Discover the ins and outs of Medicare Star Ratings and CMS translation requirements in this insightful podcast episode. Join Capital Rx's Justin Venneri and Jay Tran, PharmD as they delve into the significance of Star Ratings for health plans and Medicare payers, discussing what the ratings are based on, what drives bonus payments, as well as the role of medication therapy management (MTM) in star ratings and upcoming changes in the eligibility criteria. Additionally, this episode explores the importance of the CMS translation requirements for health plans serving diverse populations and provides practical tips for meeting the needs of non-English-speaking members.

For more information on these topics and this episode, please visit Capital Rx Insights or check out the linked content below!

Thank you for listening!

In this episode of the Astonishing Healthcare Podcast, Jeffrey Hogan, President of Upside Health Advisors, shares his insights on the current state of healthcare and the challenges plan sponsors, including employers and other payers, face. He discusses the importance of aligning supply and demand in the healthcare system in the post-COVID era, the significance of the Consolidated Appropriations Act (CAA), and why establishing a process to evaluate plan data is a must.

Jeff explains short-term steps plan fiduciaries can take to learn about their new responsibilities, gain access to their data, evaluate cost categories like pharmacy (which has been a primary driver of inflation, often compounding at 10%+ per year), and why advanced primary care models are worth a look, too. Finally, Jeff shares the most astonishing thing he's seen over his 35+ years in the business (hint: it's not exactly how you'd want to get out of a tough presentation to a client)!

Related Content: Self-funded plans ignore the Consolidated Appropriations Act at their peril

To learn more about Upside Health Advisors, click here, or you can find Jeff on LinkedIn.

For more information about Capital Rx and this episode, please visit Capital Rx Insights.

Brian TenEyck, National Director of Consultant Relations at Capital Rx, shares his insights on the pharmacy benefit management (PBM) industry in episode 3 of The Astonishing Healthcare Podcast. He discusses the importance of early engagement in pharmacy procurement and building strong relationships with vendor partners. Brian also addresses the increasing utilization of GLP-1 drugs and suggests consultants inquire about prior authorization (PA) approval rates with their PBMs. He highlights the need to hold PBMs accountable for managing plan spend, urging consultants to monitor the per member per month (PMPM) cost trend for clients rather than solely focusing on discounts and rebates.

Last, he shares one of the most astonishing things he's seen (hint: it led to the creation of a new product for the small and mid-markets).

Visit www.cap-rx.com/insights for more!

Bridget Mulvenna joined Erickson Senior Living to manage pharmacy costs and develop the pharmacy program. She ended up applying what she had learned over years of working in various pharmacy settings and in pharmacy procurement to their pharmacy benefit programs. In this episode of The Astonishing Healthcare Podcast, Bridget shares why it's so hard to control pharmacy costs, as well as her thoughts about reining in specialty drug costs, rebates, coverage of GLP-1s, and the most astonishing thing she's seen (hint: it relates to cost savings)!

For this episode's transcript and to learn more, please visit Capital Rx Insights!

Capital Rx Co-Founder & CEO AJ Loiacono is our guest for the first-ever episode of The. Astonishing Healthcare Podcast! AJ discusses the path to becoming a pharmacy benefit manager (PBM), why and how using JUDI® aided in the development of a next-generation enterprise health platform, challenges growing through the pandemic and with remote work, what plan sponsors need from their PBM partners, and a most astonishing thing: nobody knows the cost to administer their pharmacy benefit plan! 

Visit Capital Rx Insights for this episode's transcript and much more content from the Capital Rx team.