Medicare To Cut Payments To Medicare Advantage Plans

Two women walking down a sidewalk with one holding onto the other 's hand.


A battle is brewing between the Centers for Medicare and Medicaid and major insurance companies as Medicare Advantage plans could receive reduced payments next year.  Such a move could cut into profit margins unless insurers cut back on benefits to Medicare Advantage plan holders.  The proposal would change the way Medicare pays insurers.  A “risk adjustment†would give insurers more money for those who are sicker as they will generate higher expenses.  However, the new proposal would either eliminate or reduce payments for some conditions such as atherosclerosis (plaque build up) and a specific type of malnutrition.  The government says this will result in more money for insurance companies but Medicare Advantage plans think differently

Monterey, CA Hopes Dashed For Those With Alzheimer’s : Few Drugs In The Pipeline

A woman sitting on the couch with an older man.


There was a sad story about a woman named Geri Taylor in the most recent issue of Bloomberg Businessweek.  She ran a large long-term care facility into her mid-60’s at which point she started to get forgetful.  One time, she was in the middle of running a staff meeting and lost her train of thought.  When she couldn’t get it back, one of her deputies had to take over.  Another time, she got off at the wrong Manhattan subway stop and had no idea why she was there or where she was going.  She kept putting off seeing a neurologist for years until one day she walked into the bathroom and couldn’t recognizer her own face in the mirror.  She was finally diagnosed with mild cognitive impairment, likely due to Alzheimer’s disease, in 2012.  New hope arrived in 2015 when she enrolled in a clinical trial.  She had an unusual buildup of a protein in the brain called amyloid plaque, which most researchers believe is related to Alzheimer’s disease.  The drug turned out to be Aduhelm, made by Biogen Inc.  However, her hopes were quickly dashed when, despite being given FDA approval, Medicare refused to pay for the drug and it was essentially taken off the market.  Now, some researchers are wondering if the whole Amyloid plaque theory should be abandoned and scientists should focus on some other promising areas.  But there is a huge disagreement on this topic.  Rudolph Tanzi, a neurology professor at Harvard Medical School and Massachusetts General Hospital, said, “If you say amyloid doesn’t matter in this disease, you are just hiding your head in the sand.â€Â  He is more optimistic about using anti-amyloid drugs earlier as a preventative measure.  Over the next year, results from trials of three more amyloid-lowering drugs—from Eli Lilly, Roche and Eisai, are expected to be published.  If any of the trials succeed, Medicare will be under extreme pressure to pay for the drugs.  However, if they all fail, backers of the amyloid hypothesis may have to throw in the towel.  Regular readers of my blog know that both my father and my grandmother had this terrible disease when they passed away.  There are a great group of people at the Monterey Chapter of the Alzheimer’s Association in Ryan’s Ranch.  They also have a 24-hour hotline if you just want to talk at 1-800-272-3900.

Carmel, CA Alzheimer’s Research Called Into Question

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A report in Science Magazine stated that an influential 2006 study relied on fabricated images to support its conclusion, which resulted in misdirected Alzheimer’s research for the past 16 years.  Dr. Karen Ashe, a senior University of Minnesota scientist, has admitted that a junior colleague appears to have manipulated two images.  However, she claims those actions did not affect the study’s wording and conclusion.  And the first researcher to state that Alzheimer’s disease is triggered by amyloid beta plaques in the brain now concedes that after years of developing amyloid-targeting drugs that have failed, a new approach must begin.  He says a multi-drug approach will likely be more affected.  I’m confident we will gradually push back on Alzheimer’s disease in the same way that we’ve pushed back on cancer and so on,†Dr. John Hardy told USA Today.  Regular readers of my blog know that both my father and grandmother had this terrible disease when they passed away.  If you need information or just someone to talk to, there are some wonderful people at the Monterey branch of the Alzheimer’s Association in Ryan Ranch.  They also have a 24-hour hotline at 1-800-272-3900.

 

Pebble Beach, CA Early Alzheimer’s Disease Is More Common Than One Might Think

A close up of some blue and yellow cells


A new report from The Alzheimer’s Association found that 12-18% of adults 60 and older have “mild cognitive impairment†while more than 1 in 10 older adults have early stage memory or cognitive problems.  Many doctors and patients “think that it might be normal aging, and that’s something that needs to be addressed,†Maria Carillo, chief science officer of the Alzheimer’s Association, told USA Today.   “They can be diagnosed, and a delay of a diagnosis can be harmful,†she said.  Sadly, a survey of 801 primary care doctors found that 72% had difficulty differentiating normal aging from cognitive impairment.  And 60% of doctors were unfamiliar with using tests such as spinal taps or brain scans that measure disease markers such as amyloid or tau.