Today’s Hot Topics in Medicare News

Missouri Firm with Silicon Valley Ties Faces Medicare Billing Scrutiny

BY LAUREN WEBER and FRED SCHULTE: In many ways, Essence Group Holdings Corp. is a homegrown health care success story.

Founded locally, it has grown into a broader company backed by a major Silicon Valley investor. Essence now boasts Medicare Advantage plans for seniors with some 60,000 members in Missouri and across the Mississippi River in Illinois. It ranks among the city’s top 35 privately held companies, according to the St. Louis Business Journal. And market research firm PitchBook Data values the company at over $1.64 billion(read more)

Azar touts new Medicare Advantage opportunities in pay models

BY SUSANNAH LUTHI: HHS Secretary Alex Azar on Tuesday hinted that Medicare Advantage plans could see pay boosts as part of the Trump administration’s strategy to tackle maternal mortality rates, social determinants of health and rural healthcare access.

“We can also enhance value through payments in Medicare Advantage, where we want to open up more opportunities for MA plans and entities they work with, including creative value-based insurance design arrangements, moving care to the home and community, and new ways for MA plans to improve a patients’ health over the long term,” Azar said at the Better Medicare Alliance’s policy summit. (read more)

Bipartisan Senate legislation offers compromise to reduce Medicare drug costs for seniors

BY RICARDO ALONSO-ZALDIVAR: Two senior senators — a Republican and a Democrat — unveiled compromise legislation Tuesday to reduce prescription drug costs for millions of Medicare recipients, while saving money for federal and state health care programs serving seniors and low-income people.

Iowa Republican Chuck Grassley and Oregon Democrat Ron Wyden said the bill would for the first time limit drug copays for people with Medicare’s “Part D” prescription plan, by capping patients’ out-of-pocket costs at $3,100 a year starting in 2022. They’re hoping to have it ready soon for votes on the Senate floor. (read more)

What’s the Latest on Medicare Drug Price Negotiations?

BY JULIETTE CUBANSKI, TRICIA NEUMAN, SARAH TRUE, and MEREDITH FREED: Prescription drug costs are a major concern for consumers and a fiscal challenge for public and private payers. In response, lawmakers are considering a broad range of policy options, including allowing the federal government to negotiate the price of prescription drugs on behalf of people enrolled in Medicare Part D drug plans, which is prohibited under current law. Members of the 116th Congress have introduced bills to change the law and allow government drug price negotiation—a change which is also supported by some 2020 presidential candidates—and House Speaker Nancy Pelosi is reportedly working on a related proposal. Recent public opinion polls show strong and bipartisan support for allowing the federal government to negotiate drug prices in Medicare.

This issue brief begins with a brief description of the statutory prohibition on government negotiations and its history and reviews assessments made by the Congressional Budget Office (CBO) on the potential for government negotiations to achieve savings for Medicare and beneficiaries. The brief also describes the various legislative proposals introduced in the current Congressional session that would give the Health and Human Services Secretary authority to negotiate drug prices on behalf of Medicare beneficiaries. (read more)

Medicare-for-all might not cause surge in hospital use

BY LISA RAPAPORT: Medicare-for-all and other versions of universal coverage being proposed for the U.S. by several presidential hopefuls wouldn’t necessarily lead more people to seek hospital care, a new analysis suggests.

Critics of Medicare-for-all have raised concerns that it might lead to a surge in use of inpatient services, because people with comprehensive health insurance tend to use more hospital care than people with bare-bones benefits, researchers note in the Annals of Internal Medicine. (read more)

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