HealthPayerIntelligence News

Hospital Outpatient Department Costs Consistently Outpace Offices, ASCs

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Given the significant difference between cost of care in hospital outpatient department settings compared to other settings for the same services, site-neutral payments could reduce healthcare...

Blue Shield of CA Technology Partnership Improves Care Management

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Blue Shield of California has partnered with a software company to improve care management services for members and streamline enrollment for employers. Through its collaboration with Salesforce, the...

Price May Drive Affordable Care Act Marketplace Plan Selection

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The Affordable Care Act (ACA) marketplace was designed to incentivize enrollees to choose specific plans based on price and it seems to be fulfilling that goal, an analysis from the Urban Institute...

Beneficiaries with Cancer Spend Less Out-of-Pocket in Medicare Advantage

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Medicare Advantage beneficiaries with cancer experienced lower out-of-pocket costs and had access to more benefits than those in Medicare fee-for-service (FFS), research conducted by ATI Advisory and...

How Do Rebates Impact Part D Spending for Plans, Beneficiaries?

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While rebates may lower Medicare Part D spending for plan sponsors, they do not reduce drug costs for Medicare beneficiaries, a study conducted by the US Government Accountability Office (GAO)...

Medicare Part D Patients with HIV May See Lower Drug Costs Under IRA

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The Inflation Reduction Act’s Medicare Part D redesign may improve affordability for beneficiaries with HIV, but stakeholders will need to take steps to ensure beneficiaries get the most out of...

High Switching Rates from FFS to Medicare Advantage Drove MA Enrollment

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Increased rates of switching from Medicare fee-for-service (FFS) to Medicare Advantage in recent years have contributed to Medicare Advantage enrollment growth, a study published in Health Affairs...

How Quality Measures, Star Ratings Impact Healthcare Payers

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Quality performance metrics such as HEDIS, Medicare Advantage Star Ratings, and standardized core quality measures can give consumers an indication of healthcare payer quality. Standardized quality...

Half of Medicare Advantage Beneficiaries Left Plan After 5 Years

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Around half of Medicare Advantage beneficiaries disenrolled from their health plan after five years, a study published in JAMA Health Forum found. Capitated payments to Medicare Advantage plans aim to...

CMS: Ex Parte Systems May Disenroll Eligible Medicaid, CHIP Enrollees

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CMS has identified system errors that may unnecessarily disenroll eligible Medicaid and Children’s Health Insurance Program (CHIP) enrollees during the redetermination process and is calling on...

OIG Strengthens Oversight Strategy for Managed Care Organizations

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Managed care organizations (MCOs) require the same kind of oversight that fee-for-service programs receive from the Office of Inspector General (OIG), so OIG released a four-phase life cycle to align...

HHS Releases First 10 Drugs Eligible for Medicare Price Negotiation

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Updated 10/3/2023: This article has been updated to include the drug companies' decisions to participate in the negotiation process. HHS has announced the first ten drugs that will be available...

Cigna Removes Prior Authorization for 25% of Medical Services

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Cigna Healthcare is removing prior authorization requirements for nearly 25 percent of medical services, facilitating access to care for members. The Cigna Group’s health benefits provider...

Top 5 Largest Health Insurance Payers in the United States

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The Affordable Care Act (ACA) and Medicare Advantage plans continue to bolster enrollment for major payers. Enhanced premium subsidies on the ACA market along with greater federal investments in...

74% of Terminated Medicaid Enrollees Were Cut for Procedural Reasons

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Millions of Medicaid enrollees have been disenrolled from Medicaid during the redetermination process, largely for procedural reasons, a KFF tracker noted. As of August 23, 2023, over 5.36 million...

Beneficiaries Are Satisfied With Medicare Advantage Plans, Coverage

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Medicare Advantage plans received generally positive satisfaction scores, with beneficiaries giving high ratings on trust, ease of doing business, and meeting product and coverage needs, according to a...

CMS Announces Monthly Payment Option for Out-of-Pocket Part D Costs

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CMS has released draft guidance detailing a new program allowing Medicare beneficiaries to pay out-of-pocket Part D costs in monthly installments. The Medicare Prescription Payment Plan is required...

Trends in Price Ratios Between Commercial, Medicare Advantage Plans

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Insurers often negotiate hospital prices for their commercial health plans that are up to five times the Medicare Advantage price, a study published in Health Affairs found. It was already a...

How Does Medicaid Cover Obesity Treatments for Children?

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As obesity treatments become more popular, Medicaid plays a key role in facilitating access to and coverage of these services for children, according to a KFF issue brief. Obesity can increase the...