HealthPayerIntelligence News

21 Part D Plans Rank Tops in 2021 Medicare Advantage Star Ratings

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CMS has released Medicare Advantage Star Ratings for 2021 and the results demonstrate a continuation of last year’s positive trends. Medicare Advantage health plan quality steadily continued its...

Top Strategies For Driving Down Prescription Drug Spending

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High prescription drug spending has racked the American healthcare system’s cost trends for decades. Prescription drug spending will be one of the major factors influencing the 2020 medical...

5 Challenges, 5 Policy Solutions for the Medicare Enrollment Process

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Beneficiaries suffer from chronic confusion over Medicare enrollment but policymakers can take action to streamline the process and improve beneficiary experience, Better Medicare Alliance asserted in...

COVID-19 Medicaid Enrollment Is Not Tied to Unemployment Rates

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The link between Medicaid enrollment and unemployment has not been substantiated so far during the pandemic but, rather, varied largely based on state policies, a report published in Health Affairs...

Open Enrollment 2020 Marks Shift Toward Virtual Member Engagement

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The unpredictable impacts of the coronavirus pandemic on Medicare open enrollment will require both broker and member engagement to be technology-enabled, transparent, and streamlined. Britta Orr,...

Humana’s Value-Based Care MA Model Cuts ED Admissions, Costs

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Humana’s value-based care models in Medicare Advantage helped lower emergency room admissions and, in turn, boosted savings for Medicare Advantage members, according to the payer’s recent...

How to Improve Children’s Health Insurance Coverage Nationally

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Children’s health insurance coverage is not stable even under the Children’s Health Insurance Program (CHIP), a recent study published in Health Affairs discovered. “The current...

Payer-Provider Partners Tap Telehealth for Behavioral Health Access

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The coronavirus pandemic saw a huge rise in the need for behavioral health services. In June alone, 40 percent of adults in the United States reported struggling with mental health or substance abuse,...

Benefits of Digital Quality Measures for Payer Quality Reporting

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When a major crisis hits, gathering quality measures data can be challenging or nearly impossible with the current strategies. In order for a health plan to be accredited by the National Committee for...

Medicaid Expansion Produces Mixed Results on Health Disparities

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Medicaid expansion has had mixed results in reducing health disparities and advancing coverage, utilization, and quality of care equity, an issue brief from Kaiser Family Foundation revealed. The...

3 Common Telehealth Technologies that Payers Cover, Leverage

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Phone calls, secure direct messaging, and remote patient monitoring are the three leading modalities that form the backbone of payer telehealth technologies. According to the Centers for Disease...

MA Payers Focus on Cutting Out-of-Pocket Costs, Home Health in 2021

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As Medicare open enrollment approaches,  benefits from major payers emphasize lowering out-of-pocket costs and home healthcare benefits. UnitedHealthcare, Humana, and Cigna are significant...

Medicaid Expansion Could Mean $5.4B in Federal Funds for TX

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Under Medicaid expansion, Texas could receive around $5.4 billion from the federal government to cover Medicaid costs. The state could also cover a larger portion of its significant uninsured...

Surprise Billing Policies May Decrease Commercial Payer Premiums

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For three major payers, surprise billing policies had an impact on premiums, a study published in the American Journal of Managed Care found. The researchers used data from the Health Care Cost...

Cost, Health Literacy Cause for Concern Ahead of Open Enrollment

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Entering into Medicare open enrollment 2021, Medicare enrollees and nearly-eligible enrollees continue to struggle with health literacy and healthcare costs, a survey commissioned by GoHealth...

Big Premium Drop, More Medicare Advantage Benefits Slated for 2021

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As Medicare Advantage plans prepare to expand their benefits in 2021, CMS expects premiums to drop 34.2 percent from 2017 levels in the new year. “The Medicare Advantage average monthly premium...

How an Overturned Affordable Care Act Would Impact Payer Industry

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Since the passing of late Supreme Court Justice Ruth Bader Ginsburg, many have questioned whether the Affordable Care Act is at risk of being overturned, a potentiality that would be extremely...

Overview of Federal Policy Around Pre-Existing Conditions Coverage

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Update 11/5/2020: This article has been corrected to state that the Supreme Court will hear the oral arguments regarding the Affordable Care Act’s constitutionality on November 10, 2020. A...

Value-Based Care Stunted by Misaligned Payer-Provider Relationship

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A misalignment between payers and providers on their definitions of value, frequency of communication, and trust in their partnership is impeding value-based care efforts, according to research from...

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