Are you over 18 and want to see adult content?
More Annotations
A complete backup of rankaplastics.in
Are you over 18 and want to see adult content?
A complete backup of carini-subklew.de
Are you over 18 and want to see adult content?
A complete backup of futureadvisor.com
Are you over 18 and want to see adult content?
A complete backup of aircoolingstore.co.uk
Are you over 18 and want to see adult content?
A complete backup of fundaciovilacasas.com
Are you over 18 and want to see adult content?
A complete backup of quickoutline.com
Are you over 18 and want to see adult content?
Favourite Annotations
A complete backup of fortuneconferences.com
Are you over 18 and want to see adult content?
A complete backup of motointegrator.com
Are you over 18 and want to see adult content?
Text
more
GIVEN COVID, 2020 PROGRAM AUDITS WERE LIGHT ON FINDINGS Given COVID, 2020 Program Audits Were Light on Findings. May 20, 2021. Due to the unique constraints of the COVID-19 pandemic, CMS in the newly released 2020 audit report revealed that it audited only six plan sponsors, representing just 1.4% of all Medicare Parts C and D enrollment. Given the small sample size and the flexibilities that CMS THE DIRECTORY OF HEALTH PLANS The Directory of Health Plans will give you a head start on your analyses — and let you easily understand the payer landscape, conduct market research, create detailed company profiles and prioritize business development initiatives. The data you receive from AIS Health’s proprietary health plan database — directly in ouronline portal or
CVS HEALTH DRUG TREND REPORT HIGHLIGHTS SPECIALTY SPENDING In its 2020 Drug Trend Report, CVS Health Corp.’s Caremark PBM said its overall drug trend increased by 2.9% in 2020 and that 34% of its clients saw their pharmacy benefit spending decrease. According to the report, specialty drug costs were the biggest concern. In fact, specialty treatments accounted for 52% of pharmacy spending in 2020, with 90% of spending concentrated on just five EMPLOYERS SHOW INTEREST IN MOVING TO ICHRAS Employers Show Interest in Moving to ICHRAs. Dec 10, 2020. By Peter Johnson. Health care industry insiders say that employers of all sizes are beginning to take a serious look at moving some of their health benefits to Individual Coverage Health Reimbursement Arrangements (ICHRAs) starting in 2022. In July 2019, the Trump administration RADAR ON DRUG BENEFITS RADAR on Drug Benefits. Stay up-to-date on pharmacy reimbursement with business strategies and analysis for health plans, employers, PBMs and pharmaceutical companies. This biweekly publication covers targeted topics, such as drug trends for a specific class, employer attitudes toward pharmacy benefit management tools and copay/coinsurance levels. PBM REGULATION, REBATE RULE ARE HIGH ON LEGISLATIVE AGENDA PBM Regulation, Rebate Rule Are High on Legislative Agenda. Mar 31, 2021. NOTE: The abstract below is a shortened version of the RADAR on Drug Benefits article “ PBM and Part D Reform Could Be on Legislative Agenda .”. By Peter Johnson. As a new bill introduced by Sen. Bernie Sanders (I-VT) indicates, Congress is once again looking SO FAR, NEW THERAPIES HAVE LIMITED IMPACT ON ADHD In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them. AETNA PLANS TO RETURN TO ACA EXCHANGES NOTE: The abstract below is a shortened version of the Health Plan Weekly article “ACA Exchanges Get Another Boost With Aetna’s Planned Reentry.” By Leslie Small. Executives at CVS Health Corp. revealed on Feb. 16 that its Aetna insurance division plans to return to the Affordable Care Act exchanges starting in 2022, a move that health care policy experts say underscores the increasing MORE STATES CHOOSE TO CARVE OUT MEDICAID DRUG NOTE: The abstract below is a shortened version of the RADAR on Drug Benefits article “As States Carve Out Medicaid Drug Benefits, MCOs Push Back.” By Leslie Small. Beginning in April, California and New York will join a growing list of states that have opted to carve out prescription drug benefits from their Medicaid contracts with insurers, wagering that the state can do a better job at AIS HEALTH - ACTIONABLE INTELLIGENCE FOR HEALTH CARE LEADERSSECTIONSSUBSCRIBEHEALTH PLANSMEDICARE AND MEDICAIDSPECIALTY PHARMACYINFOGRAPHIC ARCHIVES OptumRx tells AIS Health, a subsidiary of MMIT, that pharmacy waste, fraud and abuse increased during 2020. Heidi Lew, Pharm.D., vice president of pharmacy network audit, asserted via email that in 2020, OptumRx: Recovered nearly $300 million of fraud, waste and abuse spend; Identified the largest-ever increase of fraudulent claims —more
GIVEN COVID, 2020 PROGRAM AUDITS WERE LIGHT ON FINDINGS Given COVID, 2020 Program Audits Were Light on Findings. May 20, 2021. Due to the unique constraints of the COVID-19 pandemic, CMS in the newly released 2020 audit report revealed that it audited only six plan sponsors, representing just 1.4% of all Medicare Parts C and D enrollment. Given the small sample size and the flexibilities that CMS THE DIRECTORY OF HEALTH PLANS The Directory of Health Plans will give you a head start on your analyses — and let you easily understand the payer landscape, conduct market research, create detailed company profiles and prioritize business development initiatives. The data you receive from AIS Health’s proprietary health plan database — directly in ouronline portal or
CVS HEALTH DRUG TREND REPORT HIGHLIGHTS SPECIALTY SPENDING In its 2020 Drug Trend Report, CVS Health Corp.’s Caremark PBM said its overall drug trend increased by 2.9% in 2020 and that 34% of its clients saw their pharmacy benefit spending decrease. According to the report, specialty drug costs were the biggest concern. In fact, specialty treatments accounted for 52% of pharmacy spending in 2020, with 90% of spending concentrated on just five EMPLOYERS SHOW INTEREST IN MOVING TO ICHRAS Employers Show Interest in Moving to ICHRAs. Dec 10, 2020. By Peter Johnson. Health care industry insiders say that employers of all sizes are beginning to take a serious look at moving some of their health benefits to Individual Coverage Health Reimbursement Arrangements (ICHRAs) starting in 2022. In July 2019, the Trump administration RADAR ON DRUG BENEFITS RADAR on Drug Benefits. Stay up-to-date on pharmacy reimbursement with business strategies and analysis for health plans, employers, PBMs and pharmaceutical companies. This biweekly publication covers targeted topics, such as drug trends for a specific class, employer attitudes toward pharmacy benefit management tools and copay/coinsurance levels. PBM REGULATION, REBATE RULE ARE HIGH ON LEGISLATIVE AGENDA PBM Regulation, Rebate Rule Are High on Legislative Agenda. Mar 31, 2021. NOTE: The abstract below is a shortened version of the RADAR on Drug Benefits article “ PBM and Part D Reform Could Be on Legislative Agenda .”