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HealthPayerIntelligence News

About 90% of Large, Mid-Size Employers Offer Medical Benefits

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Close to 90 percent of employees in large and mid-size private businesses are offered medical benefits, according to data released by the Bureau of Labor Statistics. Larger businesses tend to see higher participation in employer-sponsored...

Using a Commercial Shared Savings Program to Reduce Care Costs

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A commercial shared savings program equipped with the right leadership, clinical insights, and comprehensive care strategies can help payers save significantly on healthcare costs and produce exceptional beneficiary outcomes. In order to...

Rhode Island Aims to Expand Value-Based Care in Medicaid Program

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Rhode Island officials have requested an extension of a 1115 demonstration from CMS to expand the use of value-based care within the state’s Medicaid program. State Medicaid administrators are looking to add new value-based care...

How Do Medicare Advantage, Medicare Supplemental Insurance Differ?

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Medicare Advantage (MA) and Medicare supplemental insurance, or Medigap, are both intended to enhance the value of traditional Medicare coverage for seniors and other eligible beneficiaries. Both offer payers a lucrative opportunity to...

Pros and Cons of Small Business Health Options Program Health Plans

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Health plans offered through the Small Business Health Options Program (SHOP) exchanges allow payers to provide the nation’s smallest businesses with affordable plan options that offer critical health benefits. SHOP health plans...

Emergency Physician Group Sues Anthem for ED Payment Policies

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The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) have filed a lawsuit against Anthem BCBS of Georgia contesting an emergency department payment policy that makes patients responsible for...

All-Payers Claims Databases May Increase Healthcare Price Transparency

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Leveraging the data of all-payers claims databases (APCDs) could improve healthcare price transparency for consumers, according to testimony presented at a House Energy and Commerce Committee hearing. Jamie S. King, a professor at the USC...

High Dollar Claims Rise by 87% in Employer-Sponsored Stop-Loss Insurance

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The number of employer-sponsored stop-loss insurance claims of $1 million or more grew by 87 percent from 2014 to 2017, according to a new analysis from Sun Life Financial. Over the four-year period, 634 employees with $1 million claims...

How Payers Can Succeed Under Updated 2019 HEDIS Measures

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The Healthcare Effectiveness Data and Information Set (HEDIS) provides 90 percent of America’s health plans with the ability to directly compare performance across the national stage.   Currently, the HEDIS set contains 92...

BCBSA Adds Opioid Abuse Accreditation to Treatment Facilities

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The BlueCross BlueShield Association has announced a new accreditation program for opioid abuse treatment centers as a larger part of the organization’s mission to combat the US opioid crisis. In 2013, only 22 percent of treatment...

CMS Proposes Drug Pricing, Price Transparency Changes for Medicare

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CMS has proposed a series of policy changes for Medicare that would promote prescription drug affordability within Medicare, and has also requested stakeholder comments about ways to improve price transparency for Medicare services. As...

Medicare Advantage Savings, Outcomes Exceed Fee-For-Service

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The Medicare Advantage (MA) program has surpassed Medicare fee-for-service (FFS) in developing positive member healthcare outcomes and reducing care costs, according to an analysis of both programs from Avalere Health. Medicare Advantage...

Health Plan Cost Sharing, Deductibles Outpace Members’ Wage Growth

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Health plan cost sharing and deductible spending have outpaced employee wage growth in the last ten years, according to data released by the Peterson-Kaiser Health System Tracker. Employees’ total financial responsibility increased...

CMS Cuts ACA Navigator Funding Grants by $26M for 2019

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CMS has announced a $26 million cut to funding grants for ACA navigators, from $36 million down to $10 million. CMS will provide a minimum of $100,000 in each of the states that operate a federally-facilitated exchange (FFE). The funding...

Medicare Advantage Star Ratings Tied to Member Socioeconomic Strata

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Medicare Advantage (MA) health plans with a greater proportion of socioeconomically challenged members are more likely to have lower star ratings, according to new research from Brown University. Insufficient risk adjustment criteria in...

CMS Proposed Rule Cuts State Authority to Divert Medicaid Payments

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CMS has proposed a new rule that would eliminate a state’s authority to divert Medicaid payments away from providers. The rule is intended to ensure beneficiaries have adequate access to healthcare services through direct...

Transitional Health Insurance Plays Key Role in Coverage

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Transitional health insurance, otherwise known as a short-term health plan, is a temporary insurance policy intended to provide stop-gap coverage when an individual is in between ACA compliant policies.  The National Association of...

CMS Suspends $10.4B in Risk Adjustment Payments to Payers

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CMS has temporarily withheld $10.4 billion in risk adjustment payments for 654 healthcare payers, citing a ruling in the US District Court of New Mexico that invalidated the agency’s risk adjustment methodology. The ruling, which...

Vermont Government Plans Regulations for Association Health Plans

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Vermont’s Department of Financial Regulation (DFR) is planning to implement emergency rules and regulations for association health plans (AHPs) following the Department of Labor’s final rule to allow AHP sales nationally. DFR...

NCQA Updates, Adds HEDIS Performance Measures for Plan Year 2019

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The National Committee for Quality Assurance (NCQA) has released updates to its HEDIS performance measures for plan year 2019. The refresh includes several new measures to guide population health management initiatives, as well....

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