From ACO Business News - Insurers signing multiple types of value-based contracts need to look closely at how to structure compensation arrangements so they aren’t sharing the same savings twice with two different groups of providers, executives implementing such arrangements say. Unless the parties specify the details ahead of time, an insurer might wind up paying shared savings for a particular patient to a specialist provider participating in a bundled payment contract, while also sharing savings with the primary care physician to whom that patient is attributed as part of an accountable care organization or a patient-centered medical home (PCMH). Read more
From The AIS Report on Blue Cross and Blue Shield Plans - Third-quarter 2013 financial results indicate that not-for-profit Blues plans are building in rate increases to make up for the annual insurance industry excise tax imposed by the Affordable Care Act beginning in 2014, two industry analysts say. The ACA affords not-for-profit insurers preferential tax treatment under the law, which will cost the overall health insurance industry $8 billion this year and gradually increase to $14.3 billion by 2018. Read more
From AIS's Health Reform Week - The financially strapped cities of Detroit and Chicago have started shifting some municipal retirees onto the insurance exchanges for coverage — a move that is expected to save tens of millions of dollars annually but increase enrollment of older individuals on the exchange plans. Insurers in Illinois and Michigan, so far, appear relatively unconcerned about the threat such a move would pose to their exchange risk pools. And whether other… Read more
From Medicare Advantage News - A furor that grew out of moves by UnitedHealthcare to oust large numbers of physicians from its Medicare Advantage networks has resulted within the past month in a Senate committee hearing on so-called “narrow networks” and in calls by both consumer and provider groups to regulate the ability of MA plans to have them. Read more
From Drug Benefit News - While proponents of value-based insurance design (VBID) say it can result in lower costs and higher quality of care, how to successfully design such programs and when to expect results continue to be debated and explored. Three new studies released this month examine the potential cost savings and improvements in adherence associated with pharmacy-centric VBID programs, including one article that suggests concurrent disease management may not be beneficial. And while… Read more
From Report on Medicare Compliance - In the near future, administrative law judges (ALJs) may resolve some appeals of Medicare claim denials through mediation and statistical sampling with extrapolation. That would speed up decisions, which take six months or more, and reduce the disturbing backlog of cases. Right now, however, the adjudication of ALJ cases will happen faster if providers reduce their paperwork errors, officials from the Office of Medicare Hearings and Appeals (OMHA) said at… Read more
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