Opting Out of Medicaid Cuts
Certain states may have the opportunity to opt out of Medicaid cuts under the Senate’s new bill to repeal the Affordable Care Act. According to Politico, Alaska, Wyoming, South Dakota, North Dakota, and Montana may be able to delay the new Medicaid financing system in the bill based on their low-density populations. The rest of the states would be moved to the bill’s block grant payment system. The opportunity to opt out would expire in 2026. Alaska’s governor has come out against the bill, while Senator Lisa Murkowski, who voted against previous repeal bills, is currently undecided.
Amazon Is in Talks With PBMs
There have been rumors for a while that Amazon might be looking to get into the pharmaceutical business. Now there are reports that the retail giant is in talks with mid-size pharmacy benefit managers (PBMs) to set up contracts, according to FiercePharma. Amazon could also decide to become an online pharmacy, an integrated PBM, or a distributor for pharmacies. Amazon’s entry into the field could take 18 to 24 months and would significantly shake up the drug business.
Safety Net Hospital Payments at Risk
Hospitals are currently reimbursed for some of the costs they incur from taking care of uninsured patients or those who cannot afford their medical bills through a federal program that is now at risk of expiring. The Disproportionate Share Hospitals payments offset some of the uncompensated care hospitals provide, but a payment cut is slated for October 1, reported STAT. If Congress doesn’t act, a total of $43 billion in payment cuts will start to take effect. Safety net hospitals, which care for some of the most vulnerable populations, will be hit the hardest.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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