. By Peter Johnson. As a new bill introduced by Sen. Bernie Sanders (I-VT) indicates, Congress is once again looking SO FAR, NEW THERAPIES HAVE LIMITED IMPACT ON ADHD In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them. AETNA PLANS TO RETURN TO ACA EXCHANGES NOTE: The abstract below is a shortened version of the Health Plan Weekly article “ACA Exchanges Get Another Boost With Aetna’s Planned Reentry.” By Leslie Small. Executives at CVS Health Corp. revealed on Feb. 16 that its Aetna insurance division plans to return to the Affordable Care Act exchanges starting in 2022, a move that health care policy experts say underscores the increasing MORE STATES CHOOSE TO CARVE OUT MEDICAID DRUG NOTE: The abstract below is a shortened version of the RADAR on Drug Benefits article “As States Carve Out Medicaid Drug Benefits, MCOs Push Back.” By Leslie Small. Beginning in April, California and New York will join a growing list of states that have opted to carve out prescription drug benefits from their Medicaid contracts with insurers, wagering that the state can do a better job atNEWS BRIEFS
21 hours ago · HHS Secretary Xavier Becerra on June 9 sent a letter to health insurers and providers warning them that COVID-19 vaccines and tests must be provided free of charge to patients. “In light of recent reports of consumer cost concerns,” he wrote — citing a recent New York Times article that indicated concern over unexpected medical bills was a reason cited by people who indicated they are GIVEN COVID, 2020 PROGRAM AUDITS WERE LIGHT ON FINDINGS Given COVID, 2020 Program Audits Were Light on Findings. May 20, 2021. Due to the unique constraints of the COVID-19 pandemic, CMS in the newly released 2020 audit report revealed that it audited only six plan sponsors, representing just 1.4% of all Medicare Parts C and D enrollment. Given the small sample size and the flexibilities that CMS AS COVID-19 RECEDES, WHAT ARE NEXT STEPS FOR TELEHEALTH 21 hours ago · Telemedicine utilization boomed during the COVID-19 pandemic, filling some of the unprecedented gaps in care. But its greatly expanded use uncovered some areas where more investment is needed to encourage adoption, while at the same time creating fears that because of its convenience, the pendulum could swing to overutilization, stakeholders say. In a webinar held June 8, CareFirstNEWS BRIEFS
1 day ago · HHS said on June 9 that the U.S. government will procure approximately 1.7 million courses of Merck & Co.’s investigational antiviral treatment for COVID-19, molnupiravir (MK-4482), pending emergency use authorization or approval from the FDA. The treatment — which is designed to induce viral genome copying errors to prevent the virus from replicating in the human body — is currently ONEMEDICAL-IORA DEAL FOLLOWS PANDEMIC PRIMARY CARE TRENDS 21 hours ago · National primary care provider OneMedical Group Inc., a startup with an annual subscription service and virtual care offerings, on June 7 announced it will purchase senior-focused provider Iora Health, Inc. for $2.1 billion in an all-stock deal. Experts say the deal is a good bet for a firm that is already an appealing employer for talented, young primary care physicians whodon’t want to
NEW FDA SPECIALTY APPROVALS 1 day ago · May 5: The FDA granted accelerated approval to Merck & Co., Inc.’s Keytruda (pembrolizumab) in combination with trastuzumab, fluoropyrimidine- and platinum-containing chemotherapy for the treatment of locally advanced unresectable or metastatic human epidermal growth factor receptor 2 (HER2)-positive gastric or gastroesophageal junction adenocarcinoma. The agency MULTIPLE MYELOMA CONTINUES TO POSE MANAGEMENT CHALLENGES 1 day ago · Multiple myeloma, an incurable blood disease that starts in the bone marrow and can be a relatively rare cancer, has an array of products available to treat it, and new agents — including the first gene therapy for the disease — continue to gain FDA approval. However, as the therapies are different types of drugs, management of the space can be challenging. Winston Wong, Pharm.D UNITEDHEALTH PUTS ER COVERAGE POLICY ON ICE AFTER BACKLASH 21 hours ago · UnitedHealthcare — which recently followed in the footsteps of Anthem, Inc. by rolling out a policy that would retroactively deny certain emergency room visit claims — is now planning to hold off on implementing the change after facing fierce blowback from provider groups. Health care policy experts, meanwhile, have mixed opinions about whether the policy was wise to implement inthe first
PAYERS CREATE CAR-T APPROVAL SYSTEMS AS ADOPTION INCREASES 1 day ago · Spurred by CMS’s decision to cover chimeric antigen receptor T-cell therapies under Medicare, commercial payers are beginning to systematize approvals for CAR-T treatment as use of these breakthrough cancer therapies is beginning to ramp up, experts say. “Despite the costs of CAR-T, I know many plans were already looking at providing coverage prior to the CMS decision,” which was PRIME: MS SPEND WAS STEADY AS GENERICS HELPED OFFSET COSTS 1 day ago · More than 20 multiple sclerosis (MS) disease-modifying drugs (DMDs) currently are available in the U.S. But even with all the competition, prices for most of the agents are around $80,000 per year. Following updated professional treatment guidelines and the FDA approval of new therapies, including generics, Prime Therapeutics LLC recently conducted a study to determine spend and use of thePAYER PROFILES
Payer Profiles Unlock the Health Plan and PBM Landscape with In-Depth Narratives Focused on U.S. Payers. The journalists at AIS Health have created these reports based on primary market research and MMIT’s leading payer hierarchy data to uncover unique intelligence on key players in the industry.NEWS BRIEFS
News Briefs. Nearly 940,000 people have signed up for health insurance plans through HealthCare.gov during the pandemic-related special enrollment period as of May 6, according to HHS. Also, nearly 2 million people who are already enrolled in individual market plans “have returned to the Marketplace and reduced their monthly premiumsby over
NEWS BRIEFS
News Briefs. The Oklahoma Supreme Court ruled on June 1 that the Oklahoma Health Care Authority (OHCA) cannot create a managed care program as part of the state’s voter-approved Medicaid expansion — on the same day that enrollment for the expanded Medicaid program began. The decision is the result of a suit brought by medicalprofessional
