Recently, glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have emerged as safe and effective treatments for obesity, with ability to improve long-term cardiovascular outcomes. However, their high cost has raised concerns about their budgetary effect, particularly for public insurance programs. Medicare Part D plans statutorily cannot cover antiobesity medications, but state Medicaid programs have more flexibility.1 We examined state Medicaid coverage policies for antiobesity medications and their trends in Medicaid reimbursement from 2011 to 2022.

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Value-based payment flaws

While CMS has a target of getting 100% of Medicare beneficiaries into value-based payment (VBP) programs–such as accountable care organizations–by the end of the decade, implementing VBP in practice will be challenging. An editorial by Navathe et al. (2024) in Health Affairs provides some key considerations.

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Health Plan Switching and Health Care Utilization

This randomized clinical trial assesses whether email nudges during the 2021 special enrollment period in California’s Affordable Care Act marketplace led to increased enrollment in silver-tier health plans that cover 94% of medical costs and to increased health care utilization.

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Continued Medicare reimbursement declines could threaten access to physicians

These reimbursement trends varied widely by physician specialty (-57.6% for cardiac surgery to +189.1% for pain management). In comparison, non-physician practitioners’ reimbursement per Medicare patient increased more than 3-fold over the same period. The research, published today in INQUIRY: The Journal of Health Care Organization, Provision, and Financing evaluated changes in payments for Part B […]

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Provider Strategy reports on market developments and insights related to the healthcare provider workforce. Our publication is committed to improving the healthcare professional workforce, utilization of providers, and ultimately supporting thought leadership in workforce innovation.

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