Payers Archives - MedCity News https://medcitynews.com/category/channel/payers/ Healthcare technology news, life science current events Tue, 26 Sep 2023 22:24:00 +0000 en-US hourly 1 https://wordpress.org/?v=6.3.1 https://medcitynews.com/uploads/2021/03/cropped-mblue-32x32.png Payers Archives - MedCity News https://medcitynews.com/category/channel/payers/ 32 32 40682243 CMS: MA Premiums To Remain the Same for Most Beneficiaries in 2024 https://medcitynews.com/2023/09/cms-medicare-advantage-premiums-open-enrollment/ https://medcitynews.com/2023/09/cms-medicare-advantage-premiums-open-enrollment/#respond Tue, 26 Sep 2023 22:24:00 +0000 https://medcitynews.com/?p=649959

The average monthly plan premium for Medicare Advantage is expected to increase only slightly in 2024 from 2023, CMS said. About 73% of beneficiaries will see no increase at all.

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Study: MA Beneficiaries Have Lower Utilization Than Traditional Medicare https://medcitynews.com/2023/09/study-ma-beneficiaries-have-lower-utilization-than-traditional-medicare/ https://medcitynews.com/2023/09/study-ma-beneficiaries-have-lower-utilization-than-traditional-medicare/#respond Mon, 25 Sep 2023 22:55:33 +0000 https://medcitynews.com/?p=649806

A new study found that MA beneficiaries have more than 50% fewer inpatient stays and 22% fewer emergency department visits than traditional Medicare enrollees.

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How MIPS Value Pathways will Prove the Value of Rehab Therapy https://medcitynews.com/2023/09/how-mips-value-pathways-will-prove-the-value-of-rehab-therapy/ https://medcitynews.com/2023/09/how-mips-value-pathways-will-prove-the-value-of-rehab-therapy/#respond Mon, 25 Sep 2023 05:29:10 +0000 https://medcitynews.com/?p=645648

As value-based care models take hold, the time is ripe for rehab therapists to position themselves as primary players in the movement toward delivering optimal quality and value in the broader healthcare ecosystem.

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Report: 7 Ways Medicare Advantage Is Being Marketed on TV https://medcitynews.com/2023/09/medicare-advantage-advertisements-tv/ https://medcitynews.com/2023/09/medicare-advantage-advertisements-tv/#respond Sun, 24 Sep 2023 13:18:22 +0000 https://medcitynews.com/?p=649593

There are concerns that Medicare Advantage TV ads are misleading patients. A new KFF analysis of Medicare Advantage TV ads found that the ads often rely on celebrity endorsements and suggest that seniors are missing out on benefits that they’re entitled to.

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Is the ‘Age Wave’ An Opportunity or a Challenge? https://medcitynews.com/2023/09/age-wave-medicare-seniors-healthcare/ https://medcitynews.com/2023/09/age-wave-medicare-seniors-healthcare/#respond Thu, 21 Sep 2023 20:29:29 +0000 https://medcitynews.com/?p=649458 aging, senior, old

Americans are getting older, and some healthcare leaders expect this to be a challenge for the healthcare industry. Others, however, think this is an opportunity for the industry to make improvements, such as engaging adults in their care before they turn 65.

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HealthPartners Exec: The 5 Rules To Scale Value-Based Care in the Commercial Market https://medcitynews.com/2023/09/value-based-care-commercial-market/ https://medcitynews.com/2023/09/value-based-care-commercial-market/#respond Wed, 20 Sep 2023 21:02:10 +0000 https://medcitynews.com/?p=649362 consumerism

The commercial market has struggled to adopt value-based care, but HealthPartners has had some success, according to Mark Hansberry, senior vice president and chief marketing officer of the company. During a conference, he shared five rules for scaling value-based care, including creating trust and providing real-time data.

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Breaking Through Gridlock in the Mental Health Care System https://medcitynews.com/2023/09/breaking-through-gridlock-in-the-mental-health-care-system/ https://medcitynews.com/2023/09/breaking-through-gridlock-in-the-mental-health-care-system/#respond Tue, 19 Sep 2023 21:06:31 +0000 https://medcitynews.com/?p=645210

For the gridlock in mental healthcare to be resolved, 100% of mental healthcare providers must practice measurement-based care, utilizing validated rating scales to monitor and measure longitudinal outcomes for every patient. And payers then must offer reimbursement that appropriately rewards providers for delivering high-quality, effective care, and incentivize proactive mental health management.

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Payer’s Place: Dr. Anil Singh, Highmark Health https://medcitynews.com/2023/09/payers-place-dr-anil-singh-highmark-health/ https://medcitynews.com/2023/09/payers-place-dr-anil-singh-highmark-health/#respond Tue, 19 Sep 2023 11:45:34 +0000 https://medcitynews.com/?p=648570

Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.