PAYERS FACE CHALLENGES TO ENROLL NEWLY UNINSURED Payers Face Challenges to Enroll Newly Uninsured. Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment. SO FAR, NEW THERAPIES HAVE LIMITED IMPACT ON ADHD In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them. MMIT REACH - AIS HEALTH MMIT Reach. Comprehensive data set with contact information for more than 45,000 decision makers from thousands of health plan, PBM and health system organizations — OEP WINNERS CREDIT YEAR-ROUND OUTREACH, OMNICHANNEL Medicare Advantage enrollment grew just 1% during the 2021 Open Enrollment Period (OEP) that ran from January to March, compared with growth of 7% during the preceding Annual Election Period (AEP), according to AIS’s Directory of Health Plans (DHP). While the large MA insurers continued to nab the bulk of OEP signups (see infographic, p. 7), an AIS Health analysis finds that of the top 25 AETNA PLANS TO RETURN TO ACA EXCHANGES NOTE: The abstract below is a shortened version of the Health Plan Weekly article “ACA Exchanges Get Another Boost With Aetna’s Planned Reentry.” By Leslie Small. Executives at CVS Health Corp. revealed on Feb. 16 that its Aetna insurance division plans to return to the Affordable Care Act exchanges starting in 2022, a move that health care policy experts say underscores the increasing NEW ADMINISTRATION’S STANCE ON COPAY ACCUMULATORS REMAINS Data collected by AIS Health’s parent company, MMIT, show that copay accumulators and maximizers are gaining steam across the commercial insurance space. Of insurers covering a collective 127.5 million lives, 41% had implemented a copay accumulator program and 32% had implemented a copay maximizer program prior to 2020, and another 26%and 24
NEVADA PUBLIC OPTION WILL MAKE PAYERS, PROVIDERS ‘SWEAT Nevada lawmakers this week passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which will go into effect in 2026 and Democratic Gov. Steve Sisolak on Tuesday promised to sign. Nevada’s public option bill will require any carrierPAYER PROFILES
Payer Profiles Unlock the Health Plan and PBM Landscape with In-Depth Narratives Focused on U.S. Payers. The journalists at AIS Health have created these reports based on primary market research and MMIT’s leading payer hierarchy data to uncover unique intelligence on key players in the industry.NEWS BRIEFS
News Briefs. Nearly 940,000 people have signed up for health insurance plans through HealthCare.gov during the pandemic-related special enrollment period as of May 6, according to HHS. Also, nearly 2 million people who are already enrolled in individual market plans “have returned to the Marketplace and reduced their monthly premiumsby over
NEWS BRIEFS
News Briefs. The Oklahoma Supreme Court ruled on June 1 that the Oklahoma Health Care Authority (OHCA) cannot create a managed care program as part of the state’s voter-approved Medicaid expansion — on the same day that enrollment for the expanded Medicaid program began. The decision is the result of a suit brought by medicalprofessional
PAYERS FACE CHALLENGES TO ENROLL NEWLY UNINSURED Payers Face Challenges to Enroll Newly Uninsured. Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment. SO FAR, NEW THERAPIES HAVE LIMITED IMPACT ON ADHD In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them. MMIT REACH - AIS HEALTH MMIT Reach. Comprehensive data set with contact information for more than 45,000 decision makers from thousands of health plan, PBM and health system organizations — OEP WINNERS CREDIT YEAR-ROUND OUTREACH, OMNICHANNEL Medicare Advantage enrollment grew just 1% during the 2021 Open Enrollment Period (OEP) that ran from January to March, compared with growth of 7% during the preceding Annual Election Period (AEP), according to AIS’s Directory of Health Plans (DHP). While the large MA insurers continued to nab the bulk of OEP signups (see infographic, p. 7), an AIS Health analysis finds that of the top 25 AETNA PLANS TO RETURN TO ACA EXCHANGES NOTE: The abstract below is a shortened version of the Health Plan Weekly article “ACA Exchanges Get Another Boost With Aetna’s Planned Reentry.” By Leslie Small. Executives at CVS Health Corp. revealed on Feb. 16 that its Aetna insurance division plans to return to the Affordable Care Act exchanges starting in 2022, a move that health care policy experts say underscores the increasing NEW ADMINISTRATION’S STANCE ON COPAY ACCUMULATORS REMAINS Data collected by AIS Health’s parent company, MMIT, show that copay accumulators and maximizers are gaining steam across the commercial insurance space. Of insurers covering a collective 127.5 million lives, 41% had implemented a copay accumulator program and 32% had implemented a copay maximizer program prior to 2020, and another 26%and 24
NEVADA PUBLIC OPTION WILL MAKE PAYERS, PROVIDERS ‘SWEAT Nevada lawmakers this week passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which will go into effect in 2026 and Democratic Gov. Steve Sisolak on Tuesday promised to sign. Nevada’s public option bill will require any carrier AIS HEALTH - ACTIONABLE INTELLIGENCE FOR HEALTH CARE LEADERS OptumRx tells AIS Health, a subsidiary of MMIT, that pharmacy waste, fraud and abuse increased during 2020. Heidi Lew, Pharm.D., vice president of pharmacy network audit, asserted via email that in 2020, OptumRx: Recovered nearly $300 million of fraud, waste and abuse spend; Identified the largest-ever increase of fraudulent claims —more
DUAL PLANS ROLL OUT EFFORTS ON SDOH, TELEHEALTH IN 2021 Dual Plans Roll Out Efforts on SDOH, Telehealth in 2021. Jan 28, 2021. NOTE: The abstract below is a shortened version of the RADAR on Medicare Advantage article “ 2021 Outlook: Duals Plans Double Down on SDOH, Telehealth Investments .”. By Lauren Flynn Kelly. Amid the changes brought about by the COVID-19 pandemic, Medicare Advantage BRIGHT HEALTH EYES IPO, ACQUIRES TELEHEALTH STARTUP NOTE: The abstract below is a shortened version of the Health Plan Weekly article “With IPO Talk, Telehealth Buy, Startup’s Future May Be Bright.” By Leslie Small. After 2020 proved to be a banner year for initial public offerings, three separate startup health insurers — Alignment Healthcare, Clover Health and Oscar Health — rode the wave and launched IPOs in the early months of 2021. DUPIXENT GAINS SHARE IN ATOPIC DERMATITIS, BUT NEW DRUGS Dupixent (dupilumab), the first biologic approved for atopic dermatitis (AD), hasn’t shaken up treatment of the condition completely even as it steadily gains market share, since the bulk of plans still require patients to try mostly generic topical corticosteroids (TCSs) and topical calcineurin inhibitors (TCIs) first. But more competition could be coming to this category, with theFDA set
PAYERS FACE CHALLENGES TO ENROLL NEWLY UNINSURED Payers Face Challenges to Enroll Newly Uninsured. Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment. NEW ADMINISTRATION’S STANCE ON COPAY ACCUMULATORS REMAINS Data collected by AIS Health’s parent company, MMIT, show that copay accumulators and maximizers are gaining steam across the commercial insurance space. Of insurers covering a collective 127.5 million lives, 41% had implemented a copay accumulator program and 32% had implemented a copay maximizer program prior to 2020, and another 26%and 24
