From Health Plan Week - Anthem Blue Cross in California, a unit of Anthem, Inc., has begun a new approach to battle child obesity by teaming with a medical provider and wellness vendor for what the insurer calls a multipronged attack plan to bring rates of unhealthy behaviors for children and families down via mobile health-tracking apps and personal coaching. Read more
From Health Plan Week - Cigna Corp. says in forming its new wholly owned subsidiary, CareAllies, Inc., the insurer did not work off the blueprint that UnitedHealth Group used for its Optum unit, or mirror what Aetna Inc. did with its Healthagen operation. Read more
From AIS's Value-Based Care News - The final Medicare Shared Savings Program (MSSP) benchmarking methodology and participation rules contain important changes that mean more accountable care organizations are likely to share in savings. However, a few organizations that earned large bonus payments due to costs that were historically higher than the regional average will see lower shared savings payments, or possibly none at all. The rule, finalized by CMS on June 6, largely follows the proposed rule that… Read more
From Medicare Advantage News - Nineteen of the 23 program audits conducted in 2015 of Medicare Advantage plans that were reviewed by CMS since the beginning of 2016 have resulted in the plan involved being directed to hire an independent auditor (IA) to verify that the problems found have been corrected, a CMS official said at a conference session June 16. This figure and other comments made by Doreen Gagliano, technical advisor in the Division… Read more
From Specialty Pharmacy News - It’s not only the United States that’s seeing costs to treat cancer continue to rise. Last year the cost of cancer drugs and supportive therapies totaled $107 billion globally, an 11.5% increase in constant dollars from 2014, according to a new report from the IMS Institute for Healthcare Informatics. That’s up from an annual cost growth rate of 3.8% in 2011, according to the report, titled Global Oncology Trend