Two unnamed Medicaid managed care organizations (MCOs) in Arizona showed significant access control and configuration vulnerabilities in a Nov. 23 security review by the Office of Inspector General (OIG). Officials identified 19 different security...Arizona News
Arizona’s State House Health and Human Services Committee got an influx of new representatives and is still dominated by the GOP. The State Senate Health and Human Services Committee also released its 2019 roster with six new names.
Rep. Nancy Barto (R) will serve as the chair of the House committee and is a new member but no...Arizona News
Last week, the Centers for Medicare and Medicaid Services (CMS) released four State Empowerment and Relief waiver concepts for states to utilize under the Affordable Care Act’s (ACA) section 1332. CMS aims to encourage innovation and reduce burdens with the waivers, an action commended by Health and Human Services (HHS) secretary Alex...National News
The ink is barely dry on its $69 billion merger with Aetna and now CVS drops the news on its new Guaranteed Net Cost pricing model designed to simplify the financial arrangements underlying PBM contracts. CVS said it can deliver savings through PBM cost management strategies such as formulary, utilization management and performance...Arizona News
Insurance is evolving and Minneapolis-based Bright Health is a testament to the confidence shift toward technology-centered insurers. The healthcare startup just closed its largest funding round yet, totaling $200 million, a series C pool of capital that raised more money than expected.
Bright Health may be new in an industry...Arizona News
Mark Dewane will now chair the five-member board that oversees Maricopa Integrated Health System (MIHS), which includes Maricopa Medical Center, McDowell Healthcare Center, the Refugee Women’s Health Clinic, the Arizona Children’s Center, two behavioral health centers, and a dozen neighborhood Family Health Centers.
Chairman...National News
Megan Callahan, former chief strategy officer for McKesson was hired as Lyft's health lead as the company grows its healthcare business that focuses on aiding patients to get to their medical appointments on time.
There is buzz the company may go public in 2019 and Lyft may be looking to hike up revenues in the interim. CNBC...Arizona News
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to lower prescription drug costs for beneficiaries by making changes to Medicare Part D. The proposal could give insurers negotiating powers on drug prices by offering an expectation that plans would implement broader use of prior authorization (PA)...National News
One of the nation's pharmacy giants merges with one of the biggest health insurers with a vision of improving healthcare.
When announcing the deal on Wednesday, CVS Health President and CEO Larry Merlo said,
Today marks the start of a new day in health care and a transformative moment for our company and our industry. By delivering...Arizona News
The new, revolutionary treatment is only available at 175 hospitals across the nation.
This week, The Wall Street Journal reported on the challenges stroke victims face when a comprehensive stroke center isn't in the neighborhood.
Quoting Ryan McTaggart, director of interventional neuroradiology at Rhode Island Hospital,
There is...Arizona News
Democrats took the House during midterm elections, leaving a divided Congress to take on legislation. Healthcare policies and ideas were big ticket items on the campaign trail and Democrats are eager to implement their plans.
According to a CNN's exit polling, 41 percent of respondents said healthcare was the most important issue...Arizona News
After years of litigation, settlements and agreements, a judge presiding over the legal settlement concerning the quality of inmate care in Arizona’s prisons has raised the possibility of throwing out the four-year agreement and resuming with litigations.
This follows the state’s continuous noncompliance with the mandates...Arizona News
The California Attorney Generals office gave Dignity Health and Catholic Health Initiatives (CHI) conditional approval to merge and create a non-profit health system--CommonSpirit Health. Last November the two hospitals signed an agreement to combine operations following a year of negotiations.
CommonSpirit Health will include...Arizona News
Athletic Incident Management System (AIMS) was developed by Mayo Clinic Arizona sports neurology and concussion program co-director Jennifer Wethe, PhD. The program collects data on brain injuries, educates parents and young athletes on concussions and can help keep children safe and improve recovery after injuries. US Soccer...Arizona News
The Department of Homeland Security announced the proposal of a “public charge” in September that if enacted, would authorize the government to issue penalties to immigrants using federal programs such as Medicare or Medicaid funded through taxpayer-dollars.
A “public charge” assesses the likeliness of an immigrant being...National News
For the first time in eight years, the 2018 Medicare fee-for-service improper payment rate has seen a decline of over $4.5 billion and a drop in home health improper payments is a big contributor to the lower rate.
The rate was at 9.51 percent in 2017 and is now at 8.12 percent. This is the lowest the improper payment rate has...Arizona News
This enrollment period marks the first where individuals will not incur penalties for failing to purchase health insurance coverage and compared to last year's numbers, Affordable Care Act (ACA) enrollment has declined by eight percent in its first two weeks.
With more insurers entering the individual marketplace and incumbents...National News
The proposed rule follows a final rule published earlier this month that says it "will provide conscience protections for Americans who have a religious or moral objection to health insurance that covers contraception methods."
The proposal allows women with employer-based insurance that excludes contraceptives to attain them under...National News
According to the American Medical Association the words patients and physicians use to describe the current prior authorization process: Time-consuming, tedious and horrendous.
During its annual meeting of delegates, The American Medical Association announced it wants government officials to carefully consider evidence that prior...National News
Caring for more than 1 million employees requires lots of dealmaking; the retail giant is launching insurance products tied to value-based contracts.
Walmart works with ACOs linked to Banner Health in Arizona and last month the retailer partnered with Ochsner Accountable Care to offer a plan to workers in the New Orleans Metro, Baton...Arizona News
The statewide, multiyear agreement impacts about 2,000 physicians in Arizona practicing at Banner Health, Dignity Health and HonorHealth hospitals.
While Envision clinicians will be in-network for Cigna’s commercial, Medicare and individual plan customers in Arizona, UnitedHealthcare and Envision are facing a termination of their...Arizona News
Originally created to ensure Medicaid beneficiaries with a serious mental illness (SMI) weren't warehoused in facilities by the government, the IMD exclusion means state Medicaid agencies can't pay for mental healthcare services received in a residential treatment center with more than 16 beds.
This week, (November 13) Medicaid...National News
An internal study released Tuesday shows Humana’s shift from the traditional fee-for-service (FFS) model to value-based care is cutting costs and improving quality of care for seniors enrolled in its Medicare Advantage (MA) plans.
The study found medical costs were almost 16 percent lower for seniors enrolled in Humana MA plans...Arizona News
All eyes will most likely be on the Centers for Medicare and Medicaid Services (CMS) as the agency sparks conversation of possibly using Medicaid to pay for housing. Healthcare is continuing its move toward value-based care and judging by a speech delivered by Health and Human Services (HHS) Secretary Alex Azar last week, the government...
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The Hertel Report