PREVIEW: HEALTH PLAN WEEKLY ARCHIVES Centene Corp. has appointed Drew Asher as its new chief financial officer (CFO) and executive vice president, replacing Jeffrey Schwaneke, who is rotating to manage the firm’s HealthCare Enterprises venture capital division. TO COVER OR NOT TO COVER? PRENATAL DNA TEST CREATES NIPT is now widely covered for “high-risk” pregnant women, according to the Coalition for Access to Prenatal Screening. Plus, 40 commercial insurers cover NIPT for all pregnant women, including Cigna Corp., Geisinger Health Plan, Anthem, Inc. and slew of regional Blue Cross Blue Shield plans. But many state Medicaid programs and two ofthe
OHIO NAMES NEW MEDICAID PBM, SUES ONE OF CURRENT VENDORS NOTE: The abstract below is a shortened version of the RADAR on Drug Benefits article “Meet Ohio’s New Single PBM for Medicaid Beneficiaries.” By Leslie Small. Ohio recently cleared a key hurdle in its plan to revamp how Medicaid enrollees’ pharmacy benefits are managed, choosing Gainwell Technologies as the single PBM that will replace big-name firms including Cigna Corp.’s Express NPS IS VIEWED AS USEFUL, BUT NOT BEST AS SOLE SATISFACTION NPS is a useful tool for plans to determine who might consider switching plans and carriers during open enrollment, Badger says, since “if a person’s a promoter, they will rarely change plans.”. Still, inertia in the MA market is a powerful force: only half of MA plan enrollees who give their current plans the worst NPSscore actually
PAYER PROFILES
Payer Profiles Unlock the Health Plan and PBM Landscape with In-Depth Narratives Focused on U.S. Payers. The journalists at AIS Health have created these reports based on primary market research and MMIT’s leading payer hierarchy data to uncover unique intelligence on key players in the industry.NEWS BRIEFS
News Briefs. Nearly 940,000 people have signed up for health insurance plans through HealthCare.gov during the pandemic-related special enrollment period as of May 6, according to HHS. Also, nearly 2 million people who are already enrolled in individual market plans “have returned to the Marketplace and reduced their monthly premiumsby over
NEWS BRIEFS
News Briefs. The Oklahoma Supreme Court ruled on June 1 that the Oklahoma Health Care Authority (OHCA) cannot create a managed care program as part of the state’s voter-approved Medicaid expansion — on the same day that enrollment for the expanded Medicaid program began. The decision is the result of a suit brought by medicalprofessional
PAYERS FACE CHALLENGES TO ENROLL NEWLY UNINSURED Payers Face Challenges to Enroll Newly Uninsured. Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment. SO FAR, NEW THERAPIES HAVE LIMITED IMPACT ON ADHD In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them. MMIT REACH - AIS HEALTH MMIT Reach. Comprehensive data set with contact information for more than 45,000 decision makers from thousands of health plan, PBM and health system organizations — OEP WINNERS CREDIT YEAR-ROUND OUTREACH, OMNICHANNEL Medicare Advantage enrollment grew just 1% during the 2021 Open Enrollment Period (OEP) that ran from January to March, compared with growth of 7% during the preceding Annual Election Period (AEP), according to AIS’s Directory of Health Plans (DHP). While the large MA insurers continued to nab the bulk of OEP signups (see infographic, p. 7), an AIS Health analysis finds that of the top 25 AETNA PLANS TO RETURN TO ACA EXCHANGES NOTE: The abstract below is a shortened version of the Health Plan Weekly article “ACA Exchanges Get Another Boost With Aetna’s Planned Reentry.” By Leslie Small. Executives at CVS Health Corp. revealed on Feb. 16 that its Aetna insurance division plans to return to the Affordable Care Act exchanges starting in 2022, a move that health care policy experts say underscores the increasing NEW ADMINISTRATION’S STANCE ON COPAY ACCUMULATORS REMAINS Data collected by AIS Health’s parent company, MMIT, show that copay accumulators and maximizers are gaining steam across the commercial insurance space. Of insurers covering a collective 127.5 million lives, 41% had implemented a copay accumulator program and 32% had implemented a copay maximizer program prior to 2020, and another 26%and 24
NEVADA PUBLIC OPTION WILL MAKE PAYERS, PROVIDERS ‘SWEAT Nevada lawmakers this week passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which will go into effect in 2026 and Democratic Gov. Steve Sisolak on Tuesday promised to sign. Nevada’s public option bill will require any carrierPAYER PROFILES
Payer Profiles Unlock the Health Plan and PBM Landscape with In-Depth Narratives Focused on U.S. Payers. The journalists at AIS Health have created these reports based on primary market research and MMIT’s leading payer hierarchy data to uncover unique intelligence on key players in the industry.NEWS BRIEFS
News Briefs. Nearly 940,000 people have signed up for health insurance plans through HealthCare.gov during the pandemic-related special enrollment period as of May 6, according to HHS. Also, nearly 2 million people who are already enrolled in individual market plans “have returned to the Marketplace and reduced their monthly premiumsby over
NEWS BRIEFS
News Briefs. The Oklahoma Supreme Court ruled on June 1 that the Oklahoma Health Care Authority (OHCA) cannot create a managed care program as part of the state’s voter-approved Medicaid expansion — on the same day that enrollment for the expanded Medicaid program began. The decision is the result of a suit brought by medicalprofessional
PAYERS FACE CHALLENGES TO ENROLL NEWLY UNINSURED Payers Face Challenges to Enroll Newly Uninsured. Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment. SO FAR, NEW THERAPIES HAVE LIMITED IMPACT ON ADHD In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them. MMIT REACH - AIS HEALTH MMIT Reach. Comprehensive data set with contact information for more than 45,000 decision makers from thousands of health plan, PBM and health system organizations — OEP WINNERS CREDIT YEAR-ROUND OUTREACH, OMNICHANNEL Medicare Advantage enrollment grew just 1% during the 2021 Open Enrollment Period (OEP) that ran from January to March, compared with growth of 7% during the preceding Annual Election Period (AEP), according to AIS’s Directory of Health Plans (DHP). While the large MA insurers continued to nab the bulk of OEP signups (see infographic, p. 7), an AIS Health analysis finds that of the top 25 AETNA PLANS TO RETURN TO ACA EXCHANGES NOTE: The abstract below is a shortened version of the Health Plan Weekly article “ACA Exchanges Get Another Boost With Aetna’s Planned Reentry.” By Leslie Small. Executives at CVS Health Corp. revealed on Feb. 16 that its Aetna insurance division plans to return to the Affordable Care Act exchanges starting in 2022, a move that health care policy experts say underscores the increasing NEW ADMINISTRATION’S STANCE ON COPAY ACCUMULATORS REMAINS Data collected by AIS Health’s parent company, MMIT, show that copay accumulators and maximizers are gaining steam across the commercial insurance space. Of insurers covering a collective 127.5 million lives, 41% had implemented a copay accumulator program and 32% had implemented a copay maximizer program prior to 2020, and another 26%and 24
