Louisiana docs vote no on BCBS LA sale to Elevance
Plus: Senator compares social media CEO to tobacco exec
Good morning and happy Friday. This is the Friday Pulse Check from Fulcrum Strategies; your weekly e-newsletter keeping you connected to the healthcare issues that matter to your practice and patients.
In the news:
CMS announces a pay cut to MA benchmark payments
The Centers for Medicare and Medicaid Services announced this week that there would be an average 0.2% cut to benchmark payments to Medicare Advantage plans. Currently, the cut is merely a proposal, but it was not unexpected by many of the payers. Humana CFO Susan Diamond said the company expected the rate notice to have a negative impact. Read the fact sheet from CMS.
Louisiana physicians vote no on BCBS LA sale to Elevance; urge members to do the same
The Louisiana State Medical Society members voted and released a letter urging BlueCross BlueShield Louisiana members to vote no on a potential sale to commercial insurer Elevance. As a condition of the sale, BCBS LA policyholders would receive $3000 but the LSMS says that is simply an inducement to vote yes and that members would have to return that money to Elevance in the form of higher premiums. Elevance owns fourteen BlueCross BlueShield plans and this would be their first acquisition in twenty years. Read the letter from the Louisiana State Medical Society.
LIVE Elevance stock price: ELV 0.00%↑
Other articles of interest:
Sen. Dick Durbin (D-IL) compares Meta CEO Mark Zuckerberg to tobacco executives; Zuckerberg claimed in a Senate hearing Wednesday that there was no causal link between social media and negative mental health effects - The Hill
LIVE Meta stock price: META 0.00%↑
Who should deny your prior authorization requests?
This is a question that Ron Howirgon and I have discussed at length on the FLATLINING Podcast from Fulcrum Strategies.
One of the suggestions that has come up repeatedly for reforming the prior authorization process is only allowing medical directors who are in the same specialty as the requesting provider to review the requests. In other words, if a radiologist asks for PET scan, only a radiologist at the payer can review the claim and then deny it.
That is now the law in New Jersey for certain health plans. The new law does not apply to workers’ compensation plans, “self-insured” plans, auto insurance plans, or TRICARE supplemental plans.
Ron and I discussed the other aspects, including strengths and pitfalls, of the new law on the latest episode of FLATLINING Podcast from Fulcrum Strategies.
Have a good weekend,