Lisa Anderson-Shaw’s Post

Good news for patients in Georgia! 🍑 The CATCH Act is improving healthcare access, and health insurers must prove their compliance. The Consumer Access to Contracted Healthcare (CATCH) Act ensures residents can access various healthcare services within a reasonable distance from where they live. The law sets new network adequacy standards for health plans, prohibits preauthorization denials based on a referring provider's network status, and guarantees wider access to mental healthcare, substance abuse treatment, and pharmacy choices. Health insurers must report data to the state commissioner proving their compliance and could be penalized if the commissioner decides they aren’t following the law. Orderly Health help healthcare organizations navigate new healthcare legislation around provider data. Our platform is uniquely positioned to assist health insurers in Georgia comply with the CATCH Act's standards. Let's make healthcare more accessible together! 🤝 #GeorgiaHealthcare #CATCHAct #OrderlyHealth #ProviderData #NetworkOptimization #PatientCare https://lnkd.in/euRciNgU

🚀 The Unintended Consequences of the Required Medical Loss Ratio: A Closer Look 🏥 In 2010, the required Medical Loss Ratio (MLR) was introduced under the Affordable Care Act (ACA) with the aim of ensuring private health insurers prioritize spending on medical care. However, its implementation has unveiled a series of unintended consequences reshaping the healthcare landscape. Check out our latest blog post where we explore how the MLR, intended to rein in costs, has inadvertently incentivized behaviors that contribute to escalating medical expenses. From pricing paradoxes to real-world examples, we delve into the complexities of healthcare policy and its impact. Read more: https://lnkd.in/eJHSHh3r Let's ignite a conversation on navigating the challenges of healthcare costs and working towards a system that is equitable, affordable, and sustainable for all. Join the discussion and share your insights! #HealthcarePolicy #MedicalLossRatio #HealthcareCosts #AffordableCareAct #HealthcareSystem #LinkedInPost

Are insurers honoring arbitration decisions on surprise billing? Apparently not. According to a comprehensive survey by Americans for Fair Health Care (AFHC), which involved 48,000 physicians across 45 states, medical professionals have a growing unease about health insurers not fully complying with third-party arbitration rulings. Shockingly, more than HALF of the surprise billing awards were reportedly not reimbursed by payers. As insurers prolong award payments or even reject them outright, the stability of physician groups and practices is at stake. And as I said in my MedPage Today article, why are we tolerating this? Stay informed about the evolving landscape of healthcare legislation and industry dynamics with insights from our ABIG Health newsletter. Subscribe today and be part of the conversation at: www.ABIGHealth.com. #healthinsurance #nosurprisesact #physicianpractices Envision Healthcare

Proposed Rule Establishes Disincentives for Providers Who Commit Information Blocking Back in June (2023), the Health and Human Services Department’s Office of the Inspector General (HHS-OIG) issued a final rule outlining the penalties IT developers, health information exchanges and health information networks would face for information blocking infractions. At that time, the OIG made it clear a separate rule to address disincentives for providers would be coming. Click the link below to read the complete article.

The Supreme Court has today handed down judgment in McCulloch v Forth Valley Health Board, clarifying the meaning of the words "reasonable alternative or variant treatments" in Montgomery in the context of a healthcare professional's duty to obtain a patient's consent to treatment. The appeal was dismissed and the Supreme Court held that whether a treatment is a reasonable alternative is to be determined by the application of the professional practice test. If a responsible body of professional opinion does not consider that a particular treatment is reasonable (i.e. clinically appropriate) in the patient's circumstances, there is no duty on the doctor to offer it to the patient. This is a must read judgment for all doctors, healthcare providers and their insurers. More analysis from the med mal team at CMS to follow in the coming days. #medmal

A structured, efficient appeals and grievances process is the cornerstone of any health plan. But disconnected systems, scattered data and laborious processes often lead to complexities. Read the blog to see how insurers can achieve optimal outcomes through customized workflows, real-time operational tracking and targeted insights: https://bit.ly/AnG2_L #Healthcare #Insights #Data Jason Wolfson | Dr. Gauri Puri | Curt Dunseath | Swadhin Khawas | Asheesh Tiwari | Mike Dermont

And in the smaller and medium size practices, there is not enough organization to be able to mount a protest. Small and medium size practices get paid the least, they have the most cost of delivery increases per physician, they face more challenges in the usual disruptions (Mold, annals FM, changes of key personnel, EHR, billing, location, ownership, others not studied but there) RBRVS hits the office, basic, cognitive harder Payments are 15 - 30% lower for providers in the 2621 counties that most depend on small and medium Worst health insurance concentrations pay even less and abuse even more in the 2621 counties with concentrations of elderly, poor, disabled, and worst employers - the ones that have plans that pay so low that they cannot overcome the worst paying public plans. This keeps local health care suppressed This in turn prevents recruitment and retention of the better employers Thus lowest health workforce concentration counties will forever remain so under US designs And MD DO NP and PA academics and government entities claiming that health professional training can fix these deficits - obviously have no clue how many vote against basic health access for most Americans in so many dimensions of so many designs against. They benefit from new types or massive expansions or special training designs - THAT CANNOT WORK. CMS votes 1.4 trillion against everything that HRSA does - CHCs, incentives, and training grants. We must stop the madness of more and more being trained to be cannon fodder as their basic health access delivery teams are MELTED away and as they melt away from primary care, mental health, womens health, and where most Americans most need care. We have reached an end point with collapse of reason and accountability at the highest levels of health care leadership at the federal, state, local, and employer levels.

Prior authorizations, while intended to reduce spending on unnecessary and ineffective treatments, seem to be stalling out a lot of providers' treatment plans for their patients. Another article I read indicates that the process of prior authorizations are leading to high rates of burnout and decreased retention for physicians as they're often forced to wait for insurers to determine their patient's needs for their prescribed care. No doubt this leaves some physicians feeling powerless and disconnected from the treatment they are giving their patients. Thankfully, it seems like there are some bipartisan legislative solutions being developed at the state level to expedite the prior authorization process and remove it in particular cases. While needless spending should be a concern in healthcare coverage, delays in treatment is not a justifiable result and I hope some of this can be fixed on a national level so that all Americans can get the treatment they need.

#ManattOnHealth Insight by Randi Seigel: The #DOJ has continued to pursue #FalseClaimsAct settlements and judgments impacting stakeholders in the health care industry providing #Medicare and #Medicaid services. It's critical for health care entities to prioritize compliance in this increasingly complex environment. Hear about how they can stay out of the government's crosshairs during Manatt's upcoming webinar: