Payers Archives - MedCity News https://medcitynews.com/category/channel/payers/ Healthcare technology news, life science current events Wed, 18 Oct 2023 00:32:16 +0000 en-US hourly 1 https://wordpress.org/?v=6.3.2 https://medcitynews.com/uploads/2021/03/cropped-mblue-32x32.png Payers Archives - MedCity News https://medcitynews.com/category/channel/payers/ 32 32 40682243 Obesity Care Startup Launches With $3M in Funding https://medcitynews.com/2023/10/obesity-startup-funding-launch/ https://medcitynews.com/2023/10/obesity-startup-funding-launch/#respond Tue, 17 Oct 2023 23:29:24 +0000 https://medcitynews.com/?p=652194

Ilant Health launched out of stealth Tuesday. The company serves employers and payers and helps identify patients in need of obesity treatment and matches them to the care best for them.

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11 HLTH Announcements You Don’t Want to Miss https://medcitynews.com/2023/10/hlth-walgreens-uber-google-microsoft-technology-healthcare-ai/ https://medcitynews.com/2023/10/hlth-walgreens-uber-google-microsoft-technology-healthcare-ai/#respond Sun, 15 Oct 2023 18:28:37 +0000 https://medcitynews.com/?p=651912

This year’s HLTH conference brought a bevy of news announcements — from partnerships to new product features to acquisitions and more. In this list, MedCity News compiled short summaries for 11 of the conference’s most notable announcements.

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MedCity FemFwd Podcast: SCAN Inspired With Nancy Monk, Chief Operations Officer of SCAN Health Plan https://medcitynews.com/2023/10/medcity-femfwd-podcast-scan-inspired-with-nancy-monk-chief-operations-officer-of-scan-health-plan/ https://medcitynews.com/2023/10/medcity-femfwd-podcast-scan-inspired-with-nancy-monk-chief-operations-officer-of-scan-health-plan/#respond Thu, 12 Oct 2023 21:50:45 +0000 https://medcitynews.com/?p=651681

In this episode, we discuss SCAN Health Plan’s recent launch of SCAN Inspired, a Medicare Advantage plan designed for women.

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Is Medicare Advantage a Failed Experiment? Experts Debate https://medcitynews.com/2023/10/medicare-advantage-seniors-failed-healthcare/ https://medcitynews.com/2023/10/medicare-advantage-seniors-failed-healthcare/#respond Wed, 11 Oct 2023 22:09:42 +0000 https://medcitynews.com/?p=651540

Enrollment in Medicare Advantage is increasing, but the program has been drawing scrutiny from the government. Can the program be saved? One expert believes Medicare Advantage is a failed experiment. Another thinks that while the program has its flaws, it shows tremendous potential.

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Payer Insights Program Highlights How Payers and Tech Partners Are Thinking About AI, Health Equity, and the Consumer Experience [Sponsored] https://medcitynews.com/2023/10/payer-insights-program-highlights-how-payers-and-tech-partners-are-thinking-about-ai-health-equity-and-the-consumer-experience/ https://medcitynews.com/2023/10/payer-insights-program-highlights-how-payers-and-tech-partners-are-thinking-about-ai-health-equity-and-the-consumer-experience/#respond Wed, 11 Oct 2023 11:19:48 +0000 https://medcitynews.com/?p=651441

HLTH 2023 introduced a new program focused on technology trends for and perspectives from payers in a series of conversations around AI, health equity and healthcare innovation.

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Highmark Health, Spring Health Team Up for Mental Health Solution https://medcitynews.com/2023/10/highmark-mental-health-partnership/ https://medcitynews.com/2023/10/highmark-mental-health-partnership/#respond Tue, 10 Oct 2023 18:50:36 +0000 https://medcitynews.com/?p=651375

Spring Health and Highmark Health are collaborating to launch Mental Well-Being, a solution that offers therapy, medication and other services for some Highmark members.

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Did Cigna Deserve its $172M Penalty? https://medcitynews.com/2023/10/cigna-settlement-medicare-advantage/ https://medcitynews.com/2023/10/cigna-settlement-medicare-advantage/#respond Thu, 05 Oct 2023 21:56:26 +0000 https://medcitynews.com/?p=650952

Cigna recently agreed to pay $172 million to resolve allegations that it violated the False Claims Act. One expert said this is just a small part of the problem, while another called for more clarity from the government.

