Elizabeth Deveny’s Post

Philip Davies reminds us that "safe services of adequate quality that can be accessed in a timely manner" are really what Australian's want. I would add sustainability and affordability both individually and by governments. Fee for service is a perfect fit for "some of what we do", much of non GP specialist care (not all disciplines) but not such a good fit for multidisciplinary longitudinal care which is a large part of what we need in primary care. It is also "not much good" for prevention and proactive care or the needed transition from a sick care system to a health care system. Elizabeth Deveny reminds us about the social determinants of health, housing, education, employment, access to fresh food, safe streets, bike paths etc and the trade-offs that need to be considered by public funders. It's a wicked problem. Medicare needs help (still a lot to be implemented that was recommended by the MBS Schedule Review) but it isn't the solution for everything. Jurisdictions also need to understand that unless they embrace the broad view of health and that they are "part of the health system" and not their own island they will continue to increase their spend on the most expensive end of the health system.

As a caring supporter of Medicare and its underpinning principles too Elizabeth … I think the system (including, but not just, Medicare) also fast needs to adapt to being able to support the use of evidence based #digitaltherapeutics at scale. We are being left behind - translate that as … missing clear opportunities to provide greater volumes of safe care to service currently unmet need. The evidence on that from countries like Germany, the UK and South Korea seems very clear. They are not doing it perfectly … but at least have made a start in quite pragmatic ways. We appear to be held back by a combination of low awareness, fear and inertia ? #digitalhealth #VBDH #HTA #healthcare #quality #equity Monash Information Technology Victoria Zhu Dr Shainal Nathoo Aldeida Aleti Rashina Hoda Michael Franco Chris Pearce Outcome Health Adam McLeod ANDHealth Bronwyn Le Grice Grace Lethlean Australasian Institute of Digital Health (AIDH) Australian Digital Health Agency Zanfina Ademi ISPOR—The Professional Society for Health Economics and Outcomes Research Health Technology Assessment international (HTAi) Centre for Digital Transformation of Health Alliance for Digital health At Monash (ADAM) AIM for Health Lab Lance Emerson Professor Doron Ben-Meir Angela Ryan Digital Therapeutics Alliance Annette Schmiede Clare Morgan Wendy Chapman

A new report by Better Medicare Alliance, a group that advocates for Medicare Advantage plans, found that enrollees spend significantly less on healthcare costs compared to those in traditional Medicare. The study shows that in 2021, Medicare Advantage beneficiaries saved an average of $2,541 on out-of-pocket costs and premiums compared to traditional Medicare. This gap has grown from prior years, with the average savings being $2,400 in 2020. The savings were consistent across racial and ethnic groups, with Black beneficiaries saving $1,617, Latino beneficiaries saving $1,593 and White beneficiaries saving $2,371. Importantly, the study found that Medicare Advantage enrollees have similar access to care and quality of care as traditional Medicare beneficiaries. The report also found that Medicare Advantage enrollees are less likely to experience a high financial burden from healthcare costs. They were 31% less likely to spend more than 20% of their income on healthcare compared to traditional Medicare enrollees. Note that this study was commissioned by an industry group and some critics disagree with its findings. They argue that Medicare Advantage costs the government more than traditional Medicare and that these plans make it harder for enrollees to get the care they need. Currently, more than half of all Medicare beneficiaries are enrolled in Medicare Advantage plans. Learn more: https://hubs.ly/Q02BxQw20