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Is Medicaid Expansion Still a Political Wedge Issue? https://medcitynews.com/2023/09/medicaid-expansion-political-democrats-republicans/ https://medcitynews.com/2023/09/medicaid-expansion-political-democrats-republicans/#respond Thu, 14 Sep 2023 21:27:47 +0000 https://medcitynews.com/?p=648453 Medicaid, coverage,

When Medicaid expansion was first enacted, it was a hot topic debate between Democrats and Republicans. But more and more states are starting to expand Medicaid, including several conservative states.

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What CVS Stands to Gain by Setting Up Biosimilar Subsidiary Cordavis https://medcitynews.com/2023/09/what-cvs-stands-to-gain-by-setting-up-biosimilar-subsidiary-cordavis/ https://medcitynews.com/2023/09/what-cvs-stands-to-gain-by-setting-up-biosimilar-subsidiary-cordavis/#respond Thu, 14 Sep 2023 01:11:52 +0000 https://medcitynews.com/?p=648555

Pharmaceutical industry observers say CVS Health’s creation of Cordavis, a new biosimilar drugs company, is part of a strategy to make its move into this market as profitable as possible.

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Solera Health Launches Weight Management Solution for Payers and Employers https://medcitynews.com/2023/09/solera-health-launches-weight-management-solution-for-payers-and-employers/ https://medcitynews.com/2023/09/solera-health-launches-weight-management-solution-for-payers-and-employers/#respond Wed, 13 Sep 2023 22:55:44 +0000 https://medcitynews.com/?p=648546

Solera Health recently launched a program that aims to help patients who are interested in GLP-1s gain access to lifestyle change support. It also provides educational materials on GLP-1s.

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Report: MA Enrollment Has Quadrupled in Rural Communities Since 2010 https://medcitynews.com/2023/09/medicare-advantage-rural-enrollment-metropolitan-micropolitan/ https://medcitynews.com/2023/09/medicare-advantage-rural-enrollment-metropolitan-micropolitan/#respond Sun, 10 Sep 2023 13:58:18 +0000 https://medcitynews.com/?p=648087

In rural areas, the share of eligible beneficiaries enrolled in MA plans nearly quadrupled from 11% in 2010 to 40% in 2023, according to new research from KFF. This represents 400,000 rural MA beneficiaries in 2010 and 1.8 million in 2023.

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Alignment Health: What Are Seniors’ Top Barriers to Care? https://medcitynews.com/2023/09/seniors-barriers-healthcare-social-determinants/ https://medcitynews.com/2023/09/seniors-barriers-healthcare-social-determinants/#respond Thu, 07 Sep 2023 23:00:08 +0000 https://medcitynews.com/?p=647991

A new survey from Alignment Health found that economic instability, food insecurity, lack of support and transportation access are the biggest social barriers for seniors.

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MA Beneficiaries With Cancer Spend Less on Healthcare Than Traditional Medicare Beneficiaries https://medcitynews.com/2023/09/medicare-advantage-cancer-spending/ https://medcitynews.com/2023/09/medicare-advantage-cancer-spending/#respond Thu, 07 Sep 2023 20:17:13 +0000 https://medcitynews.com/?p=647913

Medicare Advantage beneficiaries with a cancer diagnosis spend $3,996 on out-of-pocket costs and premiums annually, versus $6,091 for traditional Medicare beneficiaries with cancer, a new report found.

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Payer’s Place: Don Antonucci, Providence Health Plan https://medcitynews.com/2023/09/payers-place-don-antonucci-providence-health-plan/ https://medcitynews.com/2023/09/payers-place-don-antonucci-providence-health-plan/#respond Thu, 07 Sep 2023 11:50:10 +0000 https://medcitynews.com/?p=647322

The CEO of Providence Health Plan visits the Payer’s Place and addresses the future of payment models.

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Two Value-Based Care Initiatives That Could Shift the Alternative Payment Model Landscape [Sponsored] https://medcitynews.com/2023/09/two-value-based-care-initiatives-that-could-shift-the-alternative-payment-model-landscape/ https://medcitynews.com/2023/09/two-value-based-care-initiatives-that-could-shift-the-alternative-payment-model-landscape/#respond Wed, 06 Sep 2023 11:30:43 +0000 https://medcitynews.com/?p=646152 Dementia or brain damage and injury as a mental health and neurology medical symbol with a thinking human organ made of crumpled paper torn in pieces as a creative concept for alzheimer disease.

