87% of Eligible Seniors Do Not Receive Lung Cancer Screenings
Seniors who do not have coverage for lung cancer screenings as a preventive service are less likely to receive the screening, a recent study from Epic Health Research Network (EHRN) found. EHRN...UHC Temporarily Reverses Emergency Department Coverage Policy
UnitedHealthcare (UHC) has announced it will delay its recent protocol change regarding emergency department (ED) claims and coverage, after receiving backlash from providers and health organizations...Wellness Programs May Not Significantly Impact Healthcare Spending
Wellness programs may influence health behaviors, but demonstrated little impact on healthcare spending, health outcomes, or employment outcomes, a study published in Health Affairs uncovered. It has...Care Deferrals, Digital Tools Will Shape 2022 Medical Cost Trend
The medical cost trend for 2022 may not be as high as expected, but it is still higher than the trend from the past few years with the exception of 2021, the PwC Health Research Institute found in...Largest Share of Premium Dollar Goes Toward Prescription Drugs
The majority of the average healthcare premium dollar goes toward prescription drugs and outpatient and inpatient hospital costs, according to AHIP’s most recent research. AHIP looked at 30...UHC Changes Emergency Department Claims Evaluation Protocols
Editor's Note: UHC has delayed implementation of this policy. Find out more here. UnitedHealthcare (UHC) announced in a network bulletin that it will be changing some of its methods around...BCBSOK, OUHP Settle Dispute, Work Toward Long-Term Contract
After months of negotiations, Blue Cross and Blue Shield of Oklahoma (BCBSOK) and OU Health Physicians (OUHP) settled their dispute and have agreed upon a contract that will keep the provider...ARP Boosted Funding for Home, Community-Based Services, SDOH
The American Rescue Plan boosted the federal matching rate (FMAP) for Medicaid home and community-based services (HCBS), thereby increasing federal spending on social determinants of health, according...FFS Medicare May Boast Lower Cost Barriers than Private Medicare
Adults ages 65 and older with traditional Medicare boasted similar access to care and a lower rate of cost barriers to care when compared with privately-insured seniors between the ages of 50 and 64, a...Sponsored Article
4 Ways ADT Event Notifications Improve Payer Performance
As a result of CMS CoPs requirements and shared risk arrangements, admission, discharge, and transfer (ADT) notifications are increasingly playing a more crucial role in coordinating care between...How AI Supports Low-Risk Member Identification, Care Management
Artificial intelligence (AI) can shed light on trends within low-risk member populations so that health plans can prevent them from progressing into the high-risk category. There are a couple of key...How Messaging Steers ACA Enrollees to Enhanced Silver Plans
Email and postal mail communications can help guide low-income Affordable Care Act enrollees to less expensive, enhanced silver plans, a recent study published in Health Affairs discovered. Sometimes...High Health Plan Costs Serve as Healthcare Coverage Barrier in TX
Texan adults are more likely to be uninsured and forgo care due to cost barriers than the average American, according to a new survey from HealthCareInsider that raises concern for healthcare...Employers: Healthcare Spending Is on an Unsustainable Trajectory
Overall, large employers find healthcare costs excessive and that the healthcare spending burden would become unsustainable in the next five to ten years, according to a recent Kaiser Family Foundation...Employer Costs Could Drop 43% with Younger Medicare Eligibility
If the Medicare eligibility threshold dropped to 50 years of age and uptake was universal among those eligible, employer-sponsored health plans could see a 43 percent reduction in their healthcare...UnitedHealth Q1 Care Activity Under Baseline, Revenue Growth Persists
While UnitedHealth Group’s Q1 total care activity came in under seasonal baselines due to low levels of outpatient care, revenues grew 9 percent, payer executives announced during UnitedHealth...Medicare Beneficiaries Strongly Satisfied with Coverage in 2019
In 2019, Medicare beneficiaries who were living in the community were in good health and reported satisfaction with their Medicare coverage, including Medicare costs, quality of care, and access to...Payer, Provider Launch Wellness-Focused Medicare Advantage Plan
MVP Health Care and the University of Vermont (UVM) Health Network plan to form a Medicare Advantage plan with an emphasis on wellness, the non-profit payer and academic healthcare system...3 Types of Funding for Employer-Sponsored Health Plan Claims
Employers have three primary options to choose from when they are deciding how to fund their employer-sponsored health plan claims: the self-insured, level-funded, or fully-insured health plan...Sponsored Article