𝐀𝐧 𝐚𝐫𝐭𝐢𝐜𝐥𝐞 𝐢𝐧 𝐭𝐨𝐝𝐚𝐲’𝐬 𝐖𝐒𝐉 𝐡𝐢𝐠𝐡𝐥𝐢𝐠𝐡𝐭𝐬 𝐭𝐡𝐞 𝐛𝐢𝐠𝐠𝐞𝐬𝐭 𝐝𝐚𝐧𝐠𝐞𝐫𝐬 𝐨𝐟 𝐣𝐨𝐢𝐧𝐢𝐧𝐠 𝐚 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞 𝐩𝐥𝐚𝐧 – 𝐭𝐡𝐞 𝐜𝐡𝐚𝐥𝐥𝐞𝐧𝐠𝐞𝐬 𝐨𝐟 𝐥𝐞𝐚𝐯𝐢𝐧𝐠, 𝐞𝐬𝐩𝐞𝐜𝐢𝐚𝐥𝐥𝐲 𝐚𝐬 𝐲𝐨𝐮 𝐠𝐞𝐭 𝐨𝐥𝐝𝐞𝐫 𝐚𝐧𝐝 𝐬𝐢𝐜𝐤𝐞𝐫. And when older, sicker patients do leave, taxpayers wind up footing the bill. https://lnkd.in/gXY5gdRB 𝐅𝐈𝐍𝐃𝐈𝐍𝐆𝐒 “A Wall Street Journal analysis of Medicare data found a pattern of Medicare Advantage’s sickest patients dropping their privately run coverage just as their health needs soared…. “As recipients get sicker, though, they may have more difficulty accessing services than people with traditional Medicare. That’s because the insurers actively manage the care, including requiring patients to get approval for certain services and limiting which hospitals and doctors patients can use. “People in the final year of their lives left Medicare Advantage for traditional Medicare at double the rate of other enrollees from 2016 to 2022, the Journal’s analysis found…They cost the federal government an average of $218 a day during that period. That is more than seven times the cost of a typical Medicare recipient, and about twice the cost of other recipients in the last year of their lives.” Kudos to Anna Wilde Matthews, Christopher Weaver, and Tom McGinty for fine reporting. 𝐌𝐘 𝐏𝐄𝐑𝐒𝐎𝐍𝐀𝐋 𝐓𝐀𝐊𝐄 I would NEVER consider joining a MA plan. The deal killer: the requirement for individual (vs. community) rating of patients' health/sickness levels if they choose to leave a Medicare Advantage plan. I can’t fathom why this isn’t more widely understood and discussed. If you choose to get into traditional Medicare before your 66th birthday, you are eligible to buy a Medigap supplement policy at a community rating, i.e., you pay a price based on the health status of all Medicare patients in your age group. If you want to LEAVE a Medicare Advantage plan after your 66th birthday, the pricing of your Medigap plan will be determined by your INDIVIDUAL health status; you can be denied coverage. This has the effect of LOCKING people into their Medicare Advantage plan when they are older, sicker and want to leave to go to traditional Medicare...and this is where prior authorization requirements can really screw older, sicker patients. This is more a criticism of how MA is structured, and less a criticism of MA plans themselves. I'm not clear on the legislative history of why this loophole exists, but as the WSJ article notes some states have regulated against this. Can anyone enlighten? …and then you get into the arbitrary prior authorization requirements. But that’s another post. “You can check out any time you like, but you can never leave" – The Eagles, Hotel California #MedicareAdvantage #Medicare The Fast Future Executive

In 2021, Medicare Advantage beneficiaries spent about $2,541 less in out-of-pocket costs and premiums than beneficiaries with fee-for-service Medicare, a new report discovered. Here is an organization funded by MA Plans, Better Medicare Allowance, promoting their sponsors with this misleading report. This organization claims Medicare beneficiaries have strong access to care and pay less for the care. This is partly bunk and misleading, the beneficiaries have less out-of-pocket costs because when they try to access their "great benefits" the plans deny the care as not medically necessary. The proof is Humana almost always denies SNF coverage for its members based on "Medical Necessity." This quote is spot on: Dr. Rick Gilfillan, an independent consultant who previously called the MA program a “failed experiment” during a panel discussion at the HLTH 2023 conference. “I say failed because for 35 years of its existence, privatized Medicare, now Subsidized Medicare Advantage, has cost more than traditional Medicare,” he said. “In 2023, those numbers are projected to be more than $75 billion to $120 billion in excess payments to MA over what the cost would be in traditional. From a quality standpoint, … what we can say is that [MA plans] put in place obstacles to care, made access to care more difficult.” Time to pull the plug on Medicare Advantage and save taxpayers from the failed Medicare Advantage experiment. #Medicareadvantageplans, #MAplans, #rippoff, #boondoggle, ##bettermedicareallowanceselfinterest https://lnkd.in/eWsNcZYJ

