Partnership To Advance Cardiovascular Health’s Post

This week, I received this message from my patient. Our appeal for her Insulin pump has been approved. It has been an ongoing ordeal for the past 3 months. We escalated the issue at the state level and finally won the battle. The patient is a newly diagnosed Type-1 DM. A1C was excellent continuous glucose monitor (CGM) results were excellent. However this was the result of endless insulin shots (8-10x a day) and preemptive correction for lows even before they happen. This was causing significant distress. I submitted a request for an automated insulin delivery system (Insulin pump) to address this concern. This was instantly denied, with reason being: “…lack of medical necessity because the blood sugars and A1C do not reflect poor control on current therapy” This is the sad reality of US Healthcare, where the insurance can dictate care. Insurance companies wield an unsettling amount of power in determining the care patients receive. Despite advances in evidence-based guidelines developed by experts to ensure optimal outcomes, payer systems often override these recommendations. This results in a system where profit margins, not science, dictate treatment. Healthcare providers, trained to follow rigorous, peer-reviewed guidelines, frequently find ourselves battling insurers over what is “covered.” Treatments, diagnostic tests, or medications deemed necessary by medical standards are often denied or delayed because they don’t fit the insurer’s cost-saving protocols in place. The consequences are devastating: delayed diagnoses, untreated conditions, and worsened health outcomes. Patients and providers alike are forced to navigate an endless cycle of appeals similar to what I went through for my patient. This convoluted path, drains time and resources while putting lives at risk. We should all advocate in prioritizing patient well-being and evidence-based care—not corporate profit. It’s time to demand accountability from insurance companies and advocate for reforms that put treatment decisions back where they belong: in the hands of healthcare providers. Our patients deserve better. #patientcenteredcare #ADA #evidencebasedpractice #endocrinology #diabetestechnology #patientsbeforeprofit #appeals #denials #UShealthcare

💡A new study has estimated the prevalence of paroxysmal nocturnal hemoglobinuria in adult patients with insurance in the United States from 2018 to 2022, along with describing the associated healthcare resource utilization and costs of #C5Inhibitors including #eculizumab, #pegcetacoplan, and #ravulizumab. Read the findings here: https://brnw.ch/21wLfqq #RareDiseaseResearch

Prior authorizations and high out-of-pocket costs often stand between patients and life-changing diabetes technologies. Up to 90% of physicians report delays in care due to insurance hurdles, eroding trust, and patient engagement. In the latest episode of The Hard Things About Healthcare, Halis Kaan Akturk, MD (Barbara Davis Center, University of Colorado Anschutz Medical Campus) highlights these challenges in his conversation with Matt Faustman and Ginger Vieira. "I would say the first thing is insurance prior authorizations because they take a lot of time and cause a lot of frustrations for everybody. I think it decreases the provider-patient relationship and trust. Other than that, the cost—obviously—and even if insurance covers it, the copayments can still be quite high. And then there’s the support—the company's support for the system, whether it’s for the CGM, AID, or a new medication." Despite these challenges, more patients are becoming informed and open to diabetes technology, making conversations about their care easier and more collaborative. 🎥 Watch the full discussion here: [https://lnkd.in/gdWKyYhR]

Dr. Haggerty has published a lot of papers, but this may be one of the most important ones. With her research team, she conceptualized it, implemented it, and published it amazingly quickly. Patients around the country are experiencing unprecedented benefits from GLP1 anti-obesity medications only to have access to those medications stripped from them mid-treatment if insurance plans stop coverage. This is the first qualitative study to assess the impact on these patients. Insurances must do better. They should have strategies to get the right people on the right treatments for obesity and should not take people doing well off of treatment. https://lnkd.in/eq5RV97R

🚨 German Health Committee Calls for Stronger Evidence on TTVR for Severe Tricuspid Regurgitation 🚨 The Gemeinsamer Bundesausschuss (G-BA) has raised critical concerns regarding the endovascular transcatheter tricuspid valve replacement (TTVR) procedure. Key takeaways from their assessment include: 🔍 Lack of Robust Evidence: Current studies are missing high-quality randomized controlled trials, leading to questions about the clinical benefits and safety of TTVR. 📊 Data Quality Issues: Concerns over data reliability hinder effective evaluation of patient outcomes, including quality of life and hospitalization rates. 💰 Uncertain Reimbursement: Without further evidence, acceptance into Statutory Health Insurance remains uncertain, emphasizing the need for comprehensive studies. The G-BA is advocating for investment in high-quality research to support market access decisions. As we move forward in exploring advanced interventions for severe tricuspid regurgitation, ensuring rigorous standards in evidence generation is paramount. Let's prioritize patient care and optimize health outcomes! 👉 Click to learn more! #ClinicalResearch #EvidenceBasedMedicine #G-BA #Healthcare #PatientCare #Pharma #Publications #TTVR #MarketAccess #MarketAccessToday

