Strategic Restructuring for the Future - Think Before You Sign: Five Key Insights for VBID and Managed Care Contracts
Part Two: The MFN Drug Pricing Rule and the Rebate Rule: Where Do We Go From Here?
Part One: Two new Medicare Drug Pricing Rules in One Day: What are the MFN and the Rebate Drug Pricing Rules?
Health Care Enforcement: The Impact on Private Equity Investments
Why Health Care Providers Need A Managed Care Strategy
On April 22, 2024, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (CMS-2439-F), effective July 9, 2024, aimed at advancing healthcare access,...more
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) published the Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality final rule. CMS finalized several substantial...more
Last week, McDermott+Consulting launched an election 2024 resource page, where you can find a 2024 health policy outlook and other insights into the November election. While regulations aren’t necessarily top-of-mind when...more
Happy New Year! As we enter 2024, we want to lay out some of the main regulatory issues (both new and old) that McDermott+Consulting will be tracking over the next year. While these may evolve, we think they are still...more
On November 24, the Massachusetts Division of Insurance (DOI) published revisions to its managed care consumer protection regulation, including new requirements related to health care provider directories, telehealth and...more
After steadying during Q2, it appears the overall volume of deals in the healthcare industry declined in Q3 compared with Q2, and year-to-date 2023 is still down from last year. A slumping economy has no doubt played a large...more
Community health workers (CHWs) are frontline public health workers who come from and/or have deep roots in the communities they serve. Many states are leveraging CHWs to build trusting relationships with patients, including...more
In 2020, Medicaid spent $220.8 billion on hospital care. Hospital care accounted for 33% of Medicaid spending. Supplemental payments are critical for closing the gap between hospital costs and Medicaid reimbursement,...more
A recent survey found that the average wait time for a new patient to see a physician in 15 of the largest cities in the U.S. was 26 days, up from 24.1 days in 2017. Timely access to health care providers has long been an...more
Editor’s Note: There is mounting evidence that addressing the social and economic factors that drive the majority of health outcomes, often called social drivers of health (DOH), can improve health, promote health equity and...more
On February 17, the Centers for Medicare & Medicaid Services (CMS) released a Request for Information (RFI) regarding the federal standards that govern access to care in Medicaid and the Children’s Health Insurance Program...more
Longstanding structural racism and related health inequities experienced by people of color further laid bare by the COVID-19 pandemic have mobilized leadership in many states to take action on health equity. Structural...more
On January 18, 2022, Governor Kathy Hochul released her budget proposal for State Fiscal Year 2023. While record-breaking in its size—totaling $216.3 billion—and inclusive of many investments in Medicaid and health care more...more
The Massachusetts Marketplace takes steps to ease consumer confusion by reducing choice among QHPs; North Carolina appears poised to pass Medicaid reform legislation; and bipartisan support is gaining for defining businesses...more
In the wake of the implementation of the Affordable Care Act, the recent Medicare Managed Care Proposed Rule (the Proposed Rule) exemplifies the accelerated push by the Department of Health and Human Services and Centers for...more
Introduced originally in California and followed by Texas, Massachusetts, New Jersey, Kansas and New York, Delivery System Reform Incentive Payment or DSRIP programs are a key feature of the dynamic and evolving Medicaid...more
Managed care is the dominant delivery model in state Medicaid programs, and is rapidly growing with the Affordable Care Act bringing over 8 million new beneficiaries into Medicaid in 2014. Today, 39 states (including the...more