Tonkon Torp LLP’s Post

Why is there such a vast range in compensation for physicians in the US? ADVI Health senior advisor, Michael Kolodziej, MD, shares his experience and perspective on the varying compensation among different medical specialties and institutions. Read more in part 8 of the "Decoding Health Care" series: https://lnkd.in/gagFKWB9

The announcements by Humana and UnitedHealthcare that they are experiencing soaring medical costs, only reinforce the need for intensifying care management health system-wide. Another great expose by Mark Hagland. Sometimes, even when difficult news is predicted in advance, it still creates an impact when it arrives. That certainly has been the case this month, as two of the largest private health insurers in the United States, UnitedHealthcare and Humana, announced that they were being affected by soaring medical costs among its insured members. First, on Jan. 12, UnitedHealthcare executives announced that medical costs had soared by 16 percent in the fourth quarter of 2023; and then on Jan. 18, Humana executives, who will share fourth-quarter 2023 financial results on Jan. 25, announced that they expected their company’s medical-loss ratio to have risen from 89.5 percent to 91.4 percent in the fourth quarter of 2023. Stocks of all the major public health insurance companies slid on the twin sets of bad news. https://lnkd.in/g3-bJb79

In a move to streamline care, LA Care Health Plan which managed Medi-Cal and several other plans for low-income Californians is cutting back 24% of its prior authorization requirements. "This change aims to reduce administrative burdens and speed up patient access to necessary treatments," the article explains. This is good to see. Could significantly benefit patient care by removing unnecessary delays in treatment approvals. Devil is in the details but still good progress, particularly for the most vulnerable. Check out the article by Nona Tepper in Modern Healthcare at https://lnkd.in/evVP3eqP

"Among other provisions, the Lower Costs, More Transparency Act codifies the hospital price transparency rule (effective in January 2021), which requires hospitals to disclose charges, cash prices and negotiated prices for all provided services, and the health coverage transparency rule (effective in July 2022), which requires group health plans to disclose negotiated in-network prices and allowed out-of-network prices for all covered services."

On Thursday, Feb. 22 at Noon ET, join Larry Levitt, for a 45-minute discussion addressing the future of prior authorization requirements in health care with Troyen Brennan, Fumiko Ladd Chino, Anna Howard, and Kaye Pestaina. The panel will discuss why insurers use prior authorization, its impact on patients and providers, and how the new regulations may change current practices. They will also examine the potential for further regulatory or legislative actions to address ongoing concerns. https://lnkd.in/gZW_TU7p

Reducing prior authorizations (not seen it yet)? We are certainly have increased denials and audits by 20-30% with still a very high 90%+ approval after review. Think about the reduction in health care costs if we de-escalated the admin costs arms race. How much more care could we collectively provide?

Everything points to BIG ICHRA growth; more carriers focused on ICHRA, more individual plan options, more ICHRA administrators, more money being invested in the space, more brokers getting involved! Are you ready? If you are a broker, Venteur has a broker program I'd love to discuss with you. If you are an employer, I can refer you to a broker that can support you with an ICHRA implementation.

Last week, HHS finalized revisions to 42 CFR Part 2. It's a lengthy final rule, so instead of a high-level summary, I wanted to provide more useful and detailed guidance. In Part 1 of a 3-part series on the final rule, I focus on the single consent for treatment, payment and healthcare operations because it is something providers can put into practice soon. #42CFRPart2 #hipaa

Healthcare's growing administrative burden may seem to signal a growing industry. In reality, it portends a period of contraction. https://loom.ly/npXKIOU #healthcare #industry #medicine #corporate #medicine #medicare #advantage