HealthPayerIntelligence News

Do State Medicaid Programs Receive As Much As They Give to Feds?

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States with lower incomes per capita often receive funding from higher income states through Medicaid and CHIP federal funding. But some low-income states without Medicaid expansion end up contributing...

Louisiana’s Population of Uninsured Children Jumped 28.2% in 2019

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The number of uninsured children in Louisiana in 2019 was 28.2 percent higher than its low number of uninsured children in 2017, following a national trend in childhood uninsurance, the Louisiana...

How a Directory Can Streamline Interoperability Rule Compliance

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As payers and vendors scramble to comply with the interoperability rule, various nonprofits seek to streamline this interoperability process with innovative solutions, such as CAQH’s upcoming...

Health Literacy Improves Medicare Spending, Member Outcomes

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Health literacy is key to improving member health outcomes, particularly among Medicare beneficiaries, a UnitedHealth Group research report emphasized. “Health literacy represents the ability of...

Pros, Cons of Individual Coverage Health Reimbursement Arrangements

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Individual coverage health reimbursement arrangements (ICHRAs), which have been offered as the alternative to the Affordable Care Act, have negative impacts on low-income New Yorkers, according to a...

59% MA Plan Proxies Rate End-of-Life Care Quality “Not Excellent”

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Responses from families and friends of deceased Medicare Advantage members indicate that Medicare Advantage plans have room for improvement on end-of-life care, a study published in JAMA Network Open...

Cancer Patients Paid $5.6B Out-of-Pocket Cancer Costs in 2018

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Cancer patients are paying higher and higher out-of-pocket costs for treatment and, according to the American Cancer Society’s recent report, payer-related costs are the most common contributor...

Top 5 Social Determinants of Health Domains for Payers to Address

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There are five social determinants of health domains, according to the Office of Disease Prevention and Health Promotion (ODPHP) Healthy People 2030 website. While certain domains will at times require...

CommonWell Mobilizes to Support Payer Interoperability Compliance

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CommonWell Health Alliance announced that it is expanding its interoperability services, a move which could support payers struggling with interoperability compliance related to the new CMS...

Navigating Generational Differences in Member Engagement

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Around a third of Millennials have a behavioral health condition, emphasizing a greater need for behavioral healthcare options and coverage as well as a new approach to millennial member engagement,...

34% Medicare Advantage Plans Will Offer COVID-19 Benefits in 2021

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Not only have Medicare Advantage plans continued to increase their health-related supplemental benefits for 2021 open enrollment, but this year one in three plans will also offer supplemental benefits...

How Do Medicaid Programs Cover Pediatric Curative, Hospice Care?

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States use Affordable Care Act flexibilities in innovative ways to set definitions for curative care, implement reimbursement models, and care coordination in Medicaid pediatric care for children with...

Average ACA Exchange Premiums Drop for Third Year Running

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The downward trend in ACA exchange premiums continued this year with the average premium for the benchmark plan dropping two percent for 2021 coverage year, although some premiums remain up to 36...

Employer Sponsored 2020 Out-of-Pocket Costs Were Stable Pre-COVID

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Employer-sponsored health plans grew more expensive for individuals and families in 2020, the Employer Health Benefits annual Kaiser Family Foundation (KFF) survey found. “Conducted partly...

GA Individual Market Reform Approved Over Industry Objections

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CMS has approved a Section 1332 demonstration for Georgia which, in part, moves the individual market to a private sector platform. “I’m thrilled to support this comprehensive state-led...

Surveys, Advanced Analytics Key for Member Experience, Star Ratings

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As health plans consider how to meet the new Medicare Advantage Star Ratings programs, they will need to design surveys and advanced analytics tools to support their member experience improvement...

Medicare Advantage Gross Margins Rise 41% Over 2019 Margins

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Compared to 2019, the fully-insured group health insurance markets and Medicare Advantage markets have seen their margins increase and loss ratios decrease in the first half of 2020, with Medicare...

AMA: 56% Increase in Payer Market Consolidation In Past 5 Years

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Payer market consolidation has been increasing over the past five years and this consolidation is having negative effects on consumers, the American Medical Association (AMA) asserted in its latest...

Payer Premiums, Out-of-Pocket Costs Burden Medicare Beneficiaries

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Medicare beneficiaries are concerned about their future healthcare costs, particularly related to their health insurance, a MedicareGuide.com survey revealed. The results represent the online...