COMING SOON: The launch of the FootCare America Networks, LLC, Limb Amputation Prevention Independent Practice Association (FCAN-IPA) is coming soon. It is a unique public health collaboration of the Lower Extremity Amputation Prevention (LEAP) Alliance, FCAN-IPA, and supporting nonprofit and commercial entities. WHY JOIN WITH OTHER PROVIDERS IN AN IPA? The costs to insurance payers for covering chronic diabetic foot ulcerative disease, amputations, and long term post amputation disability are monumental and expected to increase. Understandably, more and more of these payers are open to negotiating mutually satisfactory provider agreements with already organized provider groups committed to value based amputation prevention services at mutually agreeable, fair cost. Becoming a member of a specialized amputation prevention IPA opens a new door for practice growth and revenue acquisition. EXACTLY WHAT IS AN IPA? There are many IPA business models. The FCAN-IPA is a replication of a community based, 125 member multispecialty "messenger model" IPA in Chicago. It will have power of numbers for negotiating amputation prevention services with insurers in behalf embers, enter into contracts in their behalf, provide value-based care set fee schedules, and may even take care of the administrative aspects of amputation prevention services such as medical billing, allowing provider members to focus more on patient care. Watch for more information soon.

With Electronic Prior Authorization integrated into your ePrescribing workflow, medications that require prior authorization are flagged, and providers can submit electronic PA requests within their workflows, streamlining the approval process. Check out this MedCity News article to learn how traditional prior authorizations can impact patients' timely access to Gastrointestinal care. #priorauthorization #ePA https://lnkd.in/gUKqWaDh

The When & Why of Treatment Abandonment A survey of doctors found that 82% of insurance company prior authorization (PA) requests lead to treatment abandonment ( when a patient never begins their treatment), and 34% of doctors reported that PA requests led to a serious negative medical event for a patient. Not surprisingly, issues of cost play a factor in treatment abandonment as well. A poll by KFF in 2023 determined that 46% of uninsured adults and 25% of insured adults skipped a medical treatment due to cost. Assist Health plays a role in helping uninsured and self-pay patients afford the care they need. We are a national provider of diagnostic imaging, diagnostic lab tests, and gastroenterological procedures for uninsured and self-pay patients. Working in partnership with top-ranked providers nationwide, we put important screenings in reach of the patients that need them. Our three services, ColonoscopyAssist, RadiologyAssist, and LaboratoryAssist provide easy access to scheduling and transparent upfront pricing. Refer your uninsured/self-pay patients to ensure they get the screenings that you order and help avoid treatment abandonment. www.laboratoryassist.com www.radiologyassist.com www.colonoscopyassist.com

From medication cost to the laborious #enrollment processes, patients face numerous barriers that can hinder their #adherence to prescribed therapy regimens. Check out our recent #blog where we dive into various factors contributing to non-adherence and explore how RxLightning can help overcome these challenges.

Hey there! I want to take a moment to shine a light on something #HometownPharmacy and independent pharmacies nationwide are fighting for—patient rights and well-being. Most people don’t realize it, but Pharmacy Benefit Managers (PBMs) are middlemen between pharmacies, insurance companies, and drug manufacturers. They control which medications are covered and set prices—but they operate behind the scenes, so many don’t even know they exist. Unfortunately, PBMs often hurt independent pharmacies and patients by inflating drug prices and restricting access to vital medications. But there’s hope! We’re supporting three crucial bills that can bring real change: - Drug Price Transparency in Medicaid Act (H.R. 1613/S. 1038) - Neighborhood Options for Patients Buying Medicines (NO PBMs) Act (H.R. 5400/S. 2436) - Pharmacists Fight Back Act (H.R. 9096) These bills aren’t just about policy—they're about people. Like Cole, whose heartbreaking story reminds us of the real cost when patients are forced to choose between affording meds and paying rent. This has to stop. Please take a moment to visit the Patient Protector site, read Cole's story, and sign the petition https://lnkd.in/gNFt2KGi. Every signature helps. And if this message resonates with you, I’d be grateful if you could share it with your network—the more people know, the stronger our impact. Thanks so much for your support! https://lnkd.in/gj99Rtzi