Avicenna Medical Blog

Care Management Weekly News Update 11/13/24

Posted by DeAnn Dennis on Wed, Nov 13, 2024 @ 11:30 AM

Hospital-at-home and telehealth reimbursement from CMS will expire at the end of 2024 without congressional action. Here are five things to know about what the CMS and Congress need to do to extend reimbursement for these programs.

ACO Reach program savings grew larger in 2023. NAACOS is angling for the model's extension

Accountable care organizations in the ACO Reach program...

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Care Management Weekly News Update 11/06/24

Posted by DeAnn Dennis on Wed, Nov 06, 2024 @ 11:30 AM

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. CMS announced Friday it finalized the calendar year 2025Medicare Physician Fee Schedule rulethat sets payment rates for next year and also outlines new policies focused on primary care, preserved telehealth...

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Care Management Weekly News Update 10/30/24

Posted by DeAnn Dennis on Wed, Oct 30, 2024 @ 11:30 AM

Medicare Advantage (MA) insurers, namely industry titans UnitedHealth Group and Humana, could be using health risk assessments and chart reviews to inflate payments from Medicare through upcoding, according to a federal watchdog report. An estimated $7.5 billion in risk-adjusted payments was pocketed by MA insurers when diagnoses were only found on chart...

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Care Management Weekly News Update 10/23/24

Posted by DeAnn Dennis on Wed, Oct 23, 2024 @ 11:45 AM

Humana, one of the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star ratings results. In a lawsuit with nonprofit trade association Americans for Beneficiary Choice, the insurer said the federal government's “arbitrary” actions violates the Administrative Procedure Act. “The data and calculations underlying the annual...

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Care Management Weekly News Update 10/16/24

Posted by DeAnn Dennis on Wed, Oct 16, 2024 @ 11:30 AM

In the past 12 months, 92% of healthcare organizations reported experiencing at least one cyberattack, up from 88% in 2023, an Oct. 8surveyfrom Proofpoint and Ponemon Institute found. Of those cyberattacks, 69% reported disruptions to patient care as a direct consequence.

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Care Management Weekly News Update 10/9/24

Posted by DeAnn Dennis on Wed, Oct 09, 2024 @ 11:30 AM

The state of Texas is accusing major pharmacy benefit managers and drug companies of colluding to raise the cost of insulin. Texas alleged drug manufacturers Eli Lilly, Novo Nordisk and Sanofi raise the price of insulin and then pay an undisclosed amount back to PBMs Optum Rx, Express Scripts and CVS Caremark through a quid pro quo agreement. PBMs then give preferred status on its standard...

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Care Management Weekly News Update 10/2/24

Posted by DeAnn Dennis on Wed, Oct 02, 2024 @ 11:45 AM

If a patient receives a continuous glucose monitor device through their medical benefit, they may be more adherent and may have lower costs, according to a new analysis. Researchers at CCS, which offers clinical services and home delivery for medical supplies for people with chronic conditions, published the peer-reviewed study this week in the Journal of Medical...

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Care Management Weekly News Update 9/25/24

Posted by DeAnn Dennis on Wed, Sep 25, 2024 @ 11:30 AM

The Federal Trade Commission is suing the titans of the pharmacy benefit manager industry for anticompetitive practices and artificially raising the price of insulin drug prices, the agency announced Friday. The complaint alleges that Optum Rx, Express Scripts and Caremark—all vertically integrated with UnitedHealth Group, Cigna and CVS Health, respectively—caused patients to pay more for...

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Care Management Weekly News Update 9/18/24

Posted by DeAnn Dennis on Wed, Sep 18, 2024 @ 11:30 AM

A new study suggests major pharmacy benefit managers may be focusing on specific payer segments in a bid to maintain strong market share. The analysis,releasedin the Journal of the American Medical Association, finds that CVS Health's Caremark holds the largest market share overall in the PBM space. However, it led by the largest margin Medicaid managed care, controlling 39.2% of the market.

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Care Management Weekly News Update 9/11/24

Posted by DeAnn Dennis on Wed, Sep 11, 2024 @ 11:30 AM

CMS isnotifyingnearly a million Medicare beneficiaries of a data breach in which a hacker copied patients' files. The breach originated with Wisconsin Physicians Service Insurance Corp., an administrative services contractor for CMS that used the MOVEit file transfer software from Progress Software. MOVEit had asecurity vulnerabilityin 2023 that left its clients' data susceptible to...

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