Commercial and Medicare Advantage (MA) health insurance markets saw differing concentration trends in 2021.
The 2021 American Medical Association Competition in Health Insurance report found that 75% of the 383 metropolitan statistical area (MSA)-level markets were highly concentrated, up from 73% in 2020 and 71% in 2014. In 91% of...
There will likely be a winter surge of COVID-19 in the next few months, but Americans aren't receiving the bivalent booster shot that targets Omicron variants.
The daily global COVID-19 infection rate is expected to rise by two million daily cases by February, according to an analysis from the University of Washington. Reuters notes...
The American Hospital Association (AHA) and the American Medical Association (AMA) will end a legal challenge to federal rules on surprise billing arbitration but intend to file another suit in the future.
The suit was filed against the federal government last December, with the aggrieved parties arguing that the surprise billing...National News
Cigna contracts with MultiPlan, the largest PPO network in the country. The insurer was accused of intentionally underpaying provider claims and increasing administrative fees in a lawsuit filed in a Connecticut federal court.
The American Medical Association joined the Medical Society of New Jersey and the Washington State Medical...CMS Rules
The No Surprises Act has been a hot-button point of contention among insurers and providers as physician groups feel threatened by the leverage that insurers are given through the Act's enforcement. The Medical Group Management Association (MGMA) sent a letter to the U.S. Department of Health and Human Services (HHS) and the Centers for...National News
Medicare Advantage prior authorization reform has strong support as legislation passed through the U.S. House Ways and Means Committee last Wednesday with unanimous support.
Representative Suzan DelBene (D-Wash.), who introduced the Improving Seniors Timely Access to Care Act, said the committee vote sets the stage for a floor vote...National News
Millions of Americans in desperate need of behavioral and mental health services have turned to web-based apps like Betterhelp to find quick access to therapy, but they may not be as useful as advertised. In response to the failures of these apps and the rapidly increasing behavioral healthcare crisis, physicians are mobilizing to call...
According to USA Today, The United States of America represented 16% of the world deaths, while only representing 4% of the world population. Of countries with at least 5 million cases, the US is third in deaths per 1000 at 303. "First" on the list is Brazil with 313 and next is Poland with 307. Canada had 105 deaths per thousand and...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule for Medicare Advantage (MA) that increases the agency's efforts to provide oversight to participating plans.
The rule includes new reasons for denying contracts or expanding contracts based on past performance. Modern Healthcare...
The No Surprises Act, a law that aims to protect Americans covered by private health plans from receiving surprise medical bills relating to emergency services or non-emergency services from out-of-network providers at in-network facilities, has been met with trouble since its implementation at the beginning of the year.
In February,...
The increasing burden of prior authorization, as well as the rise of “fail first” policies has become costly and harmful for patients – so much so that the American Medical Association (AMA) has engaged a law firm to pursue curtailing prior authorization.
According to the American Journal of Managed Care (AJMA), Barbara...
A federal judge for the eastern district of Texas struck down a controversial aspect of the No Surprises Act last week, leaving in place protections for patients but siding with providers that a qualifying payment amount is not the appropriate out-of-network rate.
The No Surprises act formally went into effect on January 1 of this...National News
As the national health care worker (HCW) shortage heightens, industry advocates and Congress are searching for solutions to the behavioral health crisis. From merging telehealth programs to increasing Medicaid reimbursement for youth behavioral health services, the field has an increasing number of complex issues that require...
In a public statement on January 27, 2022, the American Hospital Association (AHA), American Medical Association (AMA) and the American Nurses Association (ANA) urged as many people as possible to donate blood. The pandemic's impact has driven down donations in communities once relied upon for large donations just as the current surge...
Following the success of Republican efforts to criminalize abortion across the country and the Supreme Court of the United States signaling that it may overturn the 1974 landmark decision Roe v. Wade, which legalized abortion, the Republicans in the Arizona State Legislature and anti-abortion advocates are wasting no time moving their...National News
The American Hospital Association (AHA) and American Medical Association (AMA) have sued the federal government over the implementation of the federal surprise billing law – specifically, a provision of a rule set to take effect January 1, 2022.
Both associations assert the provision ignores the No Surprises Act and would result...Arizona News
The Build Back Better Act (BBB) will be reviewed by Democrats in the Senate Finance and Health, Education, Labor and Pensions (HELP) committees this week, ahead of formal negotiations with the Senate parliamentarian over the "Byrd bath," a bipartisan meeting in which items from the budget reconciliation bill that do not directly impact...
Cases of COVID-19 appear to be on the downward trend nationally, as the number of new cases on October 12 falls to 111,707. Last month at this time, the surge related to the Delta variant of COVID-19 was at its worst with a seven-day average of over 175,000 new cases per day. There were 1,938 new deaths related to the coronavirus on...
The 20th edition of the American Medical Association’s (AMA) Competition in Health Insurance report published Tuesday finds 73% of MSA-level markets to be highly concentrated. In 91% of markets, at least one insurer had a market share of at least 30% and in 46% of markets, one insurer had a share of 50% or more.
The AMA report...National News
A new bill introduced by Representatives Suzan DelBene (D-Wash.), Peter Welch (D-Vt.), Darin LaHood (R-Ill.) and Brad Wenstrup (R-Ohio) looks to reverese Trump-era modifications to the Medicare Accountable Care Organization (ACO) program and restore higher cost savings to participating providers while removing some of the risk. The bill...
