Sunday Links

Keeping you ahead of the curve, one post at a time.



URAC’s Medicare Advantage deeming authority extended for six more years.

They’re the private organization that accredits Medicare Advantage plans, an essential step before such plans are allowed to be offered to beneficiaries.

There’s been some dissatisfaction with them from the insurers regarding communication and speed of approval.

All that’s behind them, apparently.

I don’t know of any organization that would be a viable alternative.





Rules for drug price transparency for Medicare Advantage plans finalized.

IN: a drug price transparency tool integrated into the EMR and a monthly notification sent to beneficiaries about the lowest prices available for the meds they’re taking.

OUT: automatically prescribing the lowest price drug (the technology to do this is not available…yet)

Upshot—more uncompensated work and lower productivity as clinicians try to match price to med.

Pharma will pay MAOs on the side to further narrow formularies in an effort to avoid cheaper alternatives (don’t worry about Pharma’s margins, they’ll just increase prices to fund those payments to the MAOs).

Patients will pay for equivalent generics out of pocket and not even bother with their part D coverage.



Awareness of STAR ratings among beneficiaries  increase from 22% to 32% over a year.

Given how much marketing bandwidth is being dedicated to this, those results are actually pretty pitiful. Look for insurance companies to double down.





Rheumatologists weigh in on Medicare Advantage changes.

They’re just the latest specialists to realize that under a global cap system, they’re a cost center—and a cost center to be crushed mercilessly.




No matter what the payment system, if you provide real value you’ll be recognized as a center of profit.


They’ll miss you when you’re gone.