Payers
Healthcare Spending Burden Is Higher for Medicare Households than Non-Medicare Households
On average, Medicare households spent 15% of their total spending on health-related expenses in 2021, versus 7% for non-Medicare households, according to a new KFF report.
Medicaid MCOs Denied 1 out of 8 Prior Authorization Requests in 2019
Medicaid managed care organizations deny prior authorization requests at high rates, according to a recent report by the Office of Inspector General. Of the 115 MCOs the OIG analyzed, 12 had prior authorization denial rates above 25%.
What is the ROI for Conversational AI in Patient Access?
Health systems need to turn their attention to technology that can improve staff retention by reducing employee burnout, according to HCA Divisional CIO Andy Draper. Here’s a look at what Parlance is doing to realize ROI with conversational AI.
Herself Health Secures $26M To Bring Primary Care to Women Ages 65+
自己健康的2600万美元资金roun系列d was led by Michael Cline, founding managing partner of Accretive, and included participation from Juxtapose. It comes six months after Herself Health raised $7 million in seed funding. In total, the company has raised $33 million.
Prominence Health Plan Taps Strive Health for Kidney Care
Prominence Health Medicare Advantage enrollees will have 24/7 access to Strive Health’s specialized care team through a new partnership. Strive Health is also teaming up with Sierra Nevada Specialty Care, a local nephrology clinic in Nevada.
Ticking the Talons of Healthcare Transparency
As of January 1, employer-sponsored Group Health Plans and Health Insurance Issuers must make make the prices of 500 medical services available via an Internet-based tool. The Transparency in Coverage final rule gets even tougher on January 1, 2024, when the prices of all medical services must be made available via an Internet-based tool.
Report: 10 Prescription Drugs Took Up 22% of Medicare Part D Spending in 2021
KFF found that the 10 top-selling Part D drugs represented $47.7 billion of the $215.7 billion total gross Medicare Part D drug spending in 2021. Eliquis, a blood thinner by Bristol Myers Squibb, accounted for the most spending out of these 10 drugs at $12.6 billion.
Health Net Invests $46M To Support Unhoused in California
Health Net is making a $46 million investment that will be spread out across 26 counties in California, and will support Continuum of Care programs, which are regional or local planning bodies that help those experiencing homelessness find housing and other services.
CVS Caremark, GoodRx Launch Program To Lower Drug Costs
CVS Caremark and GoodRx created a new program called Caremark Cost Saver, which will become available starting January 1, 2024. Through the program, eligible CVS Caremark commercially insured members will have access to GoodRx’s prescription pricing on generic medications.
Transforming Claims Denial with AI
Hospitals and health systems, overburdened by pandemic-induced staff shortages, are in need of tech to improve workflows, reduce stress and save money. The claims denial process, which is a significant time suck and prone to errors, is ripe for innovation.
Enhancing Efficiency in your Practices: Unleashing the Power of Greenway Health’s Optimization Services
Resolve your healthcare information technology concerns by optimizing your technology, boosting workflows, improving staff productivity, and driving revenue.
Health Connect America Gets Fined $4.6M for Wrongful Billing of Medicaid
Health Connect America, a mental health company, improperly billed Virginia Medicaid for three different behavioral health services for children, according to the U.S. Attorney’s Office of Western District of Virginia.
Report: MA Enrollees Are More Likely to be Socioeconomically Disadvantaged than Traditional Medicare
The average income of a traditional Medicare enrollee is $85,085, versus $76,720 for a Medicare Advantage enrollee, according to a whitepaper done in partnership between Harvard Medical School and software solutions company Inovalon.
Humana Report: Health-related Social Needs Prevalent Among Dual-eligible and Non-dual-eligible MA Enrollees
A Humana study in Health Affairs found that 80% of dual-eligible beneficiaries had at least one health-related social need in 2019, compared to 48% of non-dual-eligible enrollees. While prevalence was higher in dual-eligible enrollees, non-dual-eligible enrollees shouldn’t be overlooked, researchers said.
Report: Those With Limited English Proficiency Are More Likely to be Uninsured
Of nonelderly people with limited English proficiency in 2021, 29% were uninsured, versus 9% of English proficient people, according to a new KFF analysis.
BioPharma,Hospitals,Legal,Payers,Policy
Hospitals Have Concerns About CMS’ Proposed $9B Lump Sum Payment for Illegal 340B Cuts
CMS recently proposed a $9 billion lump sum payment to remedy illegal payment cuts for 340B drugs from 2018 to 2022. In general, hospital groups have reacted positively to the fact that 340B providers will receive lump sum payments but have expressed concern about CMS’ methods for maintaining budget neutrality with this plan.
Biden Administration Takes Action Against Junk Insurance, Surprise Bills
The Biden Administration is proposing that short-term health plans are limited to three months, or a maximum of four months if they’re extended. It comes after the Trump Administration allowed members to stay on the plans for 12 months and renew them for three years. The plans are often limited in coverage and leave consumers with high medical costs.
Promoted
Your Thought Leaders Should Be Thought-Provoking. Here’s How to Make It Happen
它需要时间去开发一个令人信服的你ght leadership platform. Julia Fuller, Executive Vice President at Ford Hutman Media provides insights, tips, and strategies for companies and industry leaders looking to get ahead and define emerging trends.
Promoted
TriNet Pharma Highlights the Rise of the Medical Science Liaison and Honors Legacy of Its Founder
For those who knew Bryan Vaughan, the late founder of TriNet Pharma, he was an […]
