Latest news with #ShawnMartin
Axios
23-06-2025
- Health
- Axios
Health plans pledge to simplify pre-treatment reviews
More than 50 health insurers are committing Monday to simplifying pre-treatment reviews and address a practice widely despised by health care providers and patients. Why it matters: Insurers maintain that requiring a sign-off before patients care get care is necessary to control costs and make sure treatments and medications are safe and effective. But more than 8 in 10 physicians said that issues with prior authorization requirements led patients to abandon treatment, according to an American Medical Association survey last year. Nearly 90% said prior authorizations contribute to burnout. State of play: Leading health plans today will voluntarily commit to answer at least 80% of electronic prior authorization requests that have the necessary clinical documentation in real time by 2027. The insurers also said they'll work to create common electronic prior authorization submission requirements for plans and providers by Jan. 1, 2027. The commitments cover all insurance markets, including private health plans and Medicare Advantage. AHIP and the Blue Cross Blue Shield Association led the commitments. UnitedHealthcare, Aetna CVS Health, Cigna, Elevance and Kaiser Permanente are among the other companies on the pledge. Each is committing to reduce the claims subject to prior authorization "as appropriate for the local market" by the start of next year, according to a joint news release. The insurers will also honor prior pre-treatment approvals when patients change plans during the course of treatment over a 90-day transition period. What they're saying: Physicians offered measured approval of the initiative. "While this commitment is a step in the right direction, we will ultimately measure its impact by real changes in the day-to-day experiences of patients and the physicians who care for them," Shawn Martin, CEO of the American Academy of Family Physicians, said in a statement included in insurers' news release. Flash back: Major trade associations for health insurers, physicians, hospitals and pharmacists released a consensus statement in 2018 on improving prior authorization, but patient and provider concerns have persisted. Congress last year considered — but ultimately did not pass — legislation that would have overhauled prior authorization in Medicare Advantage. And the Biden administration issued rules to make insurers streamline requests to cover treatments. Several insurers have announced their own plans to scale back their prior authorization requirements over the past couple of years.
CNBC
23-06-2025
- Health
- CNBC
Major U.S. health insurers say they will streamline controversial process for approving care
Health plans under major U.S. insurers said Monday they have voluntarily agreed to speed up and reduce prior authorizations – a process that is often a major pain point for patients and providers when getting and administering care. Prior authorization makes providers obtain approval from a patient's insurance company before they carry out specific services or treatments. Insurers say the process ensures patients receive medically necessary care and allows them to control costs. But patients and providers have slammed prior authorizations for, in some cases, leading to care delays or denials and physician burnout. Dozens of plans under large insurers such as CVS Health, UnitedHealthcare, Cigna, Humana, Elevance Health and Blue Cross Blue Shield committed to a series of actions that aim to connect patients to care more quickly and reduce the administrative burden on providers, according to a release from AHIP, a trade group representing health plans. Insurers will implement the changes across markets, including commercial coverage and certain Medicare and Medicaid plans. The group said the tweaks will benefit 257 million Americans. The move comes months after the U.S. health insurance industry faced a torrent of public backlash following the murder of UnitedHealthcare's top executive, Brian Thompson. It builds on the work several companies have already done to simplify their prior authorization processes. Among the efforts is establishing a common standard for submitting electronic prior authorization requests by the start of 2027. By then, at least 80% of electronic prior authorization approvals with all necessary clinical documents will be answered in real time, the release said. That aims to streamline the process and ease the workload of doctors and hospitals, many of whom still submit requests manually on paper rather than electronically. Individual plans will reduce the types of claims subject to prior authorization requests by 2026. "We look forward to collaborating with payers to ensure these efforts lead to meaningful and lasting improvements in patient care," said Shawn Martin, CEO of the American Academy of Family Physicians, in the release.
Axios
12-06-2025
- Business
- Axios
Congress' "doc fix" spurs value-based care concerns
Physicians are divided over how the massive Republican budget bill moving through Congress would insulate doctors from future Medicare cuts without continuing financial incentives to provide better care through alternative payment models. Why it matters: The "doc fix" championed by the American Medical Association, among other groups, would solve a long-standing complaint about the way Medicare pays physicians. But some physician groups worry it would maintain a system long criticized for tying pay to the volume of procedures delivered and the number of patients seen. State of play: Physician practices that agree to be paid based on patient outcomes get bigger payouts in exchange for taking on the extra financial risk are in line, under current law, for a pay boost through a key adjustment called the conversion factor, starting next year. But the version of the GOP budget bill that passed the House of Representatives would instead create a single conversion factor for all physicians that's updated based on Medicare's measure of inflation. That would leave providers in the performance-based payment models getting higher payments than currently prescribed from 2026 through 2028, but lower payments than outlined in current law after that through 2035, according to an analysis from Berkeley Research Group viewed by Axios. Primary care physicians and providers embracing value-based care worry that removing an incentive for participating in the models will set back efforts to move Medicare toward a more holistic payment system that's meant to improve patient care. "Signals matter in health care," said Shawn Martin, CEO of the American Academy of Family Physicians. "I think it's a signal [to physicians] of an entrenchment back in fee-for-service." The American College of Physicians, the trade group for internal medicine doctors, told lawmakers last month that it's concerned the policy as structured will disincentivize doctors' participation in value-based care. "It's being marketed as a long-term fix," said Mara McDermott, CEO of value-based care advocacy group Accountable for Health. "I don't read it that way. I read it as creating a new cliff." Zoom out: Many provider groups are also concerned that the legislation doesn't fix the 2.83% cut to physicians' Medicare payment that took effect in January. The American College of Surgeons in a May statement praised lawmakers for recognizing that Medicare physician payments have to be adjusted for inflation, but that the legislation's provision "is not sufficient to make up for the 2025 cut, and more work is needed." The other side: The AMA wrote to House leadership last month that it "strongly supports" the provision to consolidate into one conversion factor and tie updates to inflation starting in 2026. Reductions made to the conversion factor over the past half-decade to keep the physician fee schedule budget neutral have made private practice financially impossible for many doctors, the AMA said. "It is absolutely vital that this issue be addressed," the letter to House leaders said. The AMA disagrees that the provision would discourage participation in alternative payment models, it told Axios in an email. Although payment updates to alternative payment model physicians starting in 2029 would be lower than current law provides, those doctors will still get positive payment updates overall, it said. Between the lines: The policy would go into effect as the Trump administration seeks to leverage Medicare alternative payment models to drive HHS Secretary Robert F. Kennedy Jr.'s priorities of prevention and personal choice in health care. The Centers for Medicare and Medicaid Services told Axios it does not comment on proposed legislation, but said it's continuing to prioritize policies that encourage providers to join payment models that reward high-value and coordinated care. Reality check: Just about all physicians and physician trade organizations agree that stable Medicare payment updates with some link to inflation is necessary to ensure continuous access for Medicare patients, AAFP's Martin said. It's "extraordinarily healthy" for physician advocacy groups to have different opinions on exactly how to reach that conclusion, he added. The Senate is currently debating what to include in its own version of the reconciliation bill.
Yahoo
16-04-2025
- Yahoo
Man killed in solo motorcycle crash in Placerville
( — A 42-year-old man is dead after a solo motorcycle crash in Placerville Saturday morning, according to the Placerville Police Department. Video Above: What to do if you witness a crash PPD said officers responded to reports of the crash around 2:22 a.m. in the 2900 block of Cold Springs Road. Shawn Martin of Placerville was found and pronounced dead. Sacramento-area developer being sued over fatal Granite Bay crash The cause of the crash is under investigation. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
