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HealthPayerIntelligence News

Medicare Fraud Schemes Bring Jail Time, Admissions, Repayments

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Medicare fraud is always a risk for such a large program, but federal crackdowns on waste, abuse, and improper payments are serving as a stern warning to providers who may be considering taking advantage of the system.   The Office of the...

Senate to Vote on Funding CHIP for Five Additional Years

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A bipartisan bill to continue CHIP funding for five more years and transition to a state-federal partnership will move to a Senate vote after being approved by the Senate Finance Committee.   The “Keep Kids’ Insurance Dependable...

80% of Payers Investing in Member Engagement, Satisfaction

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Eighty percent of health plans are focusing on improving member engagement and consumer satisfaction, according to a survey by Change Healthcare.   Member engagement is a growing opportunity for payers because of the potential improvements...

HHS Nixes Proposed Rule for Health Plan Compliance Documents

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HHS has withdrawn a proposal for a rule that would have required controlling health plans (CHPs) to submit additional information and documentation demonstrating compliance with HHS operating rules, the agency posted in the Federal Register....

Medicaid Drug Pricing Rule May Inhibit Value-Based Contracts

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A Medicaid drug pricing rule which safeguards deep discounts for the public program can potentially inhibit value-based contracts agreements between payers and pharmaceutical companies, according to research from the Journal of Health Politics,...

Blue Shield of CA to Offer Statewide Healthcare Provider Directory

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Blue Shield of California plans to develop a statewide healthcare provider directory, with the help of Integrated Healthcare Association (IHA), that gives members access to current information on providers, the payer announced in a press release....

Medical Device Data, UDIs on Claims Impact Costs, Patient Safety

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Adding medical device data and unique device identifiers (UDIs) to insurance claims could have a significant positive impact on healthcare spending and patient safety, according to reports from Pew Charitable Trusts, Brigham and Women’s...

Beneficiary Segmentation, Spending by Healthcare Payer Type

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Healthcare spending in the US continues to grow steadily across all beneficiary segments and healthcare payers. 2015 data from CMS, the CDC, and the Kaiser Family Foundation (KFF) indicates that payers and individuals sponsoring their own healthcare...

Claims Analytics Help Medicare Identify, Prevent Provider Fraud

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Close to a quarter of new Medicare fraud investigations started with the use of a claims analytics platform that has helped to save approximately $6.7 million in incorrect billings, a new GAO report found.   After reviewing fraud prevention...

Pediatric Data Reveals Private Payer, Medicaid Spending Gaps

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Private payers spend close to twice as much on pediatric services as Medicaid, according to a statistical brief from AHRQ, highlighting significant disparities in cost related to visit type and geographical region. Data from the 2015 Household...

Payer Pricing, Partnership Strategies for Population Health

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Effective population health management and comprehensive preventive care open the door to new opportunities that maximize payer spending, raise care quality, and slow the progression of costly chronic conditions such as diabetes and cardiovascular...

90% Medicare Supplemental Plan Members Report Satisfaction

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Over 90 percent of Medicare supplemental plan beneficiaries cited satisfaction with their healthcare coverage, according to a recent AHIP study. Findings point out ways for payers to provide consumer-friendly health plans to a growing senior...

NB and IA Offer New Individual Market Plan For Open Enrollment

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An new individual market plan created out of Medica and CHI Health will be available to consumers during the open enrollment period in Nebraska and Iowa, the health networks announced in a press release. The Medica with CHI Health plan offers...

Payers Driving Value by Promoting Connected Care Models

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As payers vie to remain competitive in commercial insurance markets, they must be able to effectively manage consumer costs while providing beneficiaries the best possible healthcare experience now and in the future. Rising healthcare costs are...

Nevada Blue to Offer Supplemental Medicare Coverage to Members

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On October 1, Blue Cross Blue Shield (BCBS) of Nevada members can enroll in Medicare Supplemental Innovation Plans F, G, or N that provide preventative care services and extended benefits, the payer announced earlier this week. The plans will...

Large Variations Seen in Consumer Healthcare Spending

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As healthcare costs rise, beneficiaries will be more responsible for out-of-pocket healthcare expenses not covered by their health plans. But those costs drastically vary by state, family size and income, and other variables, according to a report...

6 Ways VA Can Improve Administrative Management of Care Delivery

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Even though VA has taken steps to improve administration and management of its healthcare delivery systems, the Government Accountability Office (GAO) found six action items that allows the VA to adjust policies that improve data sharing and...

Medicaid Directors Voice Concerns for Graham-Cassidy Bill

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The National Association of Medicaid Directors (NAMD) argues that a hasty passage of the Medicaid reforms presented in the Graham-Cassidy bill will have significant consequences for public payer programs and the health outcomes of their beneficiaries....

Planning for Individual Insurance Exchange Stabilization in WA

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State health insurance markets and their individual insurance exchanges have faced regular instability in the form of payer exits, imbalanced risk pools, and rising premiums that push out new and returning insurance consumers. As premiums go...

AHIP: Graham-Cassidy Bill a Poor Choice for Payers, Patients

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AHIP believes that passage of the Graham-Cassidy Bill making the rounds in the Senate would adversely affect payer market through policies that destabilize the health insurance markets, reduce patient access to healthcare, and fail to meet the...

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