Although fewer seniors will be forced to switch to new coverage optionsnext year than did last January, MCOs still are dropping out of the Medicare+Choiceprogram at a disturbing rate. Aggressive efforts by Tom Scully, administratorof the Centers for Medicare & Medicaid Services (CMS), encouraged somehealth plans to stick with the program for now, but dozens of MCOs abandonedor curtailed service areas when they filed cost proposals for contract year2002 in September. Consequently, 536,000 seniors will have to find new coverageby January, much less than the 934,000 affected by MCO departures last year.But many of those plans that remain are reducing optional benefits or raisingpremiums in order to continue coverage.
In this discussion, Ohio State economist Eric Seiber, Ph.D., explains how inconsistent claims-data definitions can skew estimates of first-episode psychosis and why standardization matters for early treatment and sustainable payment models.
Bill Kerr of Avalon Heath Solutions says incorporating Z codes into CPT codes for lab and genetic testing would add needed specificity, reduce waste and possibly head off fraud.
States have to turn that information into medical frailty determinations that are clinically credible, consistent, and workable across large Medicaid populations.
A meta-analysis found steatotic liver disease in 75% of patients with sleep-disordered breathing and that CPAP lowered liver enzymes but not liver fat.
Some predicted that drugmakers might boost launch prices to make up for Medicare drug negotiations shrinking profits. Harvard researchers find no evidence of that happening so far.
State PBM reform accelerates through 2026, with Theresa Carnegie of Mintz unpacking new laws, rebate pass-through, spread pricing bans, and compliance risks.