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Health Plan Week
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November 30, 2016

Today's Featured Story

Not Exactly ‘Mr. Robot,” Still Some Plans Do Like AI Offerings
Reprinted from Health Plan Week

Health insurers are knee-deep in data and finding new ways to create more of it as each year passes. But how to sift through and use the mountains of information a health plan can produce for each member, often in order to craft more efficient care management programs with clinicians, is where predictive analysis, or the more sci-fi term artificial intelligence (AI), comes in, says San Mateo, Calif.-based vendor Lumitia.... Read Full Story


Quote of the Day

“For decades, corporate America has been trying to get rid of the False Claims Act, but they haven’t had much luck. It’s been protected by Senator [Charles] Grassley and the court system. I could see a concerted effort with presidential backing to gut [the whistleblower part of the False Claims Act....]”

— Mark Pastin, president of the Health Ethics Trust in Alexandria, Va., told AIS’s Report on Medicare Compliance.

From REPORT ON MEDICARE COMPLIANCE — "Amid Trump Administration Unknowns, Enforcement, Compliance May Be Stable"


Today's Datapoint

34 million ... medical members and nearly $74 billion in premium revenue were registered by Anthem, Inc. in 2015, with California leading its enrollment (at 4.35 million members) and Virginia its market share (at 46%), according to AIS’s Directory of Health Plans.

Click here to read the HEALTH PLAN WEEK article in which this datapoint appeared — " Data Profile: Anthem, Inc." (Free for HPW subscribers; $17 for non-subscribers.)


Today from Washington

People on the Move

The Society for Women's Health Research named Amy M. Miller, Ph.D., CEO. Dr. Miller leaves the Personalized Medicine Coalition, where she served as executive vice president....SA Ignite appointed Matt Fusan director of solutions consulting. He previously held leadership positions at AllScripts and Blue Cross Blue Shield of North Carolina....Anthem, Inc. promoted Scott Towers to president of the company’s dental business. Towers joined Anthem in 2009 as part of its acquisition of DeCare Dental, and most recently was responsible for Anthem’s dental underwriting, product development and analytics.


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