NEVADA PUBLIC OPTION WILL MAKE PAYERS, PROVIDERS ‘SWEAT Nevada lawmakers this week passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which will go into effect in 2026 and Democratic Gov. Steve Sisolak on Tuesday promised to sign. Nevada’s public option bill will require any carrier AIS HEALTH - ACTIONABLE INTELLIGENCE FOR HEALTH CARE LEADERS OptumRx tells AIS Health, a subsidiary of MMIT, that pharmacy waste, fraud and abuse increased during 2020. Heidi Lew, Pharm.D., vice president of pharmacy network audit, asserted via email that in 2020, OptumRx: Recovered nearly $300 million of fraud, waste and abuse spend; Identified the largest-ever increase of fraudulent claims —more
DUAL PLANS ROLL OUT EFFORTS ON SDOH, TELEHEALTH IN 2021 Dual Plans Roll Out Efforts on SDOH, Telehealth in 2021. Jan 28, 2021. NOTE: The abstract below is a shortened version of the RADAR on Medicare Advantage article “ 2021 Outlook: Duals Plans Double Down on SDOH, Telehealth Investments .”. By Lauren Flynn Kelly. Amid the changes brought about by the COVID-19 pandemic, Medicare Advantage BRIGHT HEALTH EYES IPO, ACQUIRES TELEHEALTH STARTUP NOTE: The abstract below is a shortened version of the Health Plan Weekly article “With IPO Talk, Telehealth Buy, Startup’s Future May Be Bright.” By Leslie Small. After 2020 proved to be a banner year for initial public offerings, three separate startup health insurers — Alignment Healthcare, Clover Health and Oscar Health — rode the wave and launched IPOs in the early months of 2021. DUPIXENT GAINS SHARE IN ATOPIC DERMATITIS, BUT NEW DRUGS Dupixent (dupilumab), the first biologic approved for atopic dermatitis (AD), hasn’t shaken up treatment of the condition completely even as it steadily gains market share, since the bulk of plans still require patients to try mostly generic topical corticosteroids (TCSs) and topical calcineurin inhibitors (TCIs) first. But more competition could be coming to this category, with theFDA set
PAYERS FACE CHALLENGES TO ENROLL NEWLY UNINSURED Payers Face Challenges to Enroll Newly Uninsured. Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment. NEW ADMINISTRATION’S STANCE ON COPAY ACCUMULATORS REMAINS Data collected by AIS Health’s parent company, MMIT, show that copay accumulators and maximizers are gaining steam across the commercial insurance space. Of insurers covering a collective 127.5 million lives, 41% had implemented a copay accumulator program and 32% had implemented a copay maximizer program prior to 2020, and another 26%and 24
PREVIEW: HEALTH PLAN WEEKLY ARCHIVES Centene Corp. has appointed Drew Asher as its new chief financial officer (CFO) and executive vice president, replacing Jeffrey Schwaneke, who is rotating to manage the firm’s HealthCare Enterprises venture capital division. TO COVER OR NOT TO COVER? PRENATAL DNA TEST CREATES NIPT is now widely covered for “high-risk” pregnant women, according to the Coalition for Access to Prenatal Screening. Plus, 40 commercial insurers cover NIPT for all pregnant women, including Cigna Corp., Geisinger Health Plan, Anthem, Inc. and slew of regional Blue Cross Blue Shield plans. But many state Medicaid programs and two ofthe
OHIO NAMES NEW MEDICAID PBM, SUES ONE OF CURRENT VENDORS NOTE: The abstract below is a shortened version of the RADAR on Drug Benefits article “Meet Ohio’s New Single PBM for Medicaid Beneficiaries.” By Leslie Small. Ohio recently cleared a key hurdle in its plan to revamp how Medicaid enrollees’ pharmacy benefits are managed, choosing Gainwell Technologies as the single PBM that will replace big-name firms including Cigna Corp.’s Express NPS IS VIEWED AS USEFUL, BUT NOT BEST AS SOLE SATISFACTION NPS is a useful tool for plans to determine who might consider switching plans and carriers during open enrollment, Badger says, since “if a person’s a promoter, they will rarely change plans.”. Still, inertia in the MA market is a powerful force: only half of MA plan enrollees who give their current plans the worst NPSscore actually
* Sections
* Drug Benefits
* Health Plans
* Medicare and Medicaid * Specialty Pharmacy* Subscribe
* More
* About AIS Health
* Editorial Staff
* Privacy Policy
* Terms of Use
* Contact Us
Select Page
* Sections
* Drug Benefits
* Health Plans
* Medicare and Medicaid * Specialty Pharmacy* Subscribe
* More
* About AIS Health
* Editorial Staff
* Privacy Policy
* Terms of Use
* Contact Us
Search for:
* __
* LOGIN
Preview: Health Plan Weekly NEVADA PUBLIC OPTION WILL MAKE PAYERS, PROVIDERS ‘SWEAT’June 4, 2021
Nevada lawmakers this week passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which will go into effect in 2026 and Democratic Gov. Steve Sisolak on Tuesday promised to sign. Nevada’s public option bill will require any carrier that participates in the state’s Medicaid managed care program or individual exchange to provide a silver- or gold-level public option plan. Premiums for those plans will be set 5% lower than the benchmark silver plan sold on the state Affordable Care Act exchange, and both individuals and small group purchasers will be able to buy into the plan. Nevada lawmakers this week passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which will go into effect in 2026 and Democratic Gov. Steve Sisolak on Tuesday promised to sign. Nevada’s public option bill will require any carrier that participates in the state’s Medicaid managed care program or individual exchange to provide a silver- or gold-level public option plan. Premiums for those plans will be set 5% lower than the benchmark silver plan sold on the state Affordable Care Act exchange, and both individuals and small group purchasers will be able to buy into the plan. Any provider that has a network agreement with the state employee health plan or a Medicaid plan will be required to join the public option plan’s network. The bill also extends Medicaid eligibility to pregnant women who have an income of up to 200% of the federal poverty line and expands the program’s maternity benefits.The bill is part of a growing movement by Democrats at the state level to pass publicoptions.
