Last Week in Healthcare Reform: March 21st, 2022

Stakeholders urge for full implementation of consumer surprise medical billing protections; PBMs leverage technology and expertise to improve patient outcomes; and, for-profit hospitals skip less profitable services.

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Item of the Week

Week in Review

Surprise Medical Billing: Even as the “No Surprises Act” continues to defend itself against legal challenges from opponents, consumers are already benefitting from the protections that the law has established to better safeguard them from surprise medical bills.  As previously covered, a recent court ruling in Texas threatens to unravel one of the key provisions in the new law, re-exposing consumers to the threat of rising healthcare costs.  In response, a coalition of employers, insurers, health organizations, economists, and other stakeholders from across the healthcare spectrum, sent a letter to the Administration, expressing their unified support of the “No Surprises Act” and reinforcing the importance of full implementation of the law in seeking to protect consumers from harmful pricing practices.

PBMs & Patient Outcomes: Elsewhere in the debate swirling around rising drug costs, a great deal of attention has been paid to the role that pharmacy benefit managers (PBMs) play in the patient journey.  Seeking to cut through the noise, PBMs continue to focus their efforts on connecting consumers to their prescriptions efficiently and affordably, while monitoring for patient safety and medication adherence.  Through the use of advanced technologies, such as wearables and digital apps, PBMs are able to apply their expertise to helping patients better manage their prescriptions.  This expertise not only allows the PBM to check the patient’s pharmacy benefit information to ensure accuracy in cost-sharing, but check for any potential harmful drug interactions, as well.  This coordination leads to greater efficiency in patient care and better health outcomes.

For-Profit Hospitals: On the heels of a recent analysis showing that higher hospital prices don’t automatically translate into better patient outcomes (also covered in a previous newsletter), a new study delves further, exploring what types of services are offered by what types of hospitals.  According to the research published in Health Affairs, for-profit hospitals are more likely to skip less profitable services.  That leaves nonprofit and government-owned hospitals left to pick up the slack.  The research also shows that for-profit hospitals are more likely to adopt or discontinue their service offerings consistent with any changes in service profitability.


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