Morning Briefing
Summaries of health policy coverage from major news organizations
Website Shows If Medicare's Price-Transparency Rules Work
Houston Chronicle: Startup Aims To Make It Easier To Compare Prices For Medical Procedures
Will patients be able to shop around for an MRI or colonoscopy like they do for hotels on sites such as Kayak or Orbitz? The founders of Turquoise Health, a price comparison site for medical services, say yes. The start-up launched in December 2020, and now has 4,000 health care providers including hospitals and other providers such as imaging centers, across the country in its database, including 320 in Texas. There are about 6,000 hospitals in the U.S., according to the American Hospital Association, and 650 hospitals in Texas, according to the state. (Carballo, 2/8)
And more on billing —
Modern Healthcare: What Highmark's Disclosure Reveals About Fraudulent Billing Claims
Health insurer Highmark Health said it saved over $245 million last year by rooting out fraud, waste and abuse, a disclosure that quickly riled up doctors. The Blue Cross Blue Shield Association requires that its 35 member companies have such programs to detect improper claims, but it doesn't release aggregate results publicly. Pittsburgh, Pennsylvania-based Highmark said it wants to be open about the savings its program is generating, which total almost $1 billion since 2017. (Bannow, 2/8)
In other news about Medicare and Medicaid services —
Modern Healthcare: Caravan Health Grows Medicare Shared Savings Program Presence
Caravan Health is adding four accountable care organizations and 25 health systems to its Medicare Shared Savings Program business, the consulting firm announced Monday. Caravan Health agreed to absorb health systems' losses if their costs exceed projections. Typically, providers only pay Caravan when they earn shared savings. ACOs and physicians working with Caravan Health have earned more than $235 million in shared savings and saved Medicare $476 million since 2014, according to the company. All of its ACO participants collected shared savings from 2019 through 2021, the company said. (Devereaux, 2/8)
Modern Healthcare: Proposed Pay Bump For Medicare Advantage Could Keep Market Strong
Medicare Advantage plans expect a booming 2023, thanks in part to high projected revenue growth. But some Medicare watchers say the Centers for Medicare and Medicaid Services missed an opportunity to even out payments to the plans, which they say are overpaid relative to fee-for-service Medicare. CMS' advance notice on its 2023 MA payment policies projected a 7.98% average increase in revenue for MA plans next year. The final policy is expected by April 4. (Goldman, 2/8)
Health News Florida: Dentists And Hospitals Are Wary Of Lawmakers' Proposed Medicaid Changes
Florida House members Monday backed a proposal that would revamp the managed care system that serves about 4 million Medicaid beneficiaries, but key parts of the plan are fueling opposition from dentists and hospitals. Lawmakers are considering changes as the state Agency for Health Care Administration prepares to move forward with a process to award a new round of contracts worth billions of dollars to HMOs and other managed-care plans. Perhaps the most controversial part of the House proposal (HB 7047), which was approved Monday by the House Health Care Appropriations Subcommittee, centers on how dental services would be provided to Medicaid beneficiaries. (Saunders, 2/8)
KHN: ‘Somebody Is Gonna Die’: Medi-Cal Patients Struggle To Fill Prescriptions
A month into its debut, California’s new Medicaid prescription drug program is riddled with problems, leaving thousands of patients without medications — often after languishing on hold for up to eight hours on call center phone lines. On Jan. 1, the state handed control of its Medicaid drug program, known as Medi-Cal Rx, to Magellan Health, which is administering prescription drug coverage for California’s 14 million Medicaid patients, most of whom previously got their medications from about two dozen managed-care plans. But Magellan has tripped up implementation. (Young, 2/9)
