Health Plan Business

From Health Plan Week - The board of Covered California on April 7 approved a measure requiring participating health insurers to identify and exclude poorly performing hospitals from their networks by 2019. Experts say this is a “leading policy” that indicates where the industry is headed in its drive to cut cost and improve quality. In Attachment 7 to Covered California’s contract with Qualified Health Plans, insurers will be required to work with the exchange “to identify areas of ‘outlier poor performance’ based on variation analysis. Read more

From The AIS Report on Blue Cross and Blue Shield Plans - Instead of rushing patients to the emergency room, two Albuquerque paramedic companies are working with Blue Cross Blue Shield of New Mexico to keep Medicaid members out of their ambulances. The pilot project, dubbed Community Paramedicine, began operating in January with a goal of reducing 911 calls and hospital readmissions. The New Mexico Blues plan is one of five Blues plans operated by Health Care Service Corp. (HCSC). The New Mexico… Read more

Health Plan Business Blog

By Steve Davis - April 28, 2016
CMS is considering several tweaks to its risk-adjustment program established by the Affordable Care Act (ACA) including a high-risk pool, partial-year enrollments and the inclusion of prescription drug claims as predictors of diagnoses or severity of illness. On April 11, I moderated a well-...
By Patrick Connole - March 29, 2016
William Giaconia, vice president of healthcare strategy for Automatic Data Processing Inc. (ADP), says easy does it on overanalyzing why private exchange enrollment is not growing as fast as some had predicted just a few years back. After all, he says, ADP’s own ADP Private Exchange, which launched...
By Steve Davis - March 11, 2016
Leaders from some state-based exchanges (SBEs) are investigating ways to share technology, aggregate enrollment and build economies of scale. Bruce Gilbert, executive director of Nevada’s Silver State Health Insurance Exchange, says that while each of the nation’s 14 SBEs are unique, they share...

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