HealthCare Roundtable e-News – February 26, 2024


Save the Date – Upcoming Webinar!

CMS Action and the Public Sector: Navigating the Regulatory Landscape | Monday, March 4, 2024 | 3:30 to 5:00 PM (EST)

Join us for an insightful webinar focusing on CMS action and its implications for the public sector. We’ll delve into the challenges and opportunities arising from recent regulatory developments, including guidance on the Medicare Prescription Payment Plan and issues with copay smoothing, the CY 2025 Medicare Advantage Advanced Rate Notice, and general policies relating to the MA program. Don’t miss this chance to assess the landscape and gain valuable insights to navigate the evolving regulatory environment effectively.

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Top News

Public Sector HealthCare Roundtable Publishes Annual White Paper

The Public Sector HealthCare Roundtable, in collaboration with the National Institute for Public Employee Healthcare Policy, has released a report shedding light on the escalating crisis of specialty medication costs. This annual report draws data from 21 plan sponsors across 16 states representing over 157 health plans and reveals that pharmacy expenses account for a staggering 25% of total healthcare spending among public sector employers and plan sponsors. With pharmacy expenses soaring and specialty medications projected to account for over 50% of prescription expenses by 2030, urgent action is needed. To read the full report, click here.


Commonwealth Fund Releases Findings from 2024 Value of Medicare Survey

The Commonwealth Fund recently released their findings from a survey conducted between November 6, 2023, and January 4, 2024, which asked a nationally representative sample of Medicare beneficiaries aged 18 and older about the value of their care. The questions centered around access to benefits, services, providers, care coordination and satisfaction. The survey found that whether beneficiaries were enrolled in Medicare Advantage (MA) or traditional Medicare, about two in three beneficiaries say that their coverage fully met their expectations. However, findings show that larger shares of beneficiaries in MA plans than in traditional Medicare reported experiencing delays in getting care due to the need to obtain prior approval (22% vs. 13%). A notably higher amount (12% vs. 7%) of MA enrollees could not afford care because of copayments or deductibles. Overall, beneficiaries in both traditional Medicare and MA plans reported challenges in accessing care in the past two years, but more beneficiaries in MA plans experienced delays in getting care because of the need to obtain plan approval.


ACOs Urge for Increased Participation of Long-Term and Post-Acute Care Providers in New White Paper

In a recently published white paper by a roundtable convened by the National Association of ACOs (NAACOS), American Health Care Association (AHCA) and National Center for Assisted Living (NCAL), accountable care organizations (ACOs) and industry stakeholders called on federal officials to increase participation of long-term and post-acute care providers in ACOs and to better incorporate episodic-based payments. The white paper highlights ways the ACO REACH Model and Medicare Shared Savings Program (MSSP) can be utilized to grow participation. Additionally, stakeholders advocated for long-term nursing facilities to be removed from the MSSP, as many community-based providers no longer provide primary care to these beneficiaries. Participants in the roundtable also encouraged the Centers for Medicare and Medicaid Services (CMS) to better prioritize metrics and regularly share data to allow for a feedback loop to be used for updates.

Congressional Action

  • U.S. Speaker of the House Mike Johnson (R-LA) and Minority Leader Hakeem Jeffries (D-NY) announced the creation of a bipartisan Task Force on Artificial Intelligence (AI). The Task Force itself will explore how Congress can continue to support innovation in AI, while still considering regulations to safeguard the nation against emerging threats. Speaker Johnson and Leader Jeffries have each appointed twelve members to the Task Force, representing key committees of jurisdiction relating to AI. House leadership has appointed Jay Obernolte (R-CA) as Chair and Ted Lieu (D-CA) as Co-Chair of the Task Force. The Chairs have been entrusted to lead the group in producing a comprehensive report that will include guiding principles, forward-looking recommendations, and bipartisan policy proposals developed in consultation with committees of jurisdiction.
  • Senator Bill Cassidy (R-LA) and the Senate Committee on Health, Education, Labor & Pensions (HELP) released the Strengthening Health Data Privacy for Americans: Addressing the Challenges of the Modern Era report that presents a framework for strengthening privacy protections for health data. Following a request for information (RFI) in September 2023 and stakeholder feedback, the report presents three categories for legislative action: updates to existing health privacy frameworks including the Health Insurance Portability and Accountability Act (HIPAA), health data falling in the HIPAA “gray area,” and data beyond the scope of HIPAA. Given recent technological innovations, the report proposes updates and clarifications to HIPAA as well as full alignment of health data to ensure HIPAA effectively functions in the digital future. The proposal considers the implications of geolocation data, financial data, internet searchers, and biometric data on individual health and privacy and urges Congress to address these complicated data privacy reform issues.

Mark your calendar:

Roundtable’s Congressional Forum

June 6, 2024

Washington, DC

Roundtable’s 20th Annual Conference

November 6-8, 2024

The Mayflower Hotel, Washington, DC

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