Unlock the full version of this article by subscribing. Log in | Learn MoreREAD MORE READ LESS
* Health Plans
* Preview
Link
Preview: Health Plan Weekly SURVEY: VIRTUAL VISITS INCREASE HEALTH PLAN MEMBER SATISFACTIONJune 4, 2021
More than one-third of privately insured health plan members in the U.S. accessed telehealth services in 2020, up from just 9% a year ago. The increased use of telemedicine and other digital tools and services is correlated with a jump in overall member satisfaction, a study from J.D. Power shows. The numbers, contained in the J.D. Power 2021 U.S. Commercial MemberHealth Plan Study
,
can’t prove the increase in telehealth, a shift caused by thepandemic
,
has a causal relationship to improved member satisfaction. But James Beem, managing director for global healthcare intelligence at the data analytics firm, says the study shows “that health plans are becoming more customer-driven and that they came through for member responses” during the COVID-19 pandemic. More than one-third of privately insured health plan members in the U.S. accessed telehealth services in 2020, up from just 9% a year ago. The increased use of telemedicine and other digital tools and services is correlated with a jump in overall member satisfaction, a study from J.D. Power shows. The numbers, contained in the J.D. Power 2021 U.S. Commercial MemberHealth Plan Study
,
can’t prove the increase in telehealth, a shift caused by thepandemic
,
has a causal relationship to improved member satisfaction. But James Beem, managing director for global healthcare intelligence at the data analytics firm, says the study shows “that health plans are becoming more customer-driven and that they came through for member responses” during the COVID-19 pandemic. “We are only stating that digital contact and telehealth adoption increased since last year,” Beem tells AIS Health, a division of MMIT. “However, greater engagement among health plan members generally ties to an increase in satisfaction. Digital channels — website, app, text — are less utilized than phone, but associated with higher satisfaction regardless of” member age. Unlock the full version of this article by subscribing. Log in | Learn MoreREAD MORE READ LESS
* Health Plans
* Preview
Link
Preview: Health Plan Weekly REPORT: HEALTH CARE COSTS DROPPED IN 2020, WILL REBOUNDJune 4, 2021
An annual report on the cost of health care prepared by Milliman, Inc. found that, for the first time in years, health care costs for the average American family fell in 2020. However, experts say that is unlikely to happen again any time soon, as the COVID-19 pandemic caused a steep decline in health care utilization.
The report, the 2021 Milliman Medical Index,
found that the cost of health care for an average American family of four covered by an employer-sponsored PPO health plan was $26,078, down from $27,233 in 2019, a decrease of 4.2%. The drop will not be permanent, warn the authors: Milliman projects costs will increase to$28,256 in 2021.
An annual report on the cost of health care prepared by Milliman, Inc. found that, for the first time in years, health care costs for the average American family fell in 2020. However, experts say that is unlikely to happen again any time soon, as the COVID-19 pandemic caused a steep decline in health care utilization.
The report, the 2021 Milliman Medical Index,
found that the cost of health care for an average American family of four covered by an employer-sponsored PPO health plan was $26,078, down from $27,233 in 2019, a decrease of 4.2%. The drop will not be permanent, warn the authors: Milliman projects costs will increase to$28,256 in 2021.
These figures combine the employer’s contribution to health plan premiums, the employee’s premium payments and the out-of-pocket expenses paid by the employee. While employer and employee costs both dropped from 2019 to 2020, the report projects that both payers will spend more in 2021 than they did in 2019. Unlock the full version of this article by subscribing. Log in | Learn MoreREAD MORE READ LESS
* Health Plans
* Preview
Link
Preview: Health Plan Weekly MCO STOCK PERFORMANCE, MAY 2021June 4, 2021
Unlock the full version of this chart by subscribing. Log in | Learn More Unlock the full version of this chart by subscribing. Log in | Learn MoreREAD MORE READ LESS
* Health Plans
* Preview
Link
Preview: Health Plan Weekly AVERAGE BENCHMARK PLAN PREMIUM SLIGHTLY DROPS, INSURER PARTICIPATIONRISES IN 2021
June 4, 2021
The national average premium for the second-lowest-cost silver plan, or benchmark plan, sold through the Affordable Care Act exchanges is $443 per month for a 40-year-old nonsmoker in 2021, a 1.7% drop compared to 2020, according to a recent analysis by Urban Institute. Average state benchmark premiums range from $292 in Minnesota to $782 in Wyoming. The study also suggested that premium variation was strongly associated with the number of insurers participating in a region. The benchmark premium in a rating region with only one insurer was $148 higher per month than the premium in regions with five ormore insurers.
_by Jinghong Chen_
The national average premium for the second-lowest-cost silver plan, or benchmark plan, sold through the Affordable Care Act exchanges is $443 per month for a 40-year-old nonsmoker in 2021, a 1.7% drop compared to 2020, according to a recent analysis by Urban Institute. Average state benchmark premiums range from $292 in Minnesota to $782 in Wyoming. The study also suggested that premium variation was strongly associated with the number of insurers participating in a region. The benchmark premium in a rating region with only one insurer was $148 higher per month than the premium in regions with five ormore insurers.
