Utah considers LTC insurance partnership
May, 17 2013
Utah lawmakers are considering following the rest of the country in adopting a long-term care insurance public-private partnership that encourages people to buy private long-term care insurance and offset the use of Medicaid. Read more »
Medicare Advantage managed care plans surpass Medicare FFS outcomes
May, 17 2013
A new analysis of more than 3 million claims for Medicare patients found that patients enrolled in a managed Medicare Advantage plan had better health outcomes than those senior enrolled in the traditional fee-for-service Medicare model. Read more »
IDC looks to provide a roadmap for the continued development of ACOs
May, 17 2013
With recognition that "the path through accountable care is unknown," IDC Health Insights has launched a new Accountable Care Maturity Model, designed to help healthcare organizations gauge their own status and make strategic decisions for funding business and IT initiatives. Read more »
Studies debunk cost-shifting claims
May, 17 2013
One of the principal arguments for passing healthcare reform legislation circled around the theory of cost shifting. In essence, when hospitals care for uninsured patients that don't pay bills, or when they receive low reimbursements for Medicare or Medicaid patients, they charge insurers higher fees to make up for the losses. Read more »
Prosthetics association sues HHS over reimbursement documentation
May, 16 2013
The American Orthotic and Prosthetic Association (AOPA) is suing the Department of Health and Human Services over 2011 rule changes for prosthetic reimbursements requiring physician documentation, which the association claims is wreaking financial havoc on O&P practitioners due to prepayment audits and retroactive application. Read more »
eHealth seeks state HIX enrollment partnerships
May, 15 2013
A Google search for "health insurance" brings eHealthInsurance.com as one of the top results -- one reason, eHealth executives say, that state exchanges should follow the federal government in allowing consumers to enroll in subsidized health plans through private web exchanges like eHealthInsurance. Read more »
Republicans, after failing to fund the ACA, take issue with HHS solicitation
May, 15 2013
As the GOP-controlled House of Representatives prepares again to vote this week on a repeal of the 2010 health law, some key Republican senators have seized on recent news developments to show their ire. Read more »
Feds nab 89 for $223M in alleged Medicare fraud
May, 15 2013
The federal government has uncovered a string of alleged Medicare fraud attempts totalling $223 million and involving 89 individuals in eight cities. Read more »
Colorado CO-OP inks broker deal
May, 14 2013
Colorado HealthOP, the state's consumer operated and oriented plan (CO-OP), has signed an agreement with the broker network Warner Pacific to market its health plans, in the first relationship between agents and state health cooperatives. Read more »
CMS' dual eligible demo savings sources uncertain
May, 14 2013
The Centers for Medicare & Medicaid Services (CMS) is looking to more than a dozen dual eligible demonstrations to fulfill the quality improvement and cost saving aims of the Affordable Care Act, although in the five demonstrations approved so far, the exact sources of projected savings remain largely unclear, according to the Kaiser Family Foundation. Read more »
CMS won't penalize hospitals in states slow to expand Medicaid
May, 14 2013
That sigh of relief you heard Monday was from hospital administrators in nearly two dozen states, including Florida and Texas. Read more »
Value-based payments picking up steam
May, 13 2013
The number of health plans that expect more than half their business will be under value-based models is expected to triple in the next five years according to a new research report released last week by health information network Availity. Read more »
Cigna, MDLive offer 24/7 video consults
May, 10 2013
Cigna has announced that it will enlist the help of MDLIVE, a developer of telehealth technology and services, to offer eligible health plan members round-the-clock online video consultations with internal medicine, family practice and pediatric doctors. Read more »
Congressional Republicans eye Medicaid tweaks
May, 10 2013
Congressional Republicans are proposing new ideas for changing Medicaid, suggesting models based on the 1996 federal welfare reform law, and proposing a bill that would base federal allocations on population size and patient categories. Read more »
Payers struggle with which care quality measures are important
May, 10 2013
Over the years, with such large gaps in hospital safety and quality, many public and private payers have been pushing for greater hospital accountability through clinical quality measurement and reporting initiatives.Kentucky expanding Medicaid eligibility
May, 09 2013
Kentucky will be the 21st state to expand Medicaid eligibility under the Affordable Care Act, Governor Steve Beshear announced Thursday. Read more »
EEOC to issue guidance on wellness programs
May, 09 2013
The U.S. Equal Employment Opportunity Commission (EEOC) is going to offer clarification on wellness programs and federal nondiscrimination compliance, after several business groups and disability advocates asked for guidance on the issue. Read more »
CMS publishes hospital price data
May, 09 2013
In an effort to take the first steps toward a more transparent pricing structure in the U.S. healthcare market, the Center for Medicare & Medicaid Services yesterday published nationwide hospital charge data showing wide variations in how much Medicare pays for services in different markets.Humana names first CMO, adding 500 sales jobs
May, 09 2013
Humana has named its first chief medical officer, Roy Beveridge, MD, an oncologist and internist currently working as CMO at McKesson Specialty Health. Read more »
Cap on insurance exemption would save $264B
May, 08 2013
If Congress pursues tax reform in the near future, one tax expenditure likely to be considered and possibly adjusted is the exemption for employer-sponsored insurance — and it's about time, argue researchers at the Urban Institute. Read more »
Fraud recoveries on the rise
May, 08 2013
GlaxoSmithKline, $3 billion. Abbott Laboratories, $1.5 billion. Merck, $950 million. Senior Care Action Network, $323.7 million. Actavis, $202.6 million. The numbers are eye-popping. Now for the jaw drop: of these top five healthcare False Claims Act settlements in 2012, all were initiated by whistle-blowers.Medical director duties tied to quality
May, 08 2013
In the last few years the scope of responsibilities and duties delegated to medical directors has been evolving to include more responsibility over measures of quality within their healthcare organizations. Read more »
CCIIO details role of brokers on HIXs
May, 07 2013
CMS's Center for Consumer Information and Insurance Oversight (CCIIO) has outlined the roles for traditional insurance brokers and web-based brokers assisting customers in public exchanges. Read more »
Physicians accepting Medicaid patients low
May, 07 2013
An analysis from HealthPocket raises the specter that individuals who obtain health coverage under expanded Medicaid starting in 2014 will have to dig to find a clinician who will treat them. Read more »
Telemedicine's value proposition
May, 07 2013
Ironically, Andrew Watson's first telemedicine procedure was with a rural patient who was a Mennonite. At first, the patient and physician looked at each other warily. Read more »