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Payer’s Place: Camille Harrison, GuideWell, Florida Blue https://medcitynews.com/2023/10/payers-place-camille-harrison-guidewell/ https://medcitynews.com/2023/10/payers-place-camille-harrison-guidewell/#respond Thu, 05 Oct 2023 11:50:04 +0000 https://medcitynews.com/?p=650523

What does the future hold with AI and the healthcare ecosystem? Camille Harrison with GuideWell, Florida Blue joins the Payer’s Place to share her thoughts.

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Individuals Living with Kidney Disease Deserve More From Our Healthcare System https://medcitynews.com/2023/10/individuals-living-with-kidney-disease-deserve-more-from-our-healthcare-system/ https://medcitynews.com/2023/10/individuals-living-with-kidney-disease-deserve-more-from-our-healthcare-system/#respond Wed, 04 Oct 2023 14:22:53 +0000 https://medcitynews.com/?p=647859

Policymakers must work to increase access to the Medicare Kidney Disease Education Benefit and expand the Medicare annual wellness benefit to include kidney disease screening. These reforms will catch disease at earlier stages and equip patients to better recognize their risk.

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A Prescription for Social Needs: Why Human Connection is Medicine https://medcitynews.com/2023/10/a-prescription-for-social-needs-why-human-connection-is-medicine/ https://medcitynews.com/2023/10/a-prescription-for-social-needs-why-human-connection-is-medicine/#respond Mon, 02 Oct 2023 05:03:27 +0000 https://medcitynews.com/?p=646452 help, aid, trust

Weaving companionship into health care as we would a blockbuster drug can help us circumvent expensive healthcare services like emergency department visits and hospitalizations.

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SCAN Announces 10-Year Partnership With ApolloMed, Launches Female-Focused MA Plan https://medcitynews.com/2023/10/medicare-advantage-value-partnership-women/ https://medcitynews.com/2023/10/medicare-advantage-value-partnership-women/#respond Sun, 01 Oct 2023 13:30:17 +0000 https://medcitynews.com/?p=650340

In a value-based partnership with ApolloMed, SCAN is launching a Provider Specific Plan called Compass. It is also announcing a Medicare Advantage plan designed for women called SCAN Inspired.

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Payer’s Place: Dawn Maroney, Alignment Health https://medcitynews.com/2023/09/payers-place-dawn-maroney-alignment-health/ https://medcitynews.com/2023/09/payers-place-dawn-maroney-alignment-health/#respond Fri, 29 Sep 2023 11:50:02 +0000 https://medcitynews.com/?p=649119

CEO of Alignment Health joins the Payer’s Place and details how the growth of Medicare Advantage will only help patients in the future.

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C-SNPs: Promoting Healthcare Focused on Chronic Conditions https://medcitynews.com/2023/09/c-snps-promoting-healthcare-focused-on-chronic-conditions/ https://medcitynews.com/2023/09/c-snps-promoting-healthcare-focused-on-chronic-conditions/#respond Fri, 29 Sep 2023 00:10:16 +0000 https://medcitynews.com/?p=645675

C-SNPs are Medicare Advantage plans formulated to meet the desired needs of people living with chronic diseases. These plans are different from traditional Medicare plans because they’re only available to people who fit the special needs category that the plan serves.

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4 States Received Enhanced Medicaid Funding During Covid Despite Wrongly Terminating Coverage https://medcitynews.com/2023/09/medicaid-federal-funding-oig/ https://medcitynews.com/2023/09/medicaid-federal-funding-oig/#respond Thu, 28 Sep 2023 22:49:23 +0000 https://medcitynews.com/?p=650226 Medicaid, coverage,

New York, Florida, Texas and Minnesota terminated Medicaid coverage for some enrollees for “unallowable or potentially unallowable reasons” during the Covid-19 public health emergency, according to a recent Office of Inspector General report.

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CMS: MA Premiums To Remain the Same for Most Beneficiaries in 2024 https://medcitynews.com/2023/09/cms-medicare-advantage-premiums-open-enrollment/ https://medcitynews.com/2023/09/cms-medicare-advantage-premiums-open-enrollment/#respond Tue, 26 Sep 2023 22:24:00 +0000 https://medcitynews.com/?p=649959

The average monthly plan premium for Medicare Advantage is expected to increase only slightly in 2024 from 2023, CMS said. About 73% of beneficiaries will see no increase at all.

