HealthPayerIntelligence News

Humana Foundation Grants $1M to Address Food Insecurity, Mental Health

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Humana’s philanthropic arm, the Humana Foundation, has awarded research grants totaling $1 million to three universities that will go toward improving food security and mental health in their...

How Employers Can Promote Cardiovascular Care, Women’s Health

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Cardiovascular, diabetes, and obesity treatments are a critical part of women’s health, and employers can take steps to ensure that women have access to information and care related to their...

Payers Embrace Healthcare IT for Cost Optimization, Member Engagement

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Payers are investing in healthcare IT resources to support cost optimization and improve member experience, according to a study from EY-Parthenon and KLAS Research. As payers face operational and...

Medicare Hospice Model Improved Quality of Life, Reduced Medicare Spending

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The Medicare Care Choices Model (MCCM) improved end-of-life care, increased hospice use, and reduced inpatient admissions for Medicare beneficiaries while simultaneously lowering Medicare spending, a...

Blue Cross Blue Shield of MA Eliminates More Prior Authorizations

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Blue Cross Blue Shield of Massachusetts (“Blue Cross”) joined other payers in eradicating prior authorizations for certain services as part of an effort to accelerate members’ access...

Medicare ACO Enrollment Did Not Improve Mental Healthcare Outcomes

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Medicare beneficiaries newly enrolled in accountable care organizations (ACOs) did not see any improvements in their depression and anxiety symptoms, suggesting Medicare ACOs may need better incentives...

Preventive Care Visits Among Medicare Beneficiaries Grew, Study Finds

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The share of primary care visits focused on preventive care nearly doubled between 2001 and 2019, with the steepest growth among Medicare beneficiaries, a Health Affairs study found. Periodic...

Quality Outcomes Are Better When Medicaid MCOs Administer Pharmacy Benefits

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Pharmacy-related quality outcomes were better in states where Medicaid managed care organizations administered health plans’ pharmacy benefits, according to a report from Elevance Health. The...

Humana’s Value-Based Care Plans Improved Health Outcomes for MA Members

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Humana Medicare Advantage beneficiaries receiving care under value-based arrangements had better health outcomes, including fewer inpatient admissions and emergency room visits, a report from the payer...

Cardiovascular Disease Utilization Grew After Medicaid Expansion

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Adults with cardiovascular disease are more likely to utilize outpatient cardiovascular services in Medicaid expansion states than in nonexpansion states, a study published in Health Affairs...

How Much Members Spend on Diabetes Chronic Disease Management

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Members with diabetes spend between $3,300 and $4,600 per year in out-of-pocket costs for chronic disease management, including lost wages, according to a new report from GoodRx Health. These...

Avoidable Hospitalizations Less Common in Medicare Advantage, Study Finds

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Medicare Advantage beneficiaries were less likely to have avoidable hospitalizations than those in traditional Medicare, suggesting that the use of provider networks in Medicare Advantage may reduce...

KLAS: Epic’s Payer Platform Generates High User Satisfaction

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Healthcare organizations using Epic’s payer platform are satisfied with the product’s performance, including its ability to deliver meaningful information without disrupting workflows,...

What Non-Medical Supplemental Benefits Will MA Plans Offer in 2024?

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Food and produce services are the most common non-medical supplemental benefit in Medicare Advantage for 2024, offered by 1,475 plans, a report from ATI Advisory found. In addition to offering typical...

An Overview of 2024 Coverage for Veterans Beyond Veterans Affairs

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Although US veterans have many coverage options, including Veterans Affairs (VA), Medicaid, and the Affordable Care Act (ACA) marketplace, many are projected to remain uninsured in 2024, according to a...

CMS Proposals Address Anti-Competitive Practices in Medicare Advantage

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CMS has proposed provisions to improve protections for Medicare Advantage beneficiaries, prevent anti-competitive practices, and strengthen access to behavioral healthcare services. The Contract Year...

Care Quality, Health Outcomes Better in Medicare Advantage than FFS

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Medicare Advantage beneficiaries experience higher quality care and better health outcomes than fee-for-service beneficiaries, according to a report from Harvard and Inovalon. Researchers used...