About health insurance/insurers
Blue Shield of California Promise Health Plan offers to pick up the tab for Medicaid enrollees who want GEDs “Blue Shield of California Promise Health Plan is offering to foot the bill for Medicaid enrollees who want to earn a General Education Diploma and become high school graduates.
The program began this month and is being offered to enrollees in Los Angeles and San Diego Counties, where the Medi-Cal Blue Shield Promise Health Plan operates.
The program is in keeping with the insurer’s increased focus on the social determinants of health, which experts see as crucial in keeping individuals healthy. Individuals who obtain a GED can earn on average $9,000 more a year than those who don’t graduate high school, the health plan noted in a press release.”
BENEFICIARIES DUALLY ELIGIBLE FOR MEDICARE AND MEDICAID This CMS-issued report is dated January 2024, but uses 2021 data. Making policy decisions on data at least 2 years old is one of the ongoing problems with federal healthcare programs.
Medicaid Advisers Back New Protections for Patients Denied Care “Congress’s Medicaid advisers on Friday endorsed a series of steps policymakers could take to overhaul the appeal process for beneficiaries denied access to care by a managed care organization.
The proposals from the Medicaid and Chip Payment and Access Commission include allowing impartial third-party doctors to review claims in the event a claims appeal is denied by a managed care organization (MCO).
The move to protect Medicaid beneficiaries’ access to coverage comes after a July 2023 report from the Department of Health and Human Services Office of Inspector General found many MCOs had high rates of prior authorization denials, something the watchdogs said could have been mitigated with additional safeguards to protect patients, like external medical reviews.
The report found 115 managed care organizations in 37 states denied about one in eight requests for prior authorization. Twelve MCOs surveyed had denial rates above 25%.
The Congressional Budget Office estimates that implementing external medical reviews of MCO denials could cost the Medicaid program up to $500 million over the next 10 years.”
About hospitals and healthcare systems
DECEMBER 2023 National Hospital Flash Report “Key Takeaways
1. Hospital performance in November signals continued stabilization and growth. Operating margins improved compared to the previous month and last year, and other data points indicate movement towards recovery, though the gap between high and low performers remains quite wide.
2. Revenue per adjusted discharge has increased while total expense per adjusted discharge has decreased month-over-month and year-over-year—a sign of financial recovery. This reflects the efforts organizations have taken to deliver care in the most effective settings and reduce reliance on contract labor where possible.
3. Average length of stay declined indicating a shift towards more normal patient acuity. Organizations that have adopted value-based and bundled payment models will benefit further as they transition and provide care at the appropriate clinical setting.”
Community health centers serve 1 in 11 Americans. They’re a safety net under stress “[There are] nearly 1,400 federally designated community health centers. One in 11 Americans rely on these to get routine medical care, social services and, in some cases, fresh food.” Read this article to understand the population these centers serve and the challenges they face.
About pharma
Top 10 most anticipated drug launches of 2024 FYI
White House pharmacy problems Watch this short video and then decide if you want the government to administer your pharma benefits. Let me emphasize, these events were at the WHITE HOUSE PHARMACY.
Insurer, PBMs break into top 10 of health lobbying [Scroll down the page after clicking the link]
”The Pharmaceutical Care Management Association, which represents PBMs, spent $5.3 million in the last three months of last year — double the amount it had spent during the same time in 2022.”
Buried in Wegovy Costs, North Carolina Will Stop Paying for Obesity Drugs “In June 2021, the insurance plan for North Carolina state employees was paying for 2800 people to take weight-loss drugs.
Last year, it paid for nearly 25,000. Medications like Wegovy cost the North Carolina State Health Plan $100 million last year, rising seemingly out of nowhere to represent 10 percent of its spending on prescription drugs…
Alarmed by the ballooning costs, the health plan’s governing board voted on Thursday to end all coverage of medications for weight loss, including Wegovy, which accounts for the vast majority of its spending on obesity drugs. The plan will continue covering versions of the drugs for people with diabetes.”
About the public’s health
CDC warns health care workers to be on alert for measles amid rising number of cases Between Dec. 1, 2023, and Jan. 23, 2024, there have been 23 confirmed cases of measles including seven cases from international travelers and two outbreaks with five or more infections each, according to an email sent this week.
Cases have been reported in Pennsylvania, New Jersey, Delaware and the Washington, D.C. area so far.
Most of these cases were among children and adolescents who had not been vaccinated against measles, despite being eligible.”
About healthcare IT
FDA accepts first AI algorithm to drug development tool pilot, with Deliberate AI’s anxiety and depression assessment “For the first time since it launched in 2020 and began accepting submissions in 2022, a program started by the FDA to provide support for unconventional drug development tools has accepted its first artificial intelligence-powered tool.
The Innovative Science and Technology Approaches for New Drugs (ISTAND) pilot was designed to create a new pathway to FDA review for novel tools that may not fit into currently existing routes of evaluation, but that could potentially improve the development of new drugs.
The newest tool accepted into ISTAND comes from Deliberate AI. The AI-generated Clinical Outcome Assessment—AI-COA for short—uses multimodal behavioral signal processing and machine learning technology to record mental health symptoms and assess the severity of cases of anxiety and depression.”
About healthcare personnel
Why doctors are calling it quits A great article about physician burnout.
About health technology
Google captures FDA de novo clearance for Pixel smartphone thermometer app “Google has secured an FDA clearance that finally unlocks human use of the temperature sensor built into its highest-end smartphone. When the Pixel 8 Pro was first announced last October, the company said its sensor was well-suited to gauging the warmth of household objects, but that it shouldn’t be used to check someone out for a fever.
That’s changed with the agency’s green light, clearing what Google describes as the first smartphone body temperature app—and one that’s on par with other FDA-cleared thermometers that scan the temporal arteries around the forehead.”
Disparities in National Cancer Institute and Nonprofit Organization Funding Disproportionately Affect Cancers With Higher Incidence Among Black Patients and Higher Mortality Rates “Diseases with the largest combined NCI and NPO funding were breast cancer ($3.75 billion in US dollars [USD]) and leukemia ($1.99 billion USD). Those with the least funding were endometrial ($94 million USD), cervical ($292 million USD), and hepatobiliary cancers ($348 million USD). Disease-specific funding correlated well with incidence but correlated poorly with mortality (Pearson CCs, 0.74; P = .006 and .30, P = .346, respectively). Breast cancer, leukemia, and lymphoma were well-funded while colorectal, lung, hepatobiliary and uterine cancers were underfunded. Higher incidence among Black patients correlated with underfunding. The amount of funding for a particular cancer correlated strongly with the number of clinical trials for that disease (Pearson CC, 0.91; P < .0001).” Emphases added.