Payer: Page 75
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COVID-19 fuels major unknowns as insurers tackle 2021 rate setting
An American Academy of Actuaries brief laid out challenges that may boost costs, including a shift in coverage leading to adverse selection, deteriorating health for those delaying care and pressure on reimbursement rates.
By Samantha Liss • June 11, 2020 -
Master Sgt. Hecht, Matt. (2020). [Photograph]. Retrieved from Flickr.
COVID-19 testing costs may hit $25B per year, AHIP study finds
The low estimate for diagnostic testing is $6 billion, while antibody testing costs could range from $5.2 billion to $19.1 billion, according to the report paid for by the payer trade group.
By Shannon Muchmore • June 10, 2020 -
After fallout with UnitedHealthcare came COVID-19. Now Mednax is rethinking its strategy.
The company will continue to sell off other business units to achieve its singular focus on services for women and children and will change the company name to Pediatrix Medical Group to reflect the new direction.
By Samantha Liss • June 9, 2020 -
Centene to acquire NextLevel members after closure
Centene controls the largest Medicaid market share in Illinois and the transfer will only boost its enrollment. The deal is expected to close in July.
By Samantha Liss • Updated June 30, 2020 -
BCBS plans account for nearly half of ACA enrollment, but face rising competition from Medicaid insurers
Medicaid insurers' market share on the exchanges overall ballooned from 15% of the marketplace in 2016 to 27% by 2018.
By Hailey Mensik • June 3, 2020 -
CMS relaxing more value-based model requirements in wake of pandemic
The changes are aimed at minimizing reporting burden and increasing flexibilities for providers as they continue to face great financial and logistical challenges from the novel coronavirus.
By Shannon Muchmore • June 3, 2020 -
UPMC latest hospital system to report Q1 loss due to COVID-19
The Pennsylvania-based system's health insurance plan saw increased revenue due to a significant rise in its membership, but its operating income dropped by 56%.
By Ron Shinkman • June 1, 2020 -
Citing lack of funding, Oklahoma withdraws planned July 1 Medicaid expansion
Millions of Americans have likely been booted off their employer-sponsored insurance and many are newly eligible for Medicaid, something the state didn't anticipate when prepping for the expansion, Republican Gov. Kevin Stitt said.
By Rebecca Pifer Parduhn • June 1, 2020 -
Molina, Centene big winners in Kentucky Medicaid award
The lucrative contracts begin next year and cover 1.4 million people with an annual spend of $8 billion.
By Samantha Liss • June 1, 2020 -
Pathologists most frequent surprise billing offenders, HCCI finds
More than a third of pathologists who billed for inpatient visits did so on an out-of-network basis more than 90% of the time in 2017, according to the Health Care Cost Institute.
By Rebecca Pifer Parduhn • May 28, 2020 -
Medicare members using telehealth grew 120 times in early weeks of COVID-19 as regulations eased
CMS head Seema Verma said her department is evaluating the telehealth waivers to determine if they should be extended past the scope of the national emergency, and is in the process of additional rulemaking around the issue.
By Rebecca Pifer Parduhn • May 27, 2020 -
COVID-19 has forced nearly half of patients to postpone care
About a third of those who have put off treatment said they would seek it in the next three months, and 10% said they will do so in four months to a year, according to a new survey from the Kaiser Family Foundation.
By Shannon Muchmore • May 27, 2020 -
Retrieved from Mastercard on May 20, 2020
Employee wellness programs unlikely to move the needle on health, study finds
Participants said they believed they were healthier and were also more likely to have a primary care physician. However, there was no data showing their health had improved, the new study in JAMA Internal Medicine found.
By Ron Shinkman • May 27, 2020 -
Over 1,750 Part D, MA plans applied for new CMS insulin model
Payers cheered the effort to lower insulin costs and drugmakers Eli Lilly, Novo Nordisk and Sanofi have said they plan to participate. But powerful lobby PhRMA pushed back against the model.
By Rebecca Pifer Parduhn • May 26, 2020 -
Brian Tucker/Healthcare Dive
MA, Part D final rule gives more star ratings weight to patient experience
The rule also attempts to let more MA plans comply with network adequacy standards by reducing the percentage of rural beneficiaries that must reside within maximum time and distance areas.
By Shannon Muchmore • May 22, 2020 -
Labs welcome CMS rate for coronavirus antibody testing
Analysts at William Blair said the roughly $42 rate for common serological tests is higher than expected, which may bode well for antigen testing reimbursement.
By Nick Paul Taylor • May 20, 2020 -
States brace for 'nearly certain' Medicaid budget shortfalls amid COVID-19
The Kaiser Family Foundation survey comes as the House passed a $3 trillion legislative relief package Friday, which would further bump the federal match rate for Medicaid.
By Rebecca Pifer Parduhn • May 18, 2020 -
Courtesy of UnitedHealth Group
UnitedHealth, Microsoft launch COVID-19 screening app for employers
UnitedHealth will control employees' medical data and manage opt-in and consent requirements for users, the healthcare behemoth said Friday. The app will not provide tracking or contact tracing information.
By Rebecca Pifer Parduhn • May 15, 2020 -
Permission granted by BioNTech SE
ACOs ask Trump admin for more help to cope with coronavirus
Nine organizations, including NAACOs and AMA, want CMS to shelter them from financial losses in exchange for lower shared savings as well as push back some key deadlines.
By Rebecca Pifer Parduhn • May 15, 2020 -
Fitch Q2 outlook for nonprofit hospitals: 'worst on record'
Moody's Investors Service also warned this week the impact from the COVID-19 pandemic will linger into next year and noted government assistance won't make up for all the financial losses.
By Hailey Mensik • Updated May 15, 2020 -
Front-line COVID-19 responders in middle of pack on pay
Medscape's annual survey also found men continue to earn more than women, a trend that's held now for a decade. Among primary care physicians, men earn roughly 25% more than women.
By Rebecca Pifer Parduhn • May 14, 2020 -
UnitedHealthcare adds new state to ACA exchange footprint
The move comes after the payer's executives last month said they were mulling jumping back in, after largely exiting a few years ago amid steep profit losses.
By Samantha Liss • May 13, 2020 -
27M Americans may have lost job-based health insurance due to COVID-19 downturn
The new Kaiser Family Foundation estimate also found the coverage gap of those who don't qualify for ACA subsidies or Medicaid could balloon to 1.9 million Americans by 2021 as unemployment insurance runs out.
By Rebecca Pifer Parduhn • May 13, 2020 -
Sponsored by ZS
As if the move to value wasn't hard enough, now health plans have new challenges to tackle
As the public health crisis continues to unfold, health systems and independent provider practices are under increasing financial strain while their ability to deliver high-quality care is decreasing.
By Peter Manoogian • May 13, 2020 -
Kaiser reports $1.1B net loss in Q1 due to stock market slide
The quarter did include some COVID-19-related costs, including establishing mobile hospitals and triage units and increasing inpatient capacity, but they were "not significant," the integrated system said.
By Rebecca Pifer Parduhn • May 11, 2020
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