This week we are reading about Medicare Part D enrollees high out-of-pocket costs, Centene’s acquisition of Wellcare, the new 10-year contract between UPMC and Highmark, and readmission rates between Medicare Advantage and traditional Medicare.
How Many Medicare Part D Enrollees Had High Out-of-Pocket Drug Costs in 2017? | Kaiser Family Foundation | June 21, 2019
The Medicare Part D prescription drug benefit has helped improve the affordability of medications for people with Medicare. Yet Part D enrollees can face relatively high out-of-pocket costs because the Part D benefit does not have a hard cap on out-of-pocket spending. In 2017, 1 million Medicare Part D enrollees had out-of-pocket spending above the catastrophic threshold, with average annual out-of-pocket costs exceeding $3,200—over six times the average for all non-LIS enrollees.
Shareholders overwhelmingly approve Centene-WellCare union | Healthcare Dive | June 25, 2019
Shareholders overwhelmingly approved Centene’s $17 billion acquisition of rival WellCare on Monday, the companies said. Missouri’s state insurance regulator approved the Centene-WellCare deal with the condition that the WellCare unit, which does business as Missouri Care in the state, is sold.
UPMC, Highmark ink 10-year contract after years of fighting | Healthcare Dive | June 25, 2019
UPMC and rival Highmark have signed a 10-year contract allowing access to UPMC facilities for patients covered by Highmark, Pennsylvania’s governor and attorney general announced Monday. The reconciliation comes less than a week before a deadline that would cut off Highmark insured patients from access to many UPMC facilities. The contract is effective July 1 so patients won’t face any disruption in their care, according to Attorney General Josh Shapiro.
Traditional Medicare May Trump Medicare Advantage in Reducing Readmissions | Home Health Care News | June 27, 2019
Despite previously reported findings, traditional Medicare may have a better track record of lowering hospital-readmission risk compared to the Medicare Advantage (MA) program. While the re-hospitalization difference appears to be small, it’s an important observation for home health providers, especially those that work closely with MA plans.
New insights into re-hospitalization rates in Medicare and Medicare Advantage come from a study published earlier in June in the Annals of Internal Medicine. Overall, researchers found that MA patients had higher readmission rates than their traditional Medicare peers. AMI MA patients, for example, were found to have readmission rates of 17.2%, compared to 16.9% for those in traditional Medicare.