Payers have not reacted lightly to the Medicare Advantage Risk Adjustment Data Validation (RADV) final rule. Major payer Humana made the strongest display of disapproval by filing a lawsuit against CMS that seeks to invalidate the...
Payers such as UnitedHealthcare, Priority Health, and Anthem have pursued Medicare Advantage plan partnerships with retail companies. What is the attraction to this type of partnership?
Plans that are co-branded with retail companies are...
The insurtechs that saw the greatest success after the start of the coronavirus pandemic have faced a tumultuous path since their initial public offerings (IPOs).
In 2021, four insurtechs achieved their IPO. Their goal was to disrupt the...
Medicare Advantage beneficiaries with cancer experienced lower out-of-pocket costs and had access to more benefits than those in Medicare fee-for-service (FFS), research conducted by ATI Advisory and...
Increased rates of switching from Medicare fee-for-service (FFS) to Medicare Advantage in recent years have contributed to Medicare Advantage enrollment growth, a study published in Health Affairs...
Blue Cross Blue Shield is an easily recognizable name in the healthcare industry, but just how many health plans fall under this organization and what are the differences between them?
In the following article, HealthPayerIntelligence...
Around half of Medicare Advantage beneficiaries disenrolled from their health plan after five years, a study published in JAMA Health Forum found.
Capitated payments to Medicare Advantage plans aim to...
Managed care organizations (MCOs) require the same kind of oversight that fee-for-service programs receive from the Office of Inspector General (OIG), so OIG released a four-phase life cycle to align...
The Affordable Care Act (ACA) and Medicare Advantage plans continue to bolster enrollment for major payers.
Enhanced premium subsidies on the ACA market along with greater federal investments in...
Medicare Advantage plans received generally positive satisfaction scores, with beneficiaries giving high ratings on trust, ease of doing business, and meeting product and coverage needs, according to a...
Increasing internal audits and implementing additional coding oversight can benefit Medicare Advantage organizations as they manage new auditing regulations, Melissa James, senior consultant at Wolters Kluwer, told...
Insurers often negotiate hospital prices for their commercial health plans that are up to five times the Medicare Advantage price, a study published in Health Affairs found.
It was already a...
Blue Cross of Idaho and several venture capital firms have invested in Endear Health, a digital platform that aims to improve value-based care delivery for Medicare Advantage beneficiaries.
The...
Health plans must look beyond clinical outcomes and address social determinants of health to improve beneficiaries’ health. Zing Health, an Illinois-based Medicare Advantage plan, did just that for beneficiaries living with...
In an effort to improve care quality and lower costs, the healthcare industry has been working on shifting from fee-for-service to value-based care delivery. The two models differ in the way providers are reimbursed for the care they...
Psychiatrist networks in Medicare Advantage plans are narrower than those in Medicaid managed care and Affordable Care Act (ACA) plans, according to a study published in Health Affairs.
As demand for...
The Medicare Advantage quality bonus program overpays plans and does not effectively promote quality care, indicating that program reforms are needed, according to an Urban Institute report.
The...
Medicare Advantage beneficiaries with chronic conditions had lower healthcare spending and fewer emergency room visits than fee-for-service (FFS) beneficiaries, according to a report from Avalere...
Realizing value-based care success is easier said than done. While a primary goal of value-based care is to improve long-term health outcomes and costs, that can be difficult when consumers’ healthcare journeys are disrupted each...
High-risk medication use was lower among Medicare Advantage beneficiaries compared to those enrolled in traditional Medicare, a study published in JAMA Network Open revealed.
High-risk medications...