Unlock the full version of this infographic by subscribing. Log in | Learn MoreREAD MORE READ LESS
* Health Plans
* Preview
Link
Preview: Health Plan WeeklyNEWS BRIEFS
June 4, 2021
✦ _THE OKLAHOMA SUPREME COURT RULED ON JUNE 1 THAT THE OKLAHOMA HEALTH CARE AUTHORITY (OHCA) CANNOT CREATE A MANAGED CARE PROGRAM AS PART OF THE STATE’S VOTER-APPROVED MEDICAID EXPANSION — ON THE SAME DAY THAT ENROLLMENT FOR THE EXPANDED MEDICAID PROGRAM BEGAN. _Thedecision
is the result of a suit brought by medical professional associations including the Oklahoma State Medical Association and groups representing dentists, pediatricians, osteopaths and anesthesiologists. The court held that OHCA acted improperly in awarding MCO contracts to payers because “the Legislature has not authorized the creation of the SoonerSelect program.” For now, the state is obliged to avoid a capitated model for the program, as the authorizing initiative “in no way authorize this course of action. The OHCA, through an RFP process and competitive bidding, awarded contracts to MCOs without legislative authorization or required rules in place. In effect, the OHCA moved ahead without the required legislative authorization.” OHCA in January selected four MCOs to begin serving enrollees in October. ✦ _THE OKLAHOMA SUPREME COURT RULED ON JUNE 1 THAT THE OKLAHOMA HEALTH CARE AUTHORITY (OHCA) CANNOT CREATE A MANAGED CARE PROGRAM AS PART OF THE STATE’S VOTER-APPROVED MEDICAID EXPANSION — ON THE SAME DAY THAT ENROLLMENT FOR THE EXPANDED MEDICAID PROGRAM BEGAN. _Thedecision
is the result of a suit brought by medical professional associations including the Oklahoma State Medical Association and groups representing dentists, pediatricians, osteopaths and anesthesiologists. The court held that OHCA acted improperly in awarding MCO contracts to payers because “the Legislature has not authorized the creation of the SoonerSelect program.” For now, the state is obliged to avoid a capitated model for the program, as the authorizing initiative “in no way authorize this course of action. The OHCA, through an RFP process and competitive bidding, awarded contracts to MCOs without legislative authorization or required rules in place. In effect, the OHCA moved ahead without the required legislative authorization.” OHCA in January selected four MCOs to begin serving enrollees in October. Unlock the full version of this article by subscribing. Log in | Learn MoreREAD MORE READ LESS
* Health Plans
* News Briefs
* Preview
Link
MA PLANS SEEK WAYS TO IMPROVE PATIENT EXPERIENCE, STARSJune 4, 2021
Last month marked the end of a three-month data collection cycle that will have a meaningful impact on the 2023 Medicare Parts C and D star ratings, when member experience measures take on a larger weight in star ratings calculations. While it’s too late to make a difference in how members responded to the recent Consumer Assessment of Healthcare Providers and Systems (CAHPS) that reflected the patient experience in late 2020 and early 2021, Medicare Advantage organizations should be focused on innovations that can prevent and resolve issues members face throughout the year to foster more positive feedback for future surveys, advises one longtime starsexpert.
Last month marked the end of a three-month data collection cycle that will have a meaningful impact on the 2023 Medicare Parts C and D star ratings, when member experience measures take on a larger weight in star ratings calculations. While it’s too late to make a difference in how members responded to the recent Consumer Assessment of Healthcare Providers and Systems (CAHPS) that reflected the patient experience in late 2020 and early 2021, Medicare Advantage organizations should be focused on innovations that can prevent and resolve issues members face throughout the year to foster more positive feedback for future surveys, advises one longtime starsexpert.
As numerous measures based on CAHPS and CMS administrative data move from a weighting value of 2 to 4 starting with measurement year 2021, the increased value of those measures will make up 32% of the overall 2023 star rating on a weighted basis. “We’ve always known member experience was important and we’ve always agreed we need to focus effort and attention in that area, but attaching such a heavy contribution to the overall star ratings to the surveys is the forcing function that most plans are seeing as the impetus for new actions,” says Melissa Smith, who is executive vice president of consulting and professional services at HealthMine, Inc., a Dallas- based memberengagement firm.
For our occasional series of interviews that examine pertinent issues through the words of the industry’s leading executives, Smith discussed some of those actions with AIS Health, a division of MMIT. The following interview has been edited for length and clarity. _AIS HEALTH: MANY OF THE QUESTIONS THAT ARE ASKED IN CAHPS-BASED MEASURES RELATE TO HOW QUICKLY PATIENTS ARE ABLE TO ACCESS CARE OR PRESCRIPTION DRUGS. ISN’T IT HARD TO ASK QUESTIONS LIKE THAT DURING A PANDEMIC, WHEN THINGS ARE FAR FROM NORMAL?_ _MELISSA SMITH:_ Yes, it has been hard to ask those questions during the pandemic, and this has really been the genesis of CMS giving plans so much flexibility during 2020 and the early part of 2021 to compensate for that. So, it’s literally because of that question that we’ve seen the absolute explosion of telehealth, and it’s not just stars , it’s also the risk adjustable nature of telehealth that CMS gave plans during the pandemic that drove that map to telehealth exploding. _AIS HEALTH: HOW DO YOU SEE COVID IMPACTING CAHPS RESPONSES THAT WERE COLLECTED FROM MARCH TO MAY?_ _SMITH:_ Telehealth got us through the summer months but by the end of the year, virtually all of our provider community claims they were back to routine course of business with masks. So when you think about it from a CAHPS standpoint, the question in my mind is, how much will the member attribute COVID in their response? Will the member say, I couldn’t get appointments, tests, treatment, drugs because they felt like they couldn’t leave their home or will they just see that as that was all of us, that was just COVID? _AIS HEALTH: HOW ARE YOU SEEING MEMBER ENGAGEMENT TACTICS CHANGE TO ACCOUNT FOR THE INCREASED WEIGHT OF CAHPS MEASURES? _ _SMITH:_ First and foremost, more robust member engagement. We’re seeing plans begin to modernize their efforts in ways that truly reach their entire population — everyone from unhappy members…to very engaged members. So I’ve been with my clients on a couple things, and first is to recognize the reality that you’re probably going to have to blend in digital engagement to human engagement in order to accomplish that at scale. And the use of digital engagement for things like CAHPS interventions then allows us to really treat CAHPS measure monitoring improvement the same mathematized way we treat HEDIS and PDE measures as gaps incare.
_AIS HEALTH: CAN YOU PROVIDE AN EXAMPLE OF A DIGITAL ENGAGEMENT STRATEGY IN THAT AREA?_ _SMITH:_ My favorite example for digital engagement is to deploy a mock CAHPS survey to your members that they can just fill out on their phone. We then use their data to identify the members with poor responses at which point we call that a gap in care, the same way we would have categorized a missing mammogram or a missing eye exam as a gap in care, and then we deploy a phone call or a personal home visit or appointment scheduling assistant to resolve that gap in care they reported to us during their digital mock CAHPS survey. And in the digital world you can do that entire exercise in under a 24-hour cycle, because once the member submits the digital survey response data, if you’ve got the right administrative platform, you can surface the gap up to the right doctor or the right internal staff member that very same day. _by Lauren Flynn Kelly_ _A longer version of this story appeared in the May 20 issue of RADAR on Medicare Advantage._ Click here for a pdf of the full issueREAD MORE READ LESS
* Uncategorized
Link
Preview: RADAR on Medicare Advantage CMMI WIDENS DIRECT CONTRACTING POOL WITH NEXTGEN ACOSJune 3, 2021
In a move that was not entirely unexpected but irked one leading value-based provider group, CMS recently said it plans to discontinue the Next Generation ACO Model next year and instead allow NextGen ACOs to apply for the Global and Professional Direct Contracting (GPDC) Model for 2022. At least four Medicare Advantage insurers have Direct Contracting Entities (DCEs) that are serving fee-for-service (FFS) Medicare beneficiaries through the GPDC, which launched April 1.