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Study: MA Beneficiaries Have Lower Utilization Than Traditional Medicare https://medcitynews.com/2023/09/study-ma-beneficiaries-have-lower-utilization-than-traditional-medicare/ https://medcitynews.com/2023/09/study-ma-beneficiaries-have-lower-utilization-than-traditional-medicare/#respond Mon, 25 Sep 2023 22:55:33 +0000 https://medcitynews.com/?p=649806

A new study found that MA beneficiaries have more than 50% fewer inpatient stays and 22% fewer emergency department visits than traditional Medicare enrollees.

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How MIPS Value Pathways will Prove the Value of Rehab Therapy https://medcitynews.com/2023/09/how-mips-value-pathways-will-prove-the-value-of-rehab-therapy/ https://medcitynews.com/2023/09/how-mips-value-pathways-will-prove-the-value-of-rehab-therapy/#respond Mon, 25 Sep 2023 05:29:10 +0000 https://medcitynews.com/?p=645648

As value-based care models take hold, the time is ripe for rehab therapists to position themselves as primary players in the movement toward delivering optimal quality and value in the broader healthcare ecosystem.

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Report: 7 Ways Medicare Advantage Is Being Marketed on TV https://medcitynews.com/2023/09/medicare-advantage-advertisements-tv/ https://medcitynews.com/2023/09/medicare-advantage-advertisements-tv/#respond Sun, 24 Sep 2023 13:18:22 +0000 https://medcitynews.com/?p=649593

There are concerns that Medicare Advantage TV ads are misleading patients. A new KFF analysis of Medicare Advantage TV ads found that the ads often rely on celebrity endorsements and suggest that seniors are missing out on benefits that they’re entitled to.

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Is the ‘Age Wave’ An Opportunity or a Challenge? https://medcitynews.com/2023/09/age-wave-medicare-seniors-healthcare/ https://medcitynews.com/2023/09/age-wave-medicare-seniors-healthcare/#respond Thu, 21 Sep 2023 20:29:29 +0000 https://medcitynews.com/?p=649458 aging, senior, old

Americans are getting older, and some healthcare leaders expect this to be a challenge for the healthcare industry. Others, however, think this is an opportunity for the industry to make improvements, such as engaging adults in their care before they turn 65.

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HealthPartners Exec: The 5 Rules To Scale Value-Based Care in the Commercial Market https://medcitynews.com/2023/09/value-based-care-commercial-market/ https://medcitynews.com/2023/09/value-based-care-commercial-market/#respond Wed, 20 Sep 2023 21:02:10 +0000 https://medcitynews.com/?p=649362 consumerism

The commercial market has struggled to adopt value-based care, but HealthPartners has had some success, according to Mark Hansberry, senior vice president and chief marketing officer of the company. During a conference, he shared five rules for scaling value-based care, including creating trust and providing real-time data.

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Breaking Through Gridlock in the Mental Health Care System https://medcitynews.com/2023/09/breaking-through-gridlock-in-the-mental-health-care-system/ https://medcitynews.com/2023/09/breaking-through-gridlock-in-the-mental-health-care-system/#respond Tue, 19 Sep 2023 21:06:31 +0000 https://medcitynews.com/?p=645210

For the gridlock in mental healthcare to be resolved, 100% of mental healthcare providers must practice measurement-based care, utilizing validated rating scales to monitor and measure longitudinal outcomes for every patient. And payers then must offer reimbursement that appropriately rewards providers for delivering high-quality, effective care, and incentivize proactive mental health management.

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Payer’s Place: Dr. Anil Singh, Highmark Health https://medcitynews.com/2023/09/payers-place-dr-anil-singh-highmark-health/ https://medcitynews.com/2023/09/payers-place-dr-anil-singh-highmark-health/#respond Tue, 19 Sep 2023 11:45:34 +0000 https://medcitynews.com/?p=648570

Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.

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Is Medicaid Expansion Still a Political Wedge Issue? https://medcitynews.com/2023/09/medicaid-expansion-political-democrats-republicans/ https://medcitynews.com/2023/09/medicaid-expansion-political-democrats-republicans/#respond Thu, 14 Sep 2023 21:27:47 +0000 https://medcitynews.com/?p=648453 Medicaid, coverage,

When Medicaid expansion was first enacted, it was a hot topic debate between Democrats and Republicans. But more and more states are starting to expand Medicaid, including several conservative states.

