HealthPayerIntelligence News

Medicare Pays Medicare Advantage Plans 6% More Than FFS Medicare

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Medicare Advantage enrollment as a share of overall Medicare enrollment continued to rise in 2022, but payment inequity calls for serious reforms, according to a presentation from MedPAC. The Medicare...

ACA Improved Access to Health Insurance for People with Schizophrenia

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The Patient Protection and Affordable Care Act (ACA) helped boost health insurance coverage for individuals with schizophrenia, according to data published in JAMA Psychiatry. Between 0.25 percent and...

Decreased Uninsurance Rate in 2021 Driven by Public Coverage Gains

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Around 8 million people gained health insurance coverage during the second year of the COVID-19 pandemic, primarily due to increased access to public coverage, a Health Affairs study found. Temporary...

Most Impactful USPSTF Preventive Care Final Recommendations of 2022

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The US Preventive Services Task Force (USPSTF) released a list of its top preventive care recommendations that were finalized in 2022. The list is not comprehensive. Rather, USPSTF named the...

Tufts Health Plan, Harvard Pilgrim Collab Boosts Access to LGBTQ+ Care

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Tufts Health Plan and Harvard Pilgrim Health Care have partnered with a connected healthcare delivery platform to improve access to LGBTQ+ care for commercial health plan members. The collaboration...

Private Payers Reimbursed Telehealth, In-Person Care Equally in 2020

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In 2020 when the coronavirus pandemic forced a major shift to telehealth and virtual care, private payers were reimbursed for telehealth and in-person care equally, research from Peterson-Kaiser Family...

Medicaid Expansion Helped Reduce Eviction Rates, Housing Insecurity

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Medicaid expansion was associated with reductions in county-level eviction judgments and eviction rates, but results varied across states, according to a study published in JAMA Network Open. In 2020,...

US Uninsurance Dropped to 10.5% in 2021, Greater Equity in Coverage Gains

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The US non-senior uninsurance rate declined from 11.1 percent in 2019 to 10.5 percent in 2021, with low-income and historically underserved demographics seeing the highest growth in health insurance...

BCBSRI Grants $740K to Improve Health Equity, Access to Stable Housing

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Blue Cross & Blue Shield of Rhode Island (BCBSRI) is awarding $740,000 to 11 community-based organizations that address health inequities by improving access to stable housing. The funding is part...

Medicaid HCBS Recipients Had High Excess Mortality Rates During Pandemic

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Medicaid beneficiaries receiving home- and community-based services (HCBS) during the COVID-19 pandemic had higher excess mortality rates than community-dwelling beneficiaries and the general...

How State Medicaid Programs Address the Behavioral Health Workforce Shortage

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State Medicaid programs have implemented or plan to implement strategies to address the behavioral health workforce shortage, including increasing reimbursement rates and reducing administrative...

HHS Posts Timeline for Medicare 2026 Drug Price Negotiations

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In accordance with the Inflation Reduction Act, the US Department of Health and Human Services (HHS) announced that Medicare will begin drug price negotiations for prices going into effect in 2026 and...

CMS: 15.9M Enrollees Have Selected ACA Marketplace Plans for 2023

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Nearly 16 million people have enrolled in Affordable Care Act (ACA) marketplace plans since the 2023 marketplace open enrollment period began, including 3.1 million new enrollees and 12.8 million...

Medicare Advantage Beneficiaries Have Better Diabetes Patient Outcomes

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Medicare Advantage plans have seen better patient outcomes in chronic disease management for diabetes than fee-for-service Medicare, according to a study by Avalere. “Medicare Advantage is...

HHS, CMS Guidance Boosts Access to Specialty Behavioral Healthcare

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The US Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), has expanded access to specialty behavioral healthcare for Medicaid and...

Deductibles, Copayments, OOP Max Trends Indicate Cost-Sharing Growth

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From 2013 to 2020, cost-sharing trends shifted: deductibles grew, copayments increased for certain services and depending on union employment, and out-of-pocket healthcare spending maximums rose,...

Provider Orgs Join Full-Risk Value-Based Care Contracts with BCBSM

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Blue Cross Blue Shield of Michigan (BCBSM) is helping advance the shift to value-based care by initiating full-risk reimbursement arrangements with six provider organizations. The agreements are for...

Tracking the Results of Medicare Advantage Marketing Policies Remains a Challenge

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Medicare Advantage marketing practices have drawn criticism from stakeholders and regulatory changes from policymakers, but tracking the results of these policies is difficult, researchers from the...

LA Care Health Plan Grants $2M to Address Provider Burnout, Shortages

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LA Care Health Plan aims to address provider burnout and workforce shortages by providing $2 million in loan repayment grants to physicians at safety-net organizations in Los Angeles County. The...

High Perceived Healthcare Costs Limit Coverage Access for Uninsured

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High perceived healthcare costs are the biggest barrier to health insurance for the uninsured population, according to a survey conducted on behalf of Florida Blue. The online survey polled uninsured...