And while CMS is not taking applications from other new DCEs at this time, experts say there is still strong MA plan interest in the GPDC, and they should not discount the possibility that the applicant pool will open again, albeit with a few possible tweaks. In a move that was not entirely unexpected but irked one leading value-based provider group, CMS recently said it plans to discontinue the Next Generation ACO Model next year and instead allow NextGen ACOs to apply for the Global and Professional Direct Contracting (GPDC) Model for 2022. At least four Medicare Advantage insurers have Direct Contracting Entities (DCEs) that are serving fee-for-service (FFS) Medicare beneficiaries through the GPDC, which launched April 1.
And while CMS is not taking applications from other new DCEs at this time, experts say there is still strong MA plan interest in the GPDC, and they should not discount the possibility that the applicant pool will open again, albeit with a few possible tweaks. In an email sent to participating NextGen ACOs on May 21, CMS said it will end the Center for Medicare and Medicaid Innovation (CMMI) model on Dec. 31 and invited the organizations to apply to join the GPDC starting in performance year 2022 as a Standard Direct Contracting Entity. One of three options for participating in the model, Standard DCEs are composed of organizations that generally have experience serving FFS beneficiaries, including Medicare-only and dual-eligiblebeneficiaries.
America’s Physician Groups (APG), along with its Direct Contracting Coalition members, applauded the move, noting that many organizations had invested “considerable resources” in being able to apply forthe GPDC in 2022.
Unlock the full version of this article by subscribing. Log in | Learn MoreREAD MORE READ LESS
* Medicare and Medicaid* Preview
Link
Preview: RADAR on Medicare Advantage ANTHEM IS SECOND INSURER TO REFUTE OIG RISK SCORE REVIEWJune 3, 2021
In the second example in recent months of a Medicare Advantage insurer disputing the federal government’s method of identifying overpayments, a new HHS Office of Inspector General audit report limited its review to a group of diagnosis codes that it maintained are at a particular risk for being miscoded. In addition to having routine medical record review and auditing activities, MA plan sponsors should take extra precautions to identify provider trends in this high-risk group for more accurate risk adjustment, one industryexpert suggests.
Conducted separately from CMS’s contract-level Risk Adjustment Data Validation (RADV) audits that verify the accuracy of payments made to MA organizations, the recent findings are part of a series of audits in which OIG is reviewing the accuracy of diagnosis codes submitted to CMS. In a similar report released in April, OIG estimated that Humana Inc. received nearly $200 million in net overpayments for a contract serving approximately 485,000 enrollees. Humana at the time disputed the findings and said it would have the right to appeal “if CMS does determine that an overpayment exists.” In the second example in recent months of a Medicare Advantage insurer disputing the federal government’s method of identifying overpayments, a new HHS Office of Inspector General audit report limited its review to a group of diagnosis codes that it maintained are at a particular risk for being miscoded. In addition to having routine medical record review and auditing activities, MA plan sponsors should take extra precautions to identify provider trends in this high-risk group for more accurate risk adjustment, one industryexpert suggests.
Conducted separately from CMS’s contract-level Risk Adjustment Data Validation (RADV) audits that verify the accuracy of payments made to MA organizations, the recent findings are part of a series of audits in which OIG is reviewing the accuracy of diagnosis codes submitted to CMS. In a similar report released in April, OIG estimated that Humana Inc. received nearly $200 million in net overpayments for a contract serving approximately 485,000 enrollees. Humana at the time disputed the findings and said it would have the right to appeal “if CMS does determine that an overpayment exists.” Unlock the full version of this article by subscribing. Log in | Learn MoreREAD MORE READ LESS
* Medicare and Medicaid* Preview
Link
Preview: RADAR on Medicare AdvantageNEWS BRIEFS
June 3, 2021
✦ _PRESIDENT JOE BIDEN’S 2022 FISCAL YEAR BUDGET PLAN INCLUDES MULTIPLE HEALTH CARE-RELATED ASKS AIMED AT IMPROVING MEDICARE, MEDICAID AND AFFORDABLE CARE ACT COVERAGE._ The budget calls for, among other things, lowering the Medicare eligibility age to 60, enhancing access to supplemental benefits such as dental and hearing in Medicare, and providing “premium-free, Medicaid-like coverage” through a federal public option in states that have not expanded Medicaid, while financial incentives would remain in place to ensure states keep their existing expansions. ✦ _PRESIDENT JOE BIDEN’S 2022 FISCAL YEAR BUDGET PLAN INCLUDES MULTIPLE HEALTH CARE-RELATED ASKS AIMED AT IMPROVING MEDICARE, MEDICAID AND AFFORDABLE CARE ACT COVERAGE._ The budget calls for, among other things, lowering the Medicare eligibility age to 60, enhancing access to supplemental benefits such as dental and hearing in Medicare, and providing “premium-free, Medicaid-like coverage” through a federal public option in states that have not expanded Medicaid, while financial incentives would remain in place to ensure states keep their existing expansions. ✦ _THE SENATE ON MAY 25 CONFIRMED CHIQUITA BROOKS-LASURE AS THE NEW ADMINISTRATOR FOR CMS. _The Obama-era policy adviser, who was most recently a managing director with professional services firm Manatt, will be instrumental in carrying out President Joe Biden’s goals of building on the Affordable Care Act (ACA) to improve coverage and controlling prescription drug costs. Matt Eyles, president and CEO of America’s Health Insurance Plans, said the insurer trade group looks forward to “working with Brooks- LaSure to strengthen and improve Medicare, Medicaid, and ACA marketplace coverage.” Unlock the full version of this article by subscribing. Log in | Learn MoreREAD MORE READ LESS
* Medicare and Medicaid* News Briefs
* Preview
Link
← Older posts
MOST RECENT
*
NEVADA PUBLIC OPTION WILL MAKE PAYERS, PROVIDERS ‘SWEAT’*
SURVEY: VIRTUAL VISITS INCREASE HEALTH PLAN MEMBER SATISFACTION*
REPORT: HEALTH CARE COSTS DROPPED IN 2020, WILL REBOUND*
MCO STOCK PERFORMANCE, MAY 2021*
AVERAGE BENCHMARK PLAN PREMIUM SLIGHTLY DROPS, INSURER PARTICIPATIONRISES IN 2021
2021 Managed Markets Insight & Technology, LLC | support@aishealth.com | 267-751-3130__
__
Details
Copyright © 2024 ArchiveBay.com. All rights reserved. Terms of Use | Privacy Policy | DMCA | 2021 | Feedback | Advertising | RSS 2.0