📌 Navigating Medicare's Late Enrollment Periods: Empowering Members with Confidence and Clarity 👥 With over 60 million people relying on Medicare, understanding the intricacies of late enrollment periods becomes a critical part of ensuring that members won't find themselves underserved or overcharged. But why does clarity on this issue seem so elusive? Let's dive into the essential aspects that can help Medicare members make informed choices without the stress! 🔍 **Awareness** is where we begin. The ramifications of missing an enrollment window can be daunting, leading to costly penalties and gaps in coverage — situations no one wishes to encounter. By demystifying these periods, we're not just alleviating confusion; we're paving the way for a smoother healthcare journey. 🚦 First, what exactly is the Medicare Late Enrollment Period? Simply put: - **Part B Penalty**: If you didn't sign up during your initial enrollment and don't qualify for a Special Enrollment Period, be ready to face a 10% premium increase for each 12-month period you could have had Part B but didn’t sign up. - **Part D Penalty**: Miss initial enrollment, and your penalty for prescription drug coverage continues as long as you're enrolled in a Part D plan. 📅 So, when is it time to act? Awareness of the Initial Enrollment Period (IEP), the General Enrollment Period (GEP), and Special Enrollment Periods (SEPs) is key. Each has its own set of rules and qualifying events, and knowing these can save members from unwanted financial burdens. 🌟 **Empowerment through Education**: Our role as healthcare advocates doesn’t stop at providing information. We must engage, educate, and promote proactive actions among Medicare members, ensuring no one feels left behind. - Host informative sessions or webinars tailored to different community needs. - Offer personalized advice to dispel myths and bring clarity. - Develop easy-to-understand materials that members can refer to throughout their enrollment journey. 💡 **Innovation** plays a notable role here. Digital tools and platforms can guide users seamlessly, with interactive timelines and reminders that alert members about critical dates. 🤝 At Two Agencies Inc., we're committed to bridging the gap. We're excited about our initiatives designed to support healthcare literacy and ensure that every Medicare member can navigate their roadmap confidently. ✅ Let's continue the conversation! What are some effective strategies you've encountered in guiding Medicare members through their enrollment timelines? Your insights could be the key to someone else's success! #Medicare #HealthcareNavigation #EnrollmentPeriods #HealthcareAdvocacy #MedicareMembers #HealthcareEducation #TwoAgenciesInc

Does Medicare Advantage Cost Us More? Something is happening here…. In a recent Health Affairs article Michael Chernew and Paul Masi address the Medicare Payment Advisory Commission’s (MedPac) recent findings that the Federal government spends approximately 22% more on MA enrollees than on Traditional Medicare (TM). The MedPaC report raises a bright red flag at a time when more than half of eligible enrollees are in MA plans and the cost of healthcare continues to be a high policy priority. The authors point out that the major difference in payments between TM and MA derives from the risk adjustments which are largely based on the medical conditions providers attach to the bills they send Medicare for payment. Providers caring for TM beneficiaries do not receive higher payments from Medicare for adding additional diagnoses to their payment claims. However, adding additional diagnoses, known as coding intensity, acts to favorably increase the risk scores for MA plan enrollees and increases the payments that Medicare makes to the MA plan corporate owners.  The authors note that 13% of the 22% increase in MA payments is due to coding intensity and the remaining 9% is due to “favorable selection”. Favorable selection occurs when MA plans selectively market and enroll beneficiaries who, on the average, have lower than predicted Medicare spending.  This is important information about the nation’s largest healthcare payer. Naturally, the corporations that sell MA plans will challenge the validity of the data and will counter with the additional benefits that MA plans bring to some beneficiaries, like reduced premiums, dental and vision coverage. MedPac’s role in this process is to gather the data and provide a balanced analysis in a report to Congress intended to advise Federal lawmakers as they make health payment policy decisions. It should not go unnoticed that the payment gap is embedded in the broader commercialization of the nation’s largest entitlement program. As the taxpayers’ dollars intended to provide healthcare security for the elderly, are passed on to for- profit companies, the long-term consequences of that transition bear close scrutiny and careful controls by our elected officials and their agents. The MedPac report is linked in Chernow and Massi’s article (below) for those who are interested in the details. I think you will enjoy reading the thoughtful and balanced discussion by the nation’s most qualified experts in healthcare economics. Ordinarily much of this important information goes below the radar of even the most interested and impacted people but it is worth taking the time to understand. And in the words of Bob Dylan, “Because something is happening here But you don't know what it is, do you, Mister Jones?” Yours in health Howard Website link below: https://lnkd.in/eYpgpFhR?

Navigating the labyrinth of Medicare can be a daunting task for many, especially when it comes to understanding the late enrollment periods. At Two Agencies Inc., we're committed to transforming this complex journey into a seamless experience for our Medicare members. 🎯 Why is avoiding late enrollment so crucial? The costs associated with late enrollment penalties can linger for a lifetime. The first step towards a financially healthy future starts with informed decisions! Let’s break down the essentials: - **What is the Late Enrollment Penalty?** A fee that you may need to pay if you sign up for Medicare Part B or Part D after your Initial Enrollment Period without having other creditable coverage. - **Why does it matter?** These penalties can significantly increase your healthcare expenses over time. For example, Part B penalties increase your premium by 10% for each full 12-month period you delay. But fear not! Here’s how you can empower yourself: - **Know Your Timeline:** Your Initial Enrollment Period (IEP) is a 7-month period. It's crucial to mark this on your calendar and stay ahead of it. - **Special Enrollment Periods (SEPs):** Life happens. You might be eligible for SEPs if you or your spouse is still working and covered by an employer group health plan. - **Get Educated:** Knowledge is power! Attend Medicare workshops and use online resources to ensure you're making well-informed decisions. At Two Agencies Inc., we believe empathy and expertise are at the heart of guiding our members through these critical periods. Our experts are always ready to make your Medicare experience as smooth as possible, offering personalized guidance tailored to your unique needs. Here’s why our process stands out: - **Personalized Consultations:** One size does not fit all. Our advisors work with you to understand your situation and craft a plan that best suits your needs. - **Comprehensive Resources:** From webinars to one-on-one sessions, we offer myriad resources to help you understand every aspect of Medicare. - **Continuous Support:** Beyond enrollment, we're here for you — addressing questions, clarifying doubts, and ensuring that your Medicare journey is hassle-free. Are you or a loved one approaching the Medicare enrollment period? Let’s start the conversation today to avoid unnecessary late penalties and ensure a comprehensive healthcare plan that aligns with your lifestyle and needs. Reach out today and take control of your Medicare experience! 🚀 #Medicare #Healthcare #Enrollment #NavigatingMedicare #LateEnrollment #TwoAgenciesCares

