The Centers for Medicare and Medicaid Services has finalized a rule intended to make prices more transparent with Medicare Part D drug plans and allow plan sponsors to use cost-cutting tools such as step therapy under certain circumstances.
"CMS is delivering on price transparency, because patients have a right to know the cost of...National News
Across the nation, hospitals treating patients with private health insurance were paid overall 2.4 times the Medicare rates in 2017, according to the RAND analysis. The difference was largest for outpatient care, where private prices were almost triple what Medicare would have paid. The study illustrates the widening chasm between what...National News
The Centers for Medicare and Medicaid Services (CMS) acknowledged the importance of social determinants of health in a Wednesday blog post encouraging healthcare providers to utilize new resources and data-driven approaches to addressing non-clinical factors.
The blog post, by Cara James, director of the CMS office of Minority...Arizona News
Health clinics in Safeway stores across Arizona have gone completely automated, combining artificial intelligence, augmented reality and telemedicine to offer healthcare services in under 30 minutes. Patients worried about an injury or potential illness provide their physical information to a computerized program armed with artificial...National News
Debates on restructuring the nation’s healthcare system could not have hit its peak at a more appropriate time. The financial future of Medicare and Social Security, two of the nation’s pillar government programs, looks grim and in less than a decade Medicare could potentially become insolvent—already slated to run a deficit by...National News
Payment rates will increase an average of 2.53 percent for 2020. This new rate is 1.53 percent higher than originally projected due to new estimates of medical cost growth, but less than the 3.4 percent raise MA plans were given in 2019.
Also included in the proposal is a loosening of the non-health related supplemental benefits...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
Anthem individual insurance plans bid goodbye to Affordable Care Act (ACA) markets across the nation to focus on the growth of its Medicare Advantage business, an experience more sweet than bitter; the insurance giant's third quarter profits were up 29 percent, year over year.
Enrollment in Anthem's insurance plans may have taken...Arizona News
As the midterm elections are right around the corner, healthcare is on the minds of many; politicians and voters alike. The news cycle this week is marred with a slew of "he said, she said" pieces, Republicans pointing condemning fingers at the policies of Democrats and vice versa. The question is not "why healthcare", however, but "what...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
The National Committee for Quality Assurance ranked over 1,000 health plans on measures of quality, member satisfaction and the committee's survey accreditation results. The ratings aim to highlight patient care outcomes and how patients feel toward those outcomes and the care they are receiving.
The highest performing plans...Arizona News
An Avalere analysis of accountable care organizations (ACOs) found that ACOs in the Medicare Shared Savings Program (MSSP) accumulate more savings as their experience grows. ACOs in the program for four years or more accounted for nearly all of the $317 in savings reported in 2017.
As of 2018, over 10.5 million Medicare...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...News
In 2011 Medicare agreed to pay for a minimally invasive surgical procedure--transcatheter aortic valve replacement (TAVR)--that replaces leaky heart valves through the blood vessels, aiming to offer relief for patients who were in too much of a fragile state for more invasive procedures like open heart surgery.
The catch is that...National News
Congress has shown a vested interest to start modernizing Stark Law to support the Medicare reimbursement transition to a value-based system.
In a hearing last week, U.S. House of Representatives' Ways and Means Committee Subcommittee on Health expressed their dedication to making necessary changes to update the law that prohibits...National News
The Trump administration's Medicare proposals could mean big changes how physicians are compensated. A standard cold and Stage 4 cancer would offer doctors identical payments regardless of a patient's medical complexities.
Essentially, the government would pay one of two rates depending on if the patient is new--higher rate--or...National News
The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patient Communities Act received an overwhelming amount of support from representatives, passing in a 396-14 vote.
This legislation approved by the House on Friday will give various federal agencies the resources they need to combat...National News
The new model may save the Medicare program more than $180 million by keeping beneficiaries healthy and averting new cases of diabetes.
According to CMS, Medicare spends more than $104 billion every year treating patients with this preventable disease.
The Medicare diabetes prevention program was launched in 2012 as a small,...Arizona News
Banner Health has agreed to pay the United States over $18 million to settle allegations that 12 of its hospitals in Arizona and Colorado knowingly submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis.
The settlement resolves allegations that 12 Banner Health hospitals...Arizona News
Effective immediately, Health Net will not be quoting any more new business for small and large business health plans.
Health Net stated in a letter to brokers:
We want you to know that Health Net will honor all current group contracts and continue to provide high quality service to our members. Employer groups and members will...