UnitedHealthcare can’t have its cake and eat it too. That’s the message from the California health insurance marketplace, which turned aside a request from the nation’s largest health insurer to sell statewide on the exchange because it opted not to join when the effort was getting off the ground in 2014. California is one of […]
Anthem experienced a major data breach last week, and reportedly some records (Social Security Numbers and other identifying information, but not health data) of up to 80 million members and employees were obtained by hackers. There is much to be said (and much has already been said) about the need for privacy and security and protections […]
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
Square peg, round hole. More than a third of silver plans offered on the federal health insurance marketplace may be listing inaccurate or incomplete prescription drug cost-sharing information because their formularies don’t fit neatly into the federal government’s online template, a recent analysis found. Healthcare.gov is the online gateway for consumers in 37 states to compare […]
They used to call high deductible health plans “consumer-directed” plans. That was before people realized there is nothing particularly consumer driven about them. A recent poll –not the first of its kind– shows that people with high deductible plans tend to forego care. In fact they skip both unneeded and needed care. Most people don’t like the […]
The majority of people who signed up for Medicare Advantage plans in recent years were switching out of the traditional Medicare program, according to a recent study. The findings contradict the popular belief that growth in Medicare Advantage has been fueled primarily by people who choose it when they first become eligible for Medicare. The […]
In health insurance prices, as in the weather, Alaska and the Sun Belt are extremes. This year Alaska is the most expensive health insurance market for people who do not get coverage through their employers, while Phoenix, Albuquerque, N.M., and Tucson, Ariz., are among the very cheapest. In this second year of the insurance marketplaces […]
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
CMS yesterday announced that 89 new accountable care organizations were formed to join the Shared Savings Programs, bringing the total of such ACOs to 405 that serve more than 7.2 million patients. In 2014, existing Shared Savings Program ACOs added almost 17,000 healthcare providers, and the 89 new ACOs will bring approximately 23,000 additional physicians […]
Health systems that have adopted the Shared Savings model ACOs could have an additional three years before being financially penalized for poor performance under a new proposal by CMS, Kaiser Health News reported. The proposal “is one of dozens of changes” put forth by CMS in attempt to ease rules governing ACOs established under the […]
Hill Physicians Medical Group, which has 3,800 physician providers, has joined Anthem Blue Cross‘s ACO network in California as part of an effort by both organizations to reduce costs through the increased use of PPOs. Anthem’s ACO specifically targets members with two or more chronic conditions to help them better maintain overall health through care […]
CMS today unveiled a new, $114 million investment initiative for Shared Savings ACOs, prompted by efforts to improve coordination and health IT efforts. Specifically, the new ACO initiative is geared toward the more rural and underserved regions, with the $114 million going toward 75 ACOs across the country, according to CMS. Overseen by the CMS […]
Gabby Everett, the site director for BioLabs Pegasus Park, offered a tour of the space and shared some examples of why early-stage life science companies should choose North Texas.
Yet another Pioneer ACO has decided to bow out of the program overseen by CMS, this time in Indiana, with Franciscan St. Francis Health dropping out despite being among the top nationally ranked ACOs that in 2012 earned a bonus of $6.6 million. The Indianapolis Business Journal reports that, despite that seeming promise, Franciscan said it […]
Healthcare organizations that are adept at handling stressful situations can often be the most successful ACOs because of the initial risk and new environment, which can quickly sink other organizations more likely to seek the status quo. That’s according to Hoangmai Pham, director of Seamless Care Models Groups for the CMS Innovation Center, speaking on […]
Accountable care organizations could be the best way to reduce the cost of managing patients with chronic conditions in a sustainable way. But in a talk at the ENGAGE conference in Bethesda, Maryland this week, Farzad Mostashari stressed that ACOs need to be good for patients, society and physicians or the model will fail. Mostashari […]
A bill moving its ways through Congress would promote expanded use of telehealth offerings among ACOs, an issue hindered by current fee-for-service payment model, according to the bill’s sponsors. The bill, HR 5558, was introduced by Reps. Diane Black (R-Tenn) and Peter Welch (D-Vt). The legislation would allow ACOs to utilize remote patient monitoring tools […]
Apollo Medical Holdings, which operates a Southern California physician-led ACO, says it has generated nearly $11 million in savings, of which about half will go back to Apollo. Apollo is part of the shared savings ACOs, which together with the Pioneer ACOs have produced $372 million in savings, according to recently released data from CMS. […]