Unbiased Analysis of Today's Healthcare Issues
In the past, seniors in Medicare had to pay for all their prescription drugs out-of-pocket. For elderly individuals with multiple medical conditions, this lack of coverage was highly burdensome. To address this issue, in 2006, Medicare Part D began which provided some coverage for prescription drugs. To keep the cost of Part D down, however,…
Medicare Part D plans have begun using preferred pharmacy networks in order to steer their beneficiaries to lower cost pharmacies. A key question is, does this work? A paper by Xu et al. (2022) aims to answer this question using 2011-2016 data. that compares Low Income Subsidy (LIS) Medicare beneficiaries and non-LIS beneficiaries. LIS beneficiaries…
Are narrow networks a good thing or a bad thing? The first thing you need to know is what is a “narrow network”. Narrow networks is an informal terms which basically means that your health plan either places restrictions over the providers you are able to see and/or you certain providers that are out of…
Fierce Healthcare reports that in 2022 Medicare Advantage enrollment is continuing to grow at the expense of traditional fee-for-service Medicare. They write that: Medicare Advantage plans signed up another 2.3 million beneficiaries for the 2022 coverage year, with the program now making up 45% of all Medicare enrollment, a new study found. …total 2022 enrollment…
Many people might know that generally the answer is commercial health plans have the most generous reimbursement compared to government plans. However, a key question is how much more do they pay? Commercial vs. Medicare rates A January 2022 report by the Congressional Budget Office finds that commercial payers reimburse hospitals at 223% of Medicare…
Since its inception in 2006, Medicare Part D beneficiaries had to contend with the dreaded “doughnut hole”. The “doughnut hole” is a coverage gap during which patients were required to pay 100% of treatment cost. To help defray some of these costs, the Patient Protection and Affordable Care Act (ACA) implemented provisions to reduce the…
According to a paper by Rodriguez et al. (2022), the answer is ‘yes’. They use data from the 2017–18 National Survey of Healthcare Organizations and Systems (NSHOS), to determine if a physician practice has a “robust set of care management capabilities.” The specific capabilities that were used to determine whether the health system was robust…
The Urban Institute has an interesting report titled Obesity Across America. Being overweight (BMS>25), obese (BMI>30) or severely obese (BMI>40) is very common in the U.S. with three quarters of individuals being overweight and nearly half obese. Obesity varies by race and ethnicity as well. Black adults are more likely to live with obesity than…
Medicare pays higher reimbursement to teaching hospitals through indirect medical education (IME) payments to hospitals that train a high share of residents. IME inflate standard reimbursements in an attempt to compensate hospitals for these additional costs. Medicare also pay hospitals directly for some cost of training residents through the graduate medical education (GME). A key…
While generic drugs frequently replace their branded counterparts after the latter lose their market exclusivity, the uptake of biosimilar products is often slower. Further, biosimilars are relatively more expensive compared to generic small molecule drugs. A key question then is how much could payers save by switching to biosimilars after loss of exclusivity. The is…