Inside Healthcare from Fulcrum Strategies

Medicare Advantage continues to be one of the most profitable sectors of the health insurance industry, yet a lobby group backed by the nation's largest payers has claimed the federal government isn't paying them enough.  Fulcrum Strategies President and CEO Ron Howirgon and Matthew Handley discuss this. Plus, Elevance-owned Anthem BlueCross BlueShield in New Hampshire has royally screwed up their...

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a proposal in Washington to remove the site of service differential.  Removing that change would pay doctors the same regardless if a procedure is performed at a hospital or an office. Ron and Matthew also discuss if the Medicare fee schedule is going to change, a PhRMA's lawsuit against the Biden...

On today's episode of the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a current US Supreme Court case that is looking at COVID-19 misinformation and free speech.  Namely, the justices are evaluating if misinformation is protected speech.  Matthew and Ron discuss what this could mean for physicians who think they are giving their medical opinion to patients...

In our continuing series on prior authorization, Ron Howirgon and Matthew Handley discuss a press release from Cigna detailing all the "good" reasons big insurers like it use prior authorizations.  They claim it is to save patients money but ultimately, it saves patients' lives.  But a new law in New Jersey seems to fly in the face of that saying in its introduction that prior authorizations can b...

This week on the FLATLINING Podcast, Matthew and Ron talk about a new Centers for Medicare and Medicaid Services rule that requires insurance companies to respond to prior authorization requests for certain products within seventy-two hours.  Those products include Medicare, Medicaid, CHIP, and Obamacare plans.  Unfortunately, commercially insured patients are left out in the cold.  Ron shares his...

This week on the FLATLINING Podcas from Fulcrum Strategies, Matthew and Ron discuss the current situation with the Medicare fee schedule.  Unfortunately, a cut was not removed by Congress and doctors are now being paid (on average) 3% less to see Medicare patients.  Ron shares his insights into what he thinks will change in the next few weeks. Then, Matthew and Ron discuss a story that was previou...

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howirgon discuss the failed Cigna / Humana merger and why Wall Street analysts thought it was a bad idea from the start.  They also talk about the potential buyer for Cigna's Medicare Advantage business and why it doesn't really matter in the grand scheme of Medicare Advantage plans. Matthew also asks Ron what he'...

Our most listened to episode of 2023: In 2023, the nation’s largest health insurers saw several lawsuits brought against them for refusing to cover care under the guise that it was not medically necessary or that physicians did not comply with prior authorizations. This happened to otolayrngologist Dan Hurley and Matthew had the opportunity to interview him for the FLATLINING Podcast from Fulcrum...

We are continuing the Best of 2023 series on FLATLINING Podcast from Fulcrum Strategies. Weight loss drugs got a lot of hype this year as more were approved by the FDA with very promising results. But, as has been noted by several lawmakers and activists, insurance companies are still refusing to cover the drugs. Ron and Matthew discussed the new drug from Novo Nordisk called Wegovy and how it cou...

This week on the FLATLINING Podcast, we start our best of 2023 countdown with our third most popular program of the year.   Ron and Matthew discussed a bill that was proposed in the Indiana state legislature that attempted to regulate how hospitals can do business in the state.  That bill was later signed into law by Indiana Governor Jonathan Jennings.  Ron and Matthew also discussed statistics th...

This week on the FLATLINING Podcast from Fulcrum Strategies, economist and CEO Ron Howrigon and Matthew Handley discuss the recent news that health insurance giants Cigna and Humana may merge.  They discuss why Cigna's stock price has failed to rebound since the news and why Ron thinks this deal will be approved by the FTC. They also discuss, briefly, former President Donald Trump's statements tha...

We are continuing our series on the FLATLINING Podcast which takes a look at the healthcare policies of the presidential candidates.  One of the Republicans who has some concrete ideas is former United Nations Ambassador and former South Carolina Governor Nikki Haley.   Haley has proposed: Raising the Medicare and Social Security age Expanding access to Medicare Advantage plans Eliminating Certifi...

