Payers
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Two Value-Based Care Initiatives That Could Shift the Alternative Payment Model Landscape
The Centers for Medicare and Medicaid Services has announced two value-based care alternative payment models set to launch in July 2024, one focused on dementia and one on primary care.
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Integrating Workers’ Comp and Medical Benefits Makes So Much Sense
The current dual-system model is inefficient, wasteful, and inconvenient. There is a clear need to integrate workers’ comp and medical benefits programs to cut down on costs and alleviate the hassle of dealing with separate care silos. It’s possible, and its time has come.
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Payer’s Place: Dawn Maroney
Dawn Maroney, President, Markets of Alignment Health and CEO of Alignment Health Plan, to discuss how they are using technology to provide better service and care to consumers.
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Report: About Half of MA Beneficiaries Leave Their Plan After 5 Years
After five years of enrolling in a Medicare Advantage plan, 48.3% of non-dually enrolled beneficiaries left their contract and 53.4% of dually enrolled beneficiaries did, a new study found.
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Amgen, FTC Settlement Allows $28B Horizon Acquisition to Move Forward
Amgen and the Federal Trade Commission are settling the lawsuit the regulator filed to block the pharmaceutical giant’s $28 billion Horizon Therapeutics acquisition. As part of the settlement, Amgen agrees not to “bundle” its products with Horizon’s drugs in negotiations with health plans.
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MedCity Influencers, Health Tech, Payers
Streamlining Healthcare Insurers’ Processes: Unlocking Efficiency and Collaboration for Enhanced Outcomes
While the recent rollbacks of authorization requirements by insurers are a positive step forward, there is still work to be done in streamlining processes and reducing administrative burdens in the healthcare industry.
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CMS Requires States To Assess Medicaid Disenrollment Process
Some states may not be following federal requirements for the Medicaid renewal process, resulting in many individuals being wrongly removed from coverage, CMS said. Children may especially be affected.
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Bon Secours Mercy Health Sues Anthem Health Plans of Virginia for Unpaid Claims
In a new lawsuit, Bon Secours Mercy Health Virginia alleges that Anthem Health Plans of Virginia owes the health system more than $93 million in outstanding unpaid and underpaid claims.
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Hospitals, MedCity Influencers
Navigating the Journey from CMO and Physician to Patient
Even with my “VIP” access to the healthcare system as a physician who practiced in my community, I’m still struggling to coordinate my care as a cancer patient. I believe patients need more from their payers, providers, and digital health collaborators when it comes to care coordination and navigation.
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Report: MA Enrollees Use Postacute Services Less Than Traditional Medicare
A new study found that between 16.2% and 17.7% of Medicare Advantage enrollees reported using post-acute care services, compared to 22.4% to 24.1% of traditional Medicare enrollees.
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Payer’s Place: Don Antonucci
The CEO of Providence Health Plan visits the Payer’s Place and addresses the future of payment models.
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The Importance of Continuous Iteration in Health Equity Plans for REACH ACOs
Next year REACH ACOs will have to show success in developing and maintaining comprehensive health equity plans, and by kicking the can down the road they risk not knowing enough about their patient population in terms of what works better and what doesn’t. ACOs can pay in the effort of continuous iteration now or they can pay in poor health outcomes for their patients and the resulting increased costs. The choice is theirs, but one they each have to make.
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Cigna Cuts 25% of Medical Services from Prior Authorization Requirements
Cigna removed 25% of medical services from prior authorization requirements. This represents more than 600 codes, and includes 100 surgical codes, nearly 200 genetic testing codes, durable medical equipment, orthoses and prosthetics and other services, said Dr. Scott Josephs, chief medical officer of Cigna Healthcare.
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CMS: Medicare Shared Savings Program Saved Medicare $1.8B in 2022
For the sixth year in a row, the Medicare Shared Savings Program created overall savings, CMS announced. When compared to clinician groups of a similar size not participating in the program, participating ACOs performed better on quality measures, including measures for diabetes, breast cancer and colorectal cancer screenings, tobacco screenings and depression screenings.
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Humana Taps Interwell Health for Kidney Care
In a new agreement, Interwell Health will provide care to Humana Medicare Advantage HMO and PPO members with chronic kidney disease in 13 states. It will also serve patients with end-stage kidney disease across the country.
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Floridians Sue Florida Over Medicaid Redeterminations Process
Two Florida families allege that tens of thousands of Floridians are being terminated from Medicaid coverage without sufficient information as to why. This comes as the U.S. continues the unwinding of the Medicaid continuous enrollment requirement, which stopped states from disenrolling Medicaid enrollees during the Covid-19 public health emergency.
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Payer’s Place: Carrie Kincaid, Priority Health
Carrie Kincaid, Senior Vice President, Market Development at Priority Health discusses how Priority Health is addressing the gaps in rural healthcare.