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What CVS Stands to Gain by Setting Up Biosimilar Subsidiary Cordavis https://medcitynews.com/2023/09/what-cvs-stands-to-gain-by-setting-up-biosimilar-subsidiary-cordavis/ https://medcitynews.com/2023/09/what-cvs-stands-to-gain-by-setting-up-biosimilar-subsidiary-cordavis/#respond Thu, 14 Sep 2023 01:11:52 +0000 https://medcitynews.com/?p=648555

Pharmaceutical industry observers say CVS Health’s creation of Cordavis, a new biosimilar drugs company, is part of a strategy to make its move into this market as profitable as possible.

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Solera Health Launches Weight Management Solution for Payers and Employers https://medcitynews.com/2023/09/solera-health-launches-weight-management-solution-for-payers-and-employers/ https://medcitynews.com/2023/09/solera-health-launches-weight-management-solution-for-payers-and-employers/#respond Wed, 13 Sep 2023 22:55:44 +0000 https://medcitynews.com/?p=648546

Solera Health recently launched a program that aims to help patients who are interested in GLP-1s gain access to lifestyle change support. It also provides educational materials on GLP-1s.

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Report: MA Enrollment Has Quadrupled in Rural Communities Since 2010 https://medcitynews.com/2023/09/medicare-advantage-rural-enrollment-metropolitan-micropolitan/ https://medcitynews.com/2023/09/medicare-advantage-rural-enrollment-metropolitan-micropolitan/#respond Sun, 10 Sep 2023 13:58:18 +0000 https://medcitynews.com/?p=648087

In rural areas, the share of eligible beneficiaries enrolled in MA plans nearly quadrupled from 11% in 2010 to 40% in 2023, according to new research from KFF. This represents 400,000 rural MA beneficiaries in 2010 and 1.8 million in 2023.

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Alignment Health: What Are Seniors’ Top Barriers to Care? https://medcitynews.com/2023/09/seniors-barriers-healthcare-social-determinants/ https://medcitynews.com/2023/09/seniors-barriers-healthcare-social-determinants/#respond Thu, 07 Sep 2023 23:00:08 +0000 https://medcitynews.com/?p=647991

A new survey from Alignment Health found that economic instability, food insecurity, lack of support and transportation access are the biggest social barriers for seniors.

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MA Beneficiaries With Cancer Spend Less on Healthcare Than Traditional Medicare Beneficiaries https://medcitynews.com/2023/09/medicare-advantage-cancer-spending/ https://medcitynews.com/2023/09/medicare-advantage-cancer-spending/#respond Thu, 07 Sep 2023 20:17:13 +0000 https://medcitynews.com/?p=647913

Medicare Advantage beneficiaries with a cancer diagnosis spend $3,996 on out-of-pocket costs and premiums annually, versus $6,091 for traditional Medicare beneficiaries with cancer, a new report found.

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Payer’s Place: Don Antonucci, Providence Health Plan https://medcitynews.com/2023/09/payers-place-don-antonucci-providence-health-plan/ https://medcitynews.com/2023/09/payers-place-don-antonucci-providence-health-plan/#respond Thu, 07 Sep 2023 11:50:10 +0000 https://medcitynews.com/?p=647322

The CEO of Providence Health Plan visits the Payer’s Place and addresses the future of payment models.

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Two Value-Based Care Initiatives That Could Shift the Alternative Payment Model Landscape [Sponsored] https://medcitynews.com/2023/09/two-value-based-care-initiatives-that-could-shift-the-alternative-payment-model-landscape/ https://medcitynews.com/2023/09/two-value-based-care-initiatives-that-could-shift-the-alternative-payment-model-landscape/#respond Wed, 06 Sep 2023 11:30:43 +0000 https://medcitynews.com/?p=646152 Dementia or brain damage and injury as a mental health and neurology medical symbol with a thinking human organ made of crumpled paper torn in pieces as a creative concept for alzheimer disease.

The Centers for Medicare and Medicaid Services has announced two value-based care alternative payment models set to launch in July 2024, one focused on dementia and one on primary care.

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