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 https://medcitynews.com/2023/09/integrating-workers-comp-and-medical-benefits-makes-so-much-sense/ https://medcitynews.com/2023/09/integrating-workers-comp-and-medical-benefits-makes-so-much-sense/#respond Wed, 06 Sep 2023 00:53:05 +0000 https://medcitynews.com/?p=645009

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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Report: About Half of MA Beneficiaries Leave Their Plan After 5 Years https://medcitynews.com/2023/09/medicare-advantage-disenrollment-beneficiaries/ https://medcitynews.com/2023/09/medicare-advantage-disenrollment-beneficiaries/#respond Mon, 04 Sep 2023 13:48:47 +0000 https://medcitynews.com/?p=647427

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 https://medcitynews.com/2023/09/amgen-ftc-settlement-allows-28b-horizon-acquisition-to-move-forward/ https://medcitynews.com/2023/09/amgen-ftc-settlement-allows-28b-horizon-acquisition-to-move-forward/#respond Fri, 01 Sep 2023 18:22:26 +0000 https://medcitynews.com/?p=647403 Amgen

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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Streamlining Healthcare Insurers’ Processes: Unlocking Efficiency and Collaboration for Enhanced Outcomes https://medcitynews.com/2023/08/streamlining-healthcare-insurers-processes-unlocking-efficiency-and-collaboration-for-enhanced-outcomes/ https://medcitynews.com/2023/08/streamlining-healthcare-insurers-processes-unlocking-efficiency-and-collaboration-for-enhanced-outcomes/#respond Wed, 30 Aug 2023 22:19:09 +0000 https://medcitynews.com/?p=643167

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 https://medcitynews.com/2023/08/cms-medicaid-renewals-disenrolled-chip/ https://medcitynews.com/2023/08/cms-medicaid-renewals-disenrolled-chip/#respond Wed, 30 Aug 2023 22:00:02 +0000 https://medcitynews.com/?p=647160 Medicaid, coverage,

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 https://medcitynews.com/2023/08/bon-secours-mercy-health-sues-anthem-health-plans-of-virginia-for-unpaid-claims/ https://medcitynews.com/2023/08/bon-secours-mercy-health-sues-anthem-health-plans-of-virginia-for-unpaid-claims/#respond Mon, 28 Aug 2023 19:51:57 +0000 https://medcitynews.com/?p=646602

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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Navigating the Journey from CMO and Physician to Patient https://medcitynews.com/2023/08/navigating-the-journey-from-cmo-and-physician-to-patient/ https://medcitynews.com/2023/08/navigating-the-journey-from-cmo-and-physician-to-patient/#respond Mon, 28 Aug 2023 01:42:48 +0000 https://medcitynews.com/?p=642903

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 https://medcitynews.com/2023/08/report-ma-enrollees-use-postacute-services-less-than-traditional-medicare/ https://medcitynews.com/2023/08/report-ma-enrollees-use-postacute-services-less-than-traditional-medicare/#respond Sun, 27 Aug 2023 13:32:49 +0000 https://medcitynews.com/?p=646536 Medicare, Medicaid, CMS, coverage

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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The Importance of Continuous Iteration in Health Equity Plans for REACH ACOs https://medcitynews.com/2023/08/the-importance-of-continuous-iteration-in-health-equity-plans-for-reach-acos/ https://medcitynews.com/2023/08/the-importance-of-continuous-iteration-in-health-equity-plans-for-reach-acos/#respond Fri, 25 Aug 2023 18:07:51 +0000 https://medcitynews.com/?p=643215

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 https://medcitynews.com/2023/08/cigna-prior-authorization-requirements/ https://medcitynews.com/2023/08/cigna-prior-authorization-requirements/#respond Fri, 25 Aug 2023 17:47:30 +0000 https://medcitynews.com/?p=646482

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 https://medcitynews.com/2023/08/cms-medicare-shared-savings-program/ https://medcitynews.com/2023/08/cms-medicare-shared-savings-program/#respond Thu, 24 Aug 2023 21:20:34 +0000 https://medcitynews.com/?p=646386

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 https://medcitynews.com/2023/08/humana-chronic-kidney-disease/ https://medcitynews.com/2023/08/humana-chronic-kidney-disease/#respond Thu, 24 Aug 2023 19:51:41 +0000 https://medcitynews.com/?p=646350

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 https://medcitynews.com/2023/08/medicaid-redeterminations-lawsuit-florida/ https://medcitynews.com/2023/08/medicaid-redeterminations-lawsuit-florida/#respond Wed, 23 Aug 2023 21:04:48 +0000 https://medcitynews.com/?p=646236

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 https://medcitynews.com/2023/08/payers-place-carrie-kincaid-priority-health/ https://medcitynews.com/2023/08/payers-place-carrie-kincaid-priority-health/#respond Wed, 23 Aug 2023 11:30:56 +0000 https://medcitynews.com/?p=645897

Carrie Kincaid, Senior Vice President, Market Development at Priority Health discusses how Priority Health is addressing the gaps in rural healthcare.

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