Medicare Advantage plans, have become increasingly popular due to their comprehensive coverage options. However, the rise in enrollment has introduced several challenges: Increased Enrollment Strain: With more beneficiaries enrolling in Medicare Advantage plans, the system is experiencing heightened pressure. This increase demands more resources to manage the larger population efficiently. Cost Control Measures: To manage expenses, many Medicare Advantage plans have tightened their cost control measures. This includes more stringent utilization management practices such as prior authorizations, step therapy protocols, and network restrictions. Denial of Coverage: There has been a notable increase in the denial of coverage for certain treatments and services. This is often a result of the plans' efforts to control costs, which can lead to delays or denials in accessing necessary care. Administrative Challenges: The bureaucratic hurdles associated with appealing denied claims or navigating prior authorizations can be daunting for beneficiaries and their caregivers. This adds to the overall stress and can potentially delay crucial medical care. These challenges highlight the need for beneficiaries and their caregivers, like you, to stay informed and proactive in managing healthcare options. It's crucial to understand the specific plan's rules and to advocate persistently for necessary medical care. I possess current experience in the benefits and these tightening restrictions as it relates to navigating my own Mother's medical needs this year.dealing with a Medicare Advantage plan and their current limitations as I have and continue to navigate my Mother thru the complex web of healthcare this year. Consumer and their POA's need to stay current, advocate and be assertive. I am grateful my knowledge and experience in healthcare right now.

Navigating the labyrinth of Medicare can be daunting, especially when it comes to understanding the intricacies of late enrollment periods. Yet, it's critical to shine a light on these crucial phases, ensuring every Medicare member is well-equipped and informed. 🌟 Late enrollment penalties can take many by surprise, affecting not just wallets but peace of mind too. Let's delve into this important topic to safeguard your future in the world of Medicare. 🔍 **Key Questions to Consider:** - What exactly is the late enrollment period? - How do penalties impact your long-term healthcare planning? - What strategies can help you avoid these fees? Medicare's late enrollment period is not just a deadline; it’s a pivotal moment where your healthcare planning takes a decisive turn. While it may seem like an administrative detail, understanding this can mean the difference between seamless coverage and unexpected hurdles. 🏥 **Why It's Important:** - **Cost Implications:** Missing enrollment can lead to life-long penalties. Imagine paying a higher premium for the same coverage because of a simple oversight. - **Access to Care:** Missing the right enrollment period may delay access, affecting critical care decisions. - **Complexity:** Rules and regulations can vary. Without correct guidance, even the most astute individuals could stumble. Preparation is your best ally. Empowering yourself with knowledge can facilitate a smoother transition during these periods. 📚 **Tips to Navigate Late Enrollment:** - **Set Reminders:** Mark your calendar well in advance of key dates. - **Stay Informed:** Regularly review updates from Medicare and pertinent literature to stay ahead of changes. - **Consult Experts:** Reach out to knowledgeable advisors who can offer tailored advice and solutions. Wrapping it all up, the late enrollment period is more than just a date on a calendar; it’s an opportunity to reaffirm your commitment to your health journey. Let’s transform these complexities into empowering chapters in your healthcare story. At Two Agencies Inc., we're passionate about clarifying complexities and supporting our clients throughout their Medicare experience. Together, let's navigate the path to smarter, more efficient healthcare decisions. Have questions or need assistance? We're here to help! Drop a comment or reach out to our team of experts. We're ready to guide you through the journey, ensuring you never miss a beat in your Medicare plan. 👥📞 #Medicare #HealthcarePlanning #LateEnrollment #MedicareNavigators #MedicareAdvocacy