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Org Offers 25-Point Plan for NJ Medicaid Program Improvement

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The New Jersey Health Care Quality Institute (NJHCQUI) recently partnered with the Nicholson Foundation to release a 25-point plan for modernizing and improving New Jersey’s Medicaid program. “The current program has too often failed...

AHA Questions CMS Medicare Advantage Risk Score Calculation

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The American Hospital Association (AHA) has voiced concerns about the methodology the Centers for Medicare & Medicaid Services (CMS) intends to use to calculate risk scores for health plans under the Medicare Advantage and Part D prescription...

Experts Lay Out Strategy for Achieving Universal Coverage

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Experts from the Harvard Business School, Duke University, and David Geffen School of Medicine at UCLA debate the viability of an individual mandate as a means of achieving universal coverage without a single payer. According to Regina Herzlinger,...

Bill Would Make Health Insurance Liable for Antitrust Laws

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Proposed legislation supported by the American Hospital Association passed the House Judiciary Committee earlier that if approved by Congress make health insurance companies liable for anti-competitive business practices. The Competitive Health...

Researchers Expect ACA Repeal Adverse Effects on Uninsured

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Authors of a recent viewpoint published in the Journal of the American Medical Association foresee health and financial risks the uninsured patient population following a partial or complete repeal of the Affordable Care Act (ACA). “The...

ACA Consumers Dissatisfied After Private Payer Exchange Exit

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Consumer satisfaction with the Affordable Care Act fell following the departure of three private payers from the health insurance exchange, according to recent findings from Black Book. The survey comprises feedback from 34,800 consumers continually...

CMS Seeking Feedback on Pediatric Alternative Payment Model

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The Centers for Medicare & Medicaid Services (CMS) recently issued a request for information seeking input on designing an alternative payment model focused on improving care quality and cost (APM) that specializes in pediatric care. The...

Impact of Wage Level Variation on Employer-Sponsored Plans

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Findings from a recent study of healthcare utilization and spending by four self-insured employers show a correlation between wage levels and the types of services received. Based on data on 42,936 employees at four self-insured employers that...

Social Determinant Data Key to Successful Risk-Based Contracts

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From bundled payment models to capitated healthcare payments, payers implement risk contracts to financially motivate providers to target high-cost and high-utilization patient populations to reduce overall healthcare costs. But increasing payer...

CMS Continues Extension of Transitional Coverage into 2018

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The Centers for Medicare & Medicaid Services (CMS) has again extended its policy enabling states to permit health plans additional time to bring coverage into compliance with the Affordable Care Act. Jeff Wu, Acting Director of the Center...

Market Monopoly Cause of Court Blocking Cigna-Anthem Merger

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The full opinion of United States District Court for the District of Columbia blocking Anthem’s acquisition of Cigna became publicly available earlier this week and provides details into the court’s decision. In the memorandum opinion,...

CMS Solicits Payer Participation to Next Phase of CPC+

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In support of second round of payer solicitation for Comprehensive Primary Care Plus (CPC+), The Centers for Medicare & Medicaid Services (CMS) has issued a list of frequently asked questions aimed at increasing payer support for the alternative...

Single-Payer Reform Purported to Save Estimated $504 Billion

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A possible repeal of the ACA threatens to eliminate the coverage of 26 million Americans, but the authors of a recent commentary in the Annals of Internal Medicine contend that reforming to a single-payer system would allow for a Medicare expansion...

GAO: Erroneous Medicaid Claims Data Pose Fraud Risk at CMS

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Millions of people rely on long-term personal care services under Medicaid coverage, but significant gaps and errors in two major CMS data systems are creating significant opportunities for fraud and abuse.   A new report from the Government...

GOP Leaders Unveil Proposed ACA Repeal, Replacement Plans

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GOP leaders have unveiled their latest proposal to repeal and replace the Affordable Care Act with new health insurance regulations. The outline includes cutting federal Medicaid expansion, moving more Medicaid control to the states, and restructuring...

After Terminated Merger, Cigna Demands $13B from Anthem

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UPDATE: Anthem has secured a restraining order against Cigna preventing the final dissolusion of the merger.  The temporary order will be reviewed during a Delaware Chancery Court hearing on April 10. After a court ruling ended the...

CMS Proposes New Rule to Stabilize Health Insurance Exchanges

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CMS recently announced a proposed rule designed to help stabilize health insurance exchanges by promoting more coverage options and improving the risk pool for insurers. The proposed rule comes just one day after Humana publicized its decision...

Humana to Leave ACA Health Insurance Exchanges by 2018

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Humana will halt sales of individual health insurance plans through the Affordable Care Act’s exchanges by 2018, which will leave more than 150,000 Humana customers without a carrier.   Amid ongoing political uncertainty, Humana said...

Does Tiered Cost-Sharing Promote Appropriate Medication Use?

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Health plans have traditionally used tiered formulary cost-sharing arrangements to reduce healthcare spending and incentivize appropriate medication use. But a recent Journal of Managed Care & Specialty Pharmacy study found that stakeholders...

Aetna, Humana Terminate Merger Deal After Court Defeat

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Aetna and Humana have scrapped their merger plans after the Department of Justice blocked the deal due to antitrust concerns.  Aetna will pay Humana a $1 billion termination fee, included as part of the original agreement. The DOJ lawsuit,...

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