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss recent reporting that the American Medical Association may lobby to ban corporate medicine.  Corporate medicine is the practice of entities owning physicians, such as an insurance company or a large hospital system.  They also discuss the potential cuts to the Medicare fee schedule in 2024. Articl...

Yesterday, Reuters reported that Cigna is in talks to sell its Medicare Advantage line of business.  Upon the release of the news, Cigna's stock price was down nearly 4% at points and ended the day down 3.85%.  As other insurers (namely Humana) aim to get out of their commercial business because Medicare Advantage was much more profitable, how is it that Cigna was unable to make their plans as pro...

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss UnitedHealthcare's new variable co-pay product called Surest.  They talk about these questions providers and patients may have about the product: What is a variable co-pay plan and how does it work? Why will some doctors cost more than other doctors? Is this a cheaper plan for employers to buy for...

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron discuss a recent move by BlueCross BlueShield of North Carolina to purchase the NC locations of retail healthcare chain FastMed.  What does that mean for patients and nieghboring providers?  Then, they dive into a recent LinkedIn post by Ron that discussed a call he had with a managed Medicaid payer who wanted one of his...

The Centers for Medicare and Medicaid Services issued new guidance for the No Surprises Act after the previous guidance was struck down in federal court.  In short: the Department of Health and Human Services handed a win to the insurance companies that will surely end up back in court.  Fulcrum Strategies president and CEO Ron Howrigon discusses with Matthew Handley what it means for emergency me...

As we enter the open enrollment period, there is little doubt that you will be seeing ads for Medicare Advantage ads on TV.  Several weeks ago on the Friday Pulse Check Newsletter, Matthew Handley broke down the top plans by tv ads in recent years.  Regardless if you are a patient or a provider, there are things you ought to know about Medicare Advantage plans.  Can they pay a provider less than M...

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon discuss recent actions by the Biden Administration to combat medical debt.  The White House announced last week that they would be working to bar medical debt from being reported to the major credit bureaus which would then help patient's credit scores.  But what happens to physicians and hospitals when c...

This week on the FLATLINING Podcast from Fulcrum Strategies, CEO Ron Howrigon and Matthew Handley discuss political holdups to Medicaid expansion in North Carolina.  The House wants to separate the Medicaid from the state budget and pass it with a casino bill but the state Senate is refusing to agree.  So who gets hurt?  Is the state ready to handle more patients on Medicaid?  Why should you care?...

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron break down several healthcare news items that are relevant to the business administration of provider practices.  They take a look at these stories: Cigna, UnitedHealthcare, and BlueCross BlueShield of Michigan claim they have cut prior-authorizations by 20% - Becker's Payer Issues Affordable Care Act (ACA) compliant plan...

Matthew and Ron dive into the debate on whether Medicare should cover every FDA-approved drug, focusing on the case of Aduhelm and Leqembi, two Alzheimer's drugs.  Aduhelm was is not covered by Medicare due to limited effectiveness and high cost.  The Centers for Medicare and Medicaid Services announced Leqemebi would be in certain circumstances. Key highlights FDA approval does not guarantee that...

Matthew Handley and Fulcrum Strategies president and CEO Ron Howrigon discuss the recent rulings in the third Texas Medical Association case against the Centers for Medicare and Medicaid Services (CMS), commonly known as TMA 3.  Judge Jeremy Kernodle ruled that CMS violated the No Surprises Act by publishing guidelines on the Qualified Payment Amount that contradicted the law in several ways.  How...

Matthew Handley and Ron Howrigon discuss the ongoing relevance of COVID, the cost of weight loss drugs in the US, and public opinion on prescription weight loss drugs. Key highlights COVID still matters, especially for those at risk The cost of weight loss drugs in the US compared to other countries The need for a free market economy in healthcare Public opinion on prescription weight loss drugs T...

We received the news last week that Dr. Dan Hurley, who Matthew interviewed on the FLATLINING Podcast several months ago, had lost his battle with cancer.  This week, Fulcrum Strategies president and CEO Ron Howrigon shares how Dr. Hurley's story affected him and continues to motivate him to fight for physicians. You can listen to our entire interview with Dr. Dan Hurley by clicking here. This is...