HealthPayerIntelligence News

How to Increase Access to Prenatal Vaccines for Medicaid Beneficiaries

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Solidifying access to prenatal vaccines can help minimize maternal health disparities for pregnant people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). A white paper...

Healthcare Organizations Oppose UHC’s GI Prior Authorization Program

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More than 170 healthcare organizations have urged UnitedHealthcare not to implement its gastrointestinal (GI) endoscopy prior authorization program, stating that it will hurt patients and limit access...

Partnership to Improve Care Access for Florida Medicaid Beneficiaries

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A value-based agreement between Sunshine Health and Johns Hopkins All Children’s Hospital aims to provide Florida Medicaid beneficiaries with improved access to primary care and incentivize...

CMS Proposed Rule Addresses Drug Cost Transparency in Medicaid

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The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that aims to increase the transparency of prescription drug costs in Medicaid. “This proposed rule prioritizes...

Medicare Coverage of Weight Loss Drugs May Reduce Access Disparities

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Given the substantial costs, Medicare coverage of weight loss drugs could lead to higher Medicare spending but may help reduce access disparities, according to a KFF policy watch. GLP-1 (glucagon-like...

Aetna Injects $7.3M into Virginia FQHCs for Improved Cancer Outcomes

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In partnership with the Virginia Community Healthcare Association (VCHA), Aetna Better Health of Virginia has allocated over $7 million in value-based care incentives to Virginia's federally...

Biden Admin Increases Access to School-Based Mental Health Services

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The Biden-Harris Administration has announced three initiatives to increase access to school-based mental health services for children with Medicaid. “We are taking bold actions to strengthen...

KFF: Payers Will Issue $1.1B in Medical Loss Ratio Rebates in 2023

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Payers will issue around $1.1 billion in medical loss ratio (MLR) rebates across commercial markets in 2023, KFF projected. In the individual and small group markets, payers must spend at least...

4 Categories of Preventive Care Services Covered Under the ACA

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There are four types of services that private payers and employers are required to cover under the Affordable Care Act (ACA) preventive care services provision, which include screenings and...

6 Ways That Health Plans Can Influence A State’s Health Equity

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With ample fiscal resources and a wide scope of influence, payers can leverage investments, purchasing decisions, network priorities, and other strategies to contribute to health equity, a report from...

Court Upholds ACA Preventive Care Compliance Amid Legal Proceedings

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The US Court of Appeals for the Fifth Circuit determined that employers and health insurers must maintain compliance with Affordable Care Act (ACA) preventive care services provision while the law...

Blue Cross MA Expands Primary Care Network Amid Provider Shortages

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Blue Cross Blue Shield of Massachusetts (Blue Cross) has added three physician groups to its primary care network to increase member access to care amid provider shortages. Most Blue Cross members...

Medicare, Medicaid Spending Similar Among Dual Eligible Beneficiaries

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Need-based subgroups of dual eligible beneficiaries utilized both Medicare- and Medicaid-funded services, identifying the need for an integration program that includes benefits from both payers, a...

CareSource Enters Value-Based Agreement to Improve Pediatric Health Outcomes

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CareSource has entered into a value-based agreement with a clinically integrated network to improve pediatric health outcomes for Georgians. The partnership between the health plan and The...

Humana Collabs with DME Companies to Advance Value-Based Home Healthcare

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Humana has entered value-based agreements with two durable medical equipment organizations to improve home healthcare services for Medicare Advantage members. The organizations, AdaptHealth Corp. and...

Medicaid Coverage Losses Less Likely During First Year of Pandemic

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Adults were less likely to lose Medicaid coverage during the first year of the COVID-19 pandemic compared to the year before in 2019, a study published in Health Affairs found. Between February and...

Anthem Blue Cross Grants $400K to Boost Maternal Health Outcomes

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The Anthem Blue Cross Foundation has granted $400,000 to a nonprofit organization in Fresno County, California, to help improve maternal health outcomes and reduce pre-term births among women who have...

Payer Invests in Helping Young Adults Find Work After Foster Care

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Blue Cross of North Carolina (Blue Cross NC) announced a program that focuses on supporting children who are aging out of foster care through employment. “Our Apprenticeship Program provides...

1.7M Beneficiaries May Lose Coverage Under Medicaid Work Requirements

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Around 1.7 million Medicaid beneficiaries could potentially lose coverage and $10.3 billion in spending would shift from federal to state governments if Medicaid work requirements were implemented, an...