About health insurance/insurers
Behavioral Health:Information on Cost-Sharing in Medicare and Medicare Advantage [From the GAO] “Behavioral health conditions were estimated to affect at least a quarter of the 66.7 million Medicare beneficiaries in 2023. There have been longstanding concerns about behavioral health services accessibility, even for those with health coverage.
This report describes what behavioral health benefits are available under Medicare and Medicare Advantage programs, what beneficiaries pay out of pocket, and more.
For example, in traditional Medicare in 2024, beneficiaries had to pay a deductible of $1,632 for any acute or psychiatric inpatient hospital stay up to 60 days long, with coinsurance payments for additional days.”
Changes in Out-of-Pocket Spending for Common Oral Cancer Medications After the Inflation Reduction Act “This economic evaluation found that the OOP cap legislated by the IRA may save patients enrolled in Part D plans a median of $7260 in 2024 for oral cancer medications. These savings will likely continue to grow as the OOP cap decreases from about $3500 in 2024 to $2000 in 2025.”
Medicare Advantage Quality Bonus Payments Will Total at Least $11.8 Billion in 2024
”Key Takeaways:
After increasing by more than 400% between 2015 and 2023, federal spending on Medicare Advantage bonus payments will decline by $1 billion (8%) to $11.8 billion in 2024, following the expiration of pandemic-era policies that temporarily increased star ratings for some plans. Despite the decline, total spending on Medicare Advantage plan bonuses is higher in 2024 than in every year between 2015 and 2022.
Most Medicare Advantage enrollees (72%) are in plans that are receiving bonus payments in 2024. Though the share declined from 2023 (85%), it is similar to the share observed in 2022 (75%).
The average bonus payment per enrollee is highest for employer- and union-sponsored Medicare Advantage plans ($456) and lowest for special needs plans ($330), raising questions about the implications of the quality bonus program for equity.
Bonus payments vary substantially across firms, with UnitedHealthcare receiving the largest total payments ($3.4 billion) and Kaiser Permanente receiving the highest payment per enrollee ($516).”
About pharma
Open-Label Placebo Injection for Chronic Back Pain With Functional Neuroimaging “The findings of this trial suggest that open-label placebo treatments can confer meaningful clinical benefits to patients with chronic back pain by engaging prefrontal-brainstem pathways linked to pain regulation and opioidergic function.”
Evernorth making Stelara biosimilar available for $0 out-of-pocket “Evernorth Health Services, a subsidiary of Cigna, plans to have a Stelara biosimilar available for $0 out-of-pocket cost for eligible patients of its specialty pharmacy, Accredo, beginning in early 2025.
The interchangeable biosimilar will be produced for Evernorth's affiliate private label distributor, Quallent Pharmaceuticals, and will be available at $0 out-of-pocket for most patients through Quallent's copay assistance program.
The program is expected to save individual patients around $4,000 on average per year, according to Evernorth.”
About healthcare quality and safety
Data analysis reveals common errors that prevent patients from getting timely, accurate diagnoses “ECRI's data analysis found that most errors (nearly 70 percent) occurred during the testing process – including when healthcare staff are ordering, collecting, processing, obtaining results, or communicating results. Twelve percent of errors occurred in the monitoring and follow-up phase; with nearly nine percent during the referral and consultation phase.
Of errors that occurred during testing, more than 23 percent were a result of a technical or processing error, like the misuse of testing equipment, a poorly processed specimen, or a clinician lacking the proper skill to conduct the test. Another 20 percent of testing errors were a result of mixed-up samples, mislabeled specimens, and tests performed on the wrong patient.”
About healthcare personnel
US faces maternity care crisis, with 1 in 3 counties lacking obstetric doctors to provide care, report warns The United States is facing an ongoing maternity health crisis in which 1 in every 3 counties does not have a single obstetric clinician, affecting women’s access to care, according to a new report.
The report, released Tuesday by the infant and maternal health nonprofit March of Dimes, says that in many parts of the country, obstetrician/gynecologists and family physicians who deliver babies are leaving the workforce, which worsens access to care.
Ob/gyns nationwide delivered more than 85% of babies born in 2022, according to the report, but the American College of Obstetricians and Gynecologists (ACOG) now projects that the nation will face a shortage of 12,000 to 15,000 ob/gyns by 2050.”