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March 28, 2017

Hot Topic

Here’s a look at the growth of provider-led health plans:

Trend for Provider-Led Plans Is Being Fed By Economics of Reimbursement Models
Despite the probability that one of the stimulants for more providers forming health plans — the ACA public exchanges — faces gradual extinction under the Trump administration, market consultants expect the trend to continue regardless....
From HEALTH PLAN WEEK

Competitors Become Co-sponsors With New Provider-Payer MA Joint Venture
New Medicare Advantage offerings from Johns Hopkins HealthCare, the population health and managed care arm of Johns Hopkins Medicine, will get a boost in their second year of serving 11 counties in Maryland...
From MEDICARE ADVANTAGE NEWS

Alabama Hospital-Run Medicaid Managed Care Gets CMS Waiver
Alabama got approval from CMS for a long-pending plan to start a hospital-run Medicaid managed care program for 650,000 beneficiaries....
From MEDICARE ADVANTAGE NEWS

American Well
 
Today's AIS Health Datapoint

$10.64 ... is the average 30-day retail copay for generics, in-network, for silver plans on 2017 individual marketplaces. While the average coinsurance for these plans is 21.14%, most plans use copays for generic drugs. Some plans require a deductible to be paid before cost-sharing begins.

From AIS’s Rx BENEFIT DATA


Quote of the Day

“Merger and acquisition lawyers look at the [Bay Area Surgical Management] case and freak out. [It requires] a lot of due diligence to convince investors that not all out-of-network providers are crooks.”

— Carol Lucas, chair of law firm Buchalter PC’s Health Care Practice Group in Los Angeles, which represents surgery centers, physicians and other providers, speaking to Health Plan Week about concerns about providers’ out-of-network polices in the wake of the landmark $37 million victory Aetna Inc. won against Bay Area Surgical Management.

Click here to read the HEALTH PLAN WEEK article in which this quote appeared — "Aetna Wages ‘Scorched-Earth’ Litigation Against Outlier Out-of-Network Providers" (Free for HPW subscribers; $17 for non-subscribers.)

 

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