Healthcare had another busy week.
Here’s some of our top analysis to help you make sense of it all.
Right place, wrong time: BCBS insurers report Medicare gains
Blue Cross Blue Shield insurance companies have finally emerged as significant players in the Medicare Advantage market after years of struggling to make their mark. But financial pressures could drive them to depart the sector as quickly as they arrived.
Rising medical expenses, unfavorable changes to federal policies and declining federal reimbursement dogged Medicare Advantage in 2024, leading companies such as CVS Health’s Aetna and Humana to cut back where they sold policies. In some areas, Blue Cross plans were the only option left for consumers.
Site-neutral Medicare pay eyed to fund Trump tax cuts
While congressional Republicans hunt for hundreds of billions of dollars in healthcare cuts, an old, bipartisan idea seems poised for a comeback: "site-neutral" Medicare reimbursements for outpatient care.
This policy, which the hospital sector opposes and health insurers endorse, would require health systems to charge the same prices for services whether they are performed in a hospital or another location. Lawmakers advanced numerous proposals in 2023 and 2024 that would have implemented some version of site-neutral payment rules, such as barring hospitals from adding facility fees to claims or setting higher prices for services such as telehealth services or off-site drug injections.
Read more at the link in our bio.
Post-acute providers roll out game plans for TEAM demo
Post-acute providers are eager to show hospitals how they can help with a Medicare payment demonstration model that goes into effect early next year.
Compassus, Elara Caring, ArchCare and other post-acute providers said careful coordination of patient care from the hospital through the post-acute system is essential for hospitals to succeed in the Transforming Episode Accountability Model, or TEAM. Home health companies and skilled nursing facilities are gathering data on patient outcomes, adding staff, enhancing technology and taking other steps to prepare for the Centers for Medicare and Medicaid Services’ program set to launch in more than 700 hospitals Jan. 1.
Quote of the week
The first thing that we have to do consistently is lower the administrative cost as a percentage of the overall cost. We’re in a position to do that with some new technology. As a growing organization, cutting administrative costs affords us a way to reduce overall costs without negatively impacting our workforce. We have to constantly be vigilant to become more efficient in our operating structure.
— Baylor Scott & White Health CEO Peter McCanna on preparing for federal funding reductions
