From AIS's Value-Based Care News - Iora Primary Care doesn’t believe in fee-for-service payment, and its 12 practices don’t accept it. The primary care company, founded as value-based payment was gathering steam, is now growing rapidly, contracting with Humana Inc. to build four dedicated Humana Medicare Advantage practices this year and talking with other insurers about doing the same thing. Read more
From AIS's Value-Based Care News - Regulators from the Federal Trade Commission (FTC) and the HHS Office of Inspector General (OIG) are signaling increased scrutiny of accountable care organizations and other value-based payment arrangements, especially those making “creative” use of the antitrust and fraud and abuse waivers in place for Medicare ACOs. Read more
From Inside Health Insurance Exchanges - CMS is now reviewing 2016 plan designs for individual policies sold on and off of exchanges, and is expected to send deficiency notices to some carriers by the end of June. Recent actions in Florida and California to eliminate potentially discriminatory pharmacy benefits could prompt CMS to pay closer attention to qualified health plans (QHPs) that might create financial barriers for populations with costly chronic diseases, industry observers tell HEX. Read more
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