Last week, the Centers for Medicare and Medicaid Services (CMS) announced the average premium for benchmark silver plans in the Affordable Care Act (ACA) exchanges dropped by 1.5 percent for the 2019 benefit year - the first premium drop since...Arizona News
An Alternative Payment Model (APM) is one way of delivering value-based care, as the shift from traditional fee-for-service to a value-based payment model continues, programs are continuously looking to serve as a catalyst in offering cost-effective, higher-quality care. APMs incentivize this goal and can apply to an episode, condition,...Arizona News
Medicare Advantage has been dominating healthcare headlines, especially with the start of the annual enrollment period; it is no secret the Medicare alternative pulls monstrous profits, but their means are in question. A study conducted by the Health and Human Services' (HHS) Office of the Inspector General (OIG) found that MA...Arizona News
Last week on Oct. 12, 33-year-old Nicholas White and 60-year-old Jeffrey White, father and son duo pleaded guilty to defrauding Affordable Care Act (ACA) programs out of $27 million across at least 12 states--including Arizona. Both were healthcare professionals out of Twin Peaks, California.
According to the Department of Justice...Arizona News
Last week the Department of Justice gave CVS and Aetna approval for their $69 billion merger on the condition that Aetna sells off its Medicare Part D prescription drug business. Insurers cozying up with the pharmaceutical industry is a growing trend, think: OptumRx and UnitedHealth, or the recent Cigna-Express Scripts...Data Resources
Find out which insurers are participating in Arizona's 2019 MA market including plan type, premium, prescription drug deductibles, MOOP and YOY star rating comparison.
In Arizona, Medicare beneficiaries have more options than ever - MA plan growth is nearly 30 percent in the state and MA special needs plans grew by about 12 percent,...Arizona News
Michael Groeger joins BCBSAZ from Banner-Aetna, where he led the national employer solutions team. Groeger will lead the local insurer's sales team on his home turf, with more than 20 years of experience, Groeger has spent his entire career working in the Arizona health insurance industry.
He also previously served as chief...News
It is not too late to sign up and attend the annual Arizona Medical Group Management Fall Conference at the Sheraton Wild Horse Pass Resort. The event kicks off with a networking happy hour on Wednesday evening, October 17th. Of course, I will be in attendance again this year and look forward to seeing everyone. The agenda...Arizona News
Hospitals say getting paid for previously uninsured folks has saved them from potential closure. The Goldwater Institute says hospitals are raking in the dough by also raising rates on the commercial side.The Arizona Hospital and Healthcare Association (AzHHA) publishes a report that tracks uncompensated care trends for Arizona...National News
The Centers for Medicare and Medicaid Services (CMS) announced on Tuesday, almost 1,300 providers have signed themselves up to test-drive the Bundled Payment for Care Improvements (BPCI) advanced model.
Among the Arizona participants are:
Desert Institute Spine Care
Desert Orthopedic Specialists
Flagstaff Medical...Arizona News
Speaker of the House Paul Ryan, on Monday said "Medicare for all" initiative shows that the Democratic party "has gone off the rails," despite many congressional Democrats not quite so gung-ho about the idea. The "Medicare for all" bill is Sen. Bernie Sanders' crown jewel of healthcare policies, a program that would essentially shift the...National News
The National Association of ACOs (NAACOS) Fall 2018 conference kicked off with a discussion about MSSP ACOs relationships with private payers.
The strategy is payer-neutral - take care of patients regardless of the payer.
According to NAACOS more than 20 million lives are covered under commercial Medicare and Medicaid, and a...Arizona News
Lawyers representing over 34,000 inmates, whom are challenging the quality of healthcare in Arizona's prisons, are looking for another $1.6 million from the state in additional litigations fees. Since filing the lawsuit in March of 2012, the prisoner's attorneys have incurred $6.1 million in legal costs.
Following the 2014...National News
Opposition to the rule was swift, a broad coalition of healthcare organizations and advocacy groups have joined to block the proposal by the Department of Homeland Security.
According to Modern Healthcare, the American Hospital Association, America's Essential Hospitals, the American Academy of Family Physicians, and the American...National News
A final order was issued on Oct. 5 to the Centers for Medicare & Medicaid Services (CMS) to pay Montana Health Co-op over $1.2 million after a Sept. 4 ruling stating insurers are entitled to cost-sharing payments under the Affordable Care Act (ACA).
Judge Elaine Kaplan of the Court of Federal Claims sided with Montana Health...Arizona News
The Office of the Inspector General (OIG) recently discovered $5.7 billion in unreasonable and unnecessary payments to inpatient rehabilitation facilities (IRFs) after a sample audit. The review was prompted by Medicare spending of about $7 billion on IRF stays in 2013, leading the OIG to question the payment system.
The OIG sampled...National News
The Centers for Medicare & Medicaid Services (CMS) issued a notice on Friday, Oct. 5 looking to increase oversight of nursing home staff to ensure attendants are showing up to care for seniors in their home and prevent cases of elderly abuse or unlawful actions.
CMS stated in its notice that it's seeking to propose a rule that...Arizona News
In May, a final rule from the Centers for Medicare & Medicaid Services (CMS) opened the doors for Medicare Advantage (MA) insurers to offer long-term care benefits to members. About 7.5 percent of MA plan enrollees in 2019 may have access to in-home support services or extra benefits, according to CMS officials.
In a speech...Arizona News
The largest orthopedic practice in Arizona adds to its facility list a 6,500 square foot space hosting all orthopedic specialties in the Northeast Valley at 90th Street and Shea Blvd.
In addition to its practice locations, The CORE Institute has physical therapy locations, two spine centers and an orthopedic specialty hospital.
The insurer is seeking 90 full-time employees. Positions are available at its Humana Pharmacy operations center in Glendale; dispensing facility in Phoenix; and call center located in Tempe.
Humana is hiring for Inbound Customer Service Representatives, Utilization Management Administration Coordinators, Pharmacy Technician and...National News
A new analysis from the Association for Community Affiliated Plans (ACAP) focuses on new models implemented by safety-net plans and the best way high-quality coordinated care can be provided for individuals with substance abuse disorder (SUD).
Successfully managing the needs of people with SUD requires a high-level of comprehensive...Arizona News
On Friday, September 28, The Centers for Medicare & Medicaid Services (CMS) announced that Medicare Advantage (MA) premiums will decrease by six percent, on average, in 2019. Additionally, plan choices and new benefits are expected to increase as MA enrollment reaches new highs.
According to a statement from CMS, more than 36...Arizona News
Democratic gubernatorial candidate David Garcia sat down with Maria Polletta, Arizona Republic reporter, on Thursday for a live interview to help Arizonans gain better insight on Garcia's policies and what his administration would look like if voted into office.
Running up against Republican incumbent Gov. Doug Ducey, the...
Solve.Care's blockchain technology and digital currency is adopted by a leading accountable care organization.
The Care.Wallet's physician app displays provider quality data and metrics while tracking overall performance and rewards earned. The application uses Care.Cards within the blockchain system which sync and provide real time...
Former Apple CEO John Sculley spoke out last week about the key role Amazon could play in the healthcare industry. The conglomerate partnership between Amazon, Berkshire Hathaway, and JP Morgan Chase & Co. has turned the heads of many in the three-trillion dollar industry, but little is known as to what exactly they have in store for...