Cigna announced it is undertaking a major business expansion in the Medicare Advantage space at the JPMorgan Healthcare Conference. Big name companies in the health insurance market are also looking to expand into other regions to offer more of their Medicare Advantage benefits.
Cigna CEO David Cordani commented on the expansion...Arizona News
UnitedHealth Group launched its concierge service, Navigate4Me just last year. The insurer already significantly expanded the services it offers to its Medicare Advantage enrollees.
The service started with just 12 navigators and has expanded to over 800 consisting of nurses and customer service advocates supporting 215,000...National News
UnitedHealthcare won its case over a 2014 rule implemented by the Centers for Medicare and Medicaid Services (CMS) requiring that Medicare Advantage organizations report and return any identified overpayments. The rule was deemed arbitrary and capricious.
U.S. District Court Judge Rosemary Collyer vacated the rule in its entirety,...Arizona News
San Francisco-based Clover Health plans to launch Medicare Advantage plans in six new cities in 2019, including Tucson, Arizona. Like Oscar Health, Clover is technology focused and uses data analytics as well as artificial intelligence to better serve its patient population.
Oscar Health, the newest ACA exchange insurer to enter...National News
Google's parent organization, Alphabet, recently invested approximately $375 million in tech-centered payer Oscar Health--giving them ten percent stake in the company. Oscar has secured funding from Capital G and Verily prior (a $165 million funding round), both financed by Alphabet, but this large sum of dough will give means to launch...Arizona News
Humana took a $790 million hit after selling off long-time subsidiary KMG America Corporation, but beat analyst estimates with a reported $16 million increase in operating cash flows over the last year.
In a second quarter earnings call on Aug. 1, executive at Humana Brian A. Kane acknowledged the losses incurred from the KMG...National News
A couple of Medicare Advantage (MA) policy changes implemented earlier this year point to MA insurers as the perfect candidates to pay for senior living services as part of new supplementary benefits.
Medicare Advantage allows government Medicare dollars to go through private insurers that in turn offer seniors benefit packages as...National News
Medicare Advantage plans have faced obstacles providing customized care for complex and seriously ill patients, but a recent report found it was primed to provide innovative ways to improve care for the seriously ill.
A report published by the Margolis Center for Health Policy at Duke University found "Medicare Advantage’s...National News
The Healthcare Effectiveness Data and Information Set (HEDIS) is a popular performance improvement tool among health plans, for which four new measures were released by the National Committee for Quality Assurance (NCQA) for 2019.
According to the NCQA, the updates address "emerging health priorities and evolving processes in care...National News
Currently, researchers have access only to Medicare claims data for the fee-for-service program.
Release of Medicare Advantage data will provide a more comprehensive view of care provided to Medicare beneficiaries, said Verma at last week’s Health Datapalooza conference in Washington. Health Data Management quotes CMS Administrator...National News
Ride-sharing services Uber and Lyft may see big gains.
The Centers for Medicare & Medicaid Services (CMS) finalized polices for Medicare health and drug plans for 2019 that will save Medicare beneficiaries money on prescription drugs while offering additional plan choices.
In the press release, CMS Administrator Seema Verma...National News
Medicare ranks plans on a five-star quality scale and provides financial bonuses to providers of top-ranked plans.
When a Medicare Advantage plan is not in line to receive a financial bonus, health insurance companies will merge those patients into plans with higher scores, which preserves the bonuses. Using this tactic, health...National News
CMS said it will increase payments to privately run health plans for the elderly by an average of 3.4 percent next year, almost double the amount it had previously estimated.
Insurers such as UnitedHealth Group Inc. and Humana Inc. have big lines of business selling Medicare Advantage plans. Including changes based on how sick or...National News
Justice Department claimed the insurer obtained more than $1 billion from Medicare based on inaccurate information. Judge disagreed. United counter sues.
Reuters is referenced in a Becker's Hospital Review report. The original False Claims Act lawsuit claimed UnitedHealth received at least $1 billion in Medicare reimbursement by...National News
Medicare Advantage enrollment is projected to rise to 38 million, or 50% market penetration, by the end of 2025.
Anthem, Humana and WellCare Health Plans are signaling plans to aggressively grow their Medicare Advantage businesses with the help of mergers and acquisitions. The three health insurers are in a competitive battle with...National News
The Omaha-based carrier plans to offer Medicare Advantage plans with a prescription drug benefit in selected markets.
Mutual of Omaha announces a strategic alliance with Lumeris, a company with over 10 years of experience with Medicare Advantage plans using a successful, collaborative payer model to deliver better clinical outcomes...
L.E.K. Consultants release white paper after in-depth analysis.
L.E.K. Consulting’s proprietary county-level projection model shows Medicare Advantage enrollment rising from roughly 20 million, or 35% penetration, at the end of 2017 to approximately 38 million, or 50% penetration, by the end of 2025. Nor will it stop there....
Narrow networks are already the norm in Medicare Advantage and ACA exchange plans.
Narrow networks are open only to providers and hospitals that agree to meet specific quality requirements and likely accept lower reimbursements. The theory is to offer higher value care at a lower cost.
Payers and employers using narrow networks...National News
Payment reform is critical to building a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.
The Health Care Payment Learning & Action Network (LAN), is a public-private partnership launched in March 2015 to drive adoption and alignment of Alternative Payment Models...National News
Supporters say care is better, detractors say access to specialists is difficult.
The Government Accountability Office, the auditing arm of Congress, looked at 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to "preferred...
