From Health Plan Week - Back in 2011, when the medical loss ratio (MLR) rules went into effect, many market consultants said health insurers had a “perverse” disincentive to manage medical costs because of the structure of the MLR provision, which requires insurers to pay rebates to consumers if they spend too low a percentage of premiums on medical expenses. Read more
From Health Plan Week - Recent results from a UnitedHealthcare oncology-focused bundling pilot have caught the attention of the health insurance industry by demonstrating that the model saves money for more than just procedural care, like knee replacements. Read more
From ACO Business News - Antitrust laws treat collaborations among health care providers — including accountable care organizations — differently from the way they treat price-fixing schemes. But that doesn’t mean ACOs will never merit scrutiny from the Federal Trade Commission, FTC Bureau of Competition Director Deborah Feinstein says. To date, the FTC hasn’t opposed the formation of an ACO, Feinstein told attendees at the recent National Accountable Care Organization Summit in Washington, D.C., sponsored by… Read more
From Medicare Advantage News - CMS on July 16 took another step in the move toward the start of a long-delayed Recovery Audit Contractor (RAC) program for Medicare Advantage plans, as required under the 2010 Affordable Care Act. But the issuance by the agency’s Center for Program Integrity of a Statement of Work (SOW) for the MA RAC initiative still leaves attorneys with questions about how effective the program might be and what problems it… Read more
From Specialty Pharmacy News - Although the FDA has yet to approve a product through the 351(k) biosimilar pathway, multiple follow-on drugs are working their way through the pipeline, noted Kate Keeping, senior director of biosimilars research for BioTrends Research Group at a June 30 webinar sponsored by the company. “The United States is the only developed market to have no biosimilars, but development is ramping up,” Keeping said. As of June, 23 biosimilar products were… Read more
From Report on Medicare Compliance - About a year after Community Health Systems (CHS) bought Chestnut Hill Hospital in Philadelphia, its new CEO allegedly told emergency-room doctors they weren’t admitting enough patients. Then CHS replaced the longtime ER physician group, allegedly because it wasn’t on board with a corporate plan to increase inpatient admissions. When the new ER physician group took over, far more patients were admitted to the hospital, exactly what CHS allegedly intended all… Read more
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