29, 2021
Healthcare reform in the United States, Bundled payment, Medicare, Articles, Hospital readmission

Research led by Abt Associates, in partnership with the Lewin Group, finds that physician group practices participating in CMSs Bundled Payment for Care Improvement (BPCI) initiative did not deliver diminished patient-reported health outcomes.

Key Points: 
  • Research led by Abt Associates, in partnership with the Lewin Group, finds that physician group practices participating in CMSs Bundled Payment for Care Improvement (BPCI) initiative did not deliver diminished patient-reported health outcomes.
  • This builds on previous research that found practices participating in BPCI were, in fact, able to reduce the cost of care.
  • CMS designed the BPCI initiative to reward providers who delivered care more efficiently to Medicare beneficiaries, while preserving or enhancing the quality of care.
  • This is reassuring evidence that reducing costs did not jeopardize patient care experiences or their post-hospital recovery.