Medicare Is Now Profitable as a Total Program Because of Medicare Advantage
By GEORGE HALVORSON
Medicare made $83.4 billion very real dollars in 2022. The 17% discounts below the average cost of fee-for-service Medicare, that happen in every county for Medicare Advantage, have been very real and extremely successful in paying for Medicare coverage — in a way that now makes the program a profit center for the US Government.
You can see the actual financial report page from the 2023 Medicare trustee report below. It shows that the Medicare trust fund grew in 2022 for the first time in decades. More than half of the Medicare members are now enrolled in Medicare Advantage plans. Those members ...
Source: The Health Care Blog - February 7, 2024 Category: Consumer Health News Authors: matthew holt Tags: Health Policy George Halvorson Medicare Advantage Medicare Trustees report Source Type: blogs
DecisionRx Announces $100 Million Credit Facility with Carlyle
Funds to Support Delivery of DecisionRx’s Comprehensive Medication Therapy Optimization Program
DecisionRx, Inc., a value-based healthcare company reducing the cost of care by helping physicians eliminate medication failure, today announced that it has entered into a $100 million credit facility with global investment firm Carlyle.
The financing will support the cost-bearing that is key to DecisionRx’s unique business model: DecisionRx can assume the full cost of delivering Medication Therapy Optimization to patients of Accountable Care Organizations, Medicare Advantage Plans, and self-insured employers. The facility...
Source: EMR and HIPAA - February 5, 2024 Category: Information Technology Authors: Healthcare IT News Tags: Health IT Company Healthcare IT Akhil Bansal Aon Aon Securities Carlyle DecisionRx Health IT Funding Health IT Fundings Health IT Investment James Wallace Sourna Daneshvar Source Type: blogs
Bonus Features – February 4, 2024 – 67% of healthcare pros say the top use case for AI is improving the digital front door, 78% of healthcare shift workers have trouble covering living expenses, plus 25 more stories
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.
News
HHS released a set of Cybersecurity Performance Goals. There are 10 Essential Goals that set “a floor of safeguards,” such as multifactor authentication and data encryption, and 10 Enhanced Goals for maturing c...
Source: EMR and HIPAA - February 4, 2024 Category: Information Technology Authors: Brian Eastwood Tags: Healthcare IT American Telemedicine Association Atropos Health Avaamo Avanade Bicycle Health Bruce Cerullo Datycs Department of Health and Human Services Deputy directtrust DUOS eClinicalWorks ECRI Institute Ensemble Health Par Source Type: blogs
AusHealthIT Poll Number 732 – Results – 04 February, 2024.
Here are the results of the
poll.
Medicare Is Now 40 Years Old. Overall, Has It Been A Success?
Yes (Source: Australian Health Information Technology)
Source: Australian Health Information Technology - February 4, 2024 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
Too much fawning over Len Schaeffer?
By MATTHEW HOLT
There’s a lot of strum & dangst about the uptick in system utilization that has boosted hospital profits and hit Humana and United’s bottom line (But not so much Elevance’s). Kevin O’ Leary over at Health Tech Nerds brought this up today and I was reminded of this piece I wrote in 2006. And a big issue was, how much understanding and control do insurers have over the utilization in (and out of) their networks. So take a look at this piece and particularly, given the issues at the BUCAHs and at smaller players like Agilon, consider how much insurers actually know about spending...
Source: The Health Care Blog - February 1, 2024 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Health insurers Len Schaeffer Medicare Advantage Oldies Utilization Source Type: blogs
I Think There Is Little Doubt That, After 40 Years, Medicare Is An Overall Success.
This article is a great summary of a major innovation which, despite some false starts and ongoing issues, overall has been a success. It has genuinely become part of the fabric of Australian life and it is hard to find a better national health system anywhere on the globe! This fact is something we should all celebrate! Mind the gap: At 40, Medicare feels the pain of age as patients pay (Source: Australian Health Information Technology)
Source: Australian Health Information Technology - January 28, 2024 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
Drug prices continued: Innovation?
Pharmaceutical manufacturers claim that they need patent protection and marketing exclusivity so they can charge high prices to recoup the costs of drug development and clinical trials. There are a few things wrong with this argument, but they add up to the general fact that the system does not serve the public interest. Drug companies care about one thing only, that is profit. And the pursuit of profit does not serve the interests of public health or social welfare.One obvious mismatch between the goal of public health and the goal of profit is that a relatively cheap drug that you can take once or for a week or so, that ...
Source: Stayin' Alive - January 23, 2024 Category: American Health Source Type: blogs
Pharmaceutical profiteering
Another reason why we spend more on pharmaceuticals than the rest of the world ( " drugs " also means fentanyl and crank so I ' m trying to disambiguate here) is the profit motive. There are perverse incentives built into the system that encourage use of higher priced chemicals when cheaper ones would be as good or better for patients.There are some medications that people can ' t take at home. You have to go to a physician ' s office and have them infused. Medicare pays the physician a percentage of the cost of the drug, which means, obviously, that doctors make more money infusing a $10,000 drug than they would infusing ...
Source: Stayin' Alive - January 20, 2024 Category: American Health Source Type: blogs
Okay, getting back to drug prices . . .
As I noted previously, prescription drugs cost much more in the U.S. than everywhere else in the world. Yes, yes, I know, the drug companies say they need to recoup the high costs of research, development, and clinical trials, so the U.S. is subsidizing that for everyone else. I ' ll get around to why that ' s a crock, but first let ' s deal with the fact of high prices. As we learned last time, drug makers have a period of patent protection and then additional " marketing exclusivity " after their drugs are approved by the FDA. During that period, they have no competition, and they can charge as much as they think th...
Source: Stayin' Alive - January 18, 2024 Category: American Health Source Type: blogs
Health IT – 2024 Health IT Predictions
As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. We asked the Healthcare IT Today community to submit their predictions and we received a wide ranging set of responses that we grouped into a number of themes. In fact, we got so many that we had to narrow them down to just the best and most interesting. Check out our community’s predictions below and be sure to add your own thoughts and/or places you disagree with these predictions in the comments and on social media.
All of this year’s 2024 health IT predictions (updated as they’re shared):
John and ...
Source: EMR and HIPAA - January 18, 2024 Category: Information Technology Authors: John Lynn Tags: Ambulatory C-Suite Leadership Health IT Company Healthcare IT Hospital - Health System LTPAC 2024 Health IT Predictions Aasim Saeed Amenities Health Andrew Harding Ankit Gupta Anthony Hare Ash Wellness Availity Bicycle Health Source Type: blogs
Uses of AI in Healthcare – 2024 Health IT Predictions
As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. We asked the Healthcare IT Today community to submit their predictions and we received a wide ranging set of responses that we grouped into a number of themes. In fact, we got so many that we had to narrow them down to just the best and most interesting. Check out our community’s predictions below and be sure to add your own thoughts and/or places you disagree with these predictions in the comments and on social media.
All of this year’s 2024 health IT predictions (updated as they’re shared):
John and ...
Source: EMR and HIPAA - January 17, 2024 Category: Information Technology Authors: John Lynn Tags: Administration AI/Machine Learning Ambulatory C-Suite Leadership Clinical Health IT Company Healthcare IT Hospital - Health System LTPAC 2024 Health IT Predictions 2bPrecise Alexander Nazem Anish Sebastian Arascia Arun Nagdev Source Type: blogs
2023 Benchmark Report: Healthy Bottom Lines are Reliant on Cross-Functional Team Collaboration, Technology, & AI Investments
The following is a guest article by Ritesh Ramesh, CEO at MDaudit
Safeguarding revenues in the coming year requires healthcare systems to proactively navigate an evolving landscape with cross-functional collaboration, technological innovation, and increased AI investments. Additionally, going into 2024 operational excellence is the table stakes for healthcare organizations to improve bottom lines, and where AI and automation can provide a boost in productivity and costs.
Those are the high-level findings of MDaudit’s 2023 Benchmark Report on the trends, challenges, and opportunities encountered by U.S. healthcare organiz...
Source: EMR and HIPAA - January 17, 2024 Category: Information Technology Authors: Guest Author Tags: Administration Analytics/Big Data C-Suite Leadership Health IT Company Healthcare IT Hospital - Health System Revenue Cycle Management 2023 Benchmark Report ADR Audit Documentation Request Healthcare Audits Healthcare Billing Audits Source Type: blogs
Bonus Features – January 14, 2024 – Epic Research shows telehealth results in more follow-up visits that in-office care, Elevance Health to offer smartphones to qualified Medicaid beneficiaries, plus 21 more stories
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.
News and Studies
Follow-up rates for telehealth and in-office visits have remained consistent since 2020, according to analysis from Epic Research. That said, telehealth visits are more likely to result in follow-ups at the 7-, ...
Source: EMR and HIPAA - January 14, 2024 Category: Information Technology Authors: Brian Eastwood Tags: Ambulatory Health IT Company Healthcare IT Hospital - Health System LTPAC Abbott Alliance for Pediatric Device Innovation American Telemedicine Association Atropos Health Butterfly Network Caregility Cedar Gate Technologies Childre Source Type: blogs
From denial to redemption: a physician ’ s Medicare battle [PODCAST]
Subscribe to The Podcast by KevinMD. Catch up on old episodes! We sit down with Catherine L. Chen, an anesthesiologist and health services researcher. Join us as she shares her personal story of facing a Medicare Part B enrollment denial for her mother during a vacation in Hawaii. Catherine’s unique perspective as a physician-scientist unveils
Read more…
From denial to redemption: a physician’s Medicare battle [PODCAST] originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - January 12, 2024 Category: General Medicine Authors: The Podcast by KevinMD Tags: Podcast Medicare Source Type: blogs
Consider Bypassing Your Health Insurance to Afford Certain Type 1 Diabetes-Related Medicines and Supplies
Since it ' s January (a new year), and about half of all Americans with employer-sponsored healthcare insurance plans have some deductibles to satisfy before their healthcare insurance really kicks-in to cover much of anything and deductibles reset on January 1, I thought perhaps this might be a good time to write about my own experience with high-deductible insurance plans and some intelligent work-arounds which I ' ve discovered to deal with those. Who knows? You might (as I did) find you actually like using a particular brand or variety of insulin which is not " preferred " by your insurance ' s PBM, or maybe you f...
Source: Scott's Web Log - January 11, 2024 Category: Endocrinology Tags: type 1 diabetes 2024 bypass insurance manufacturer coupons PBM ' PBMs unbranded insulin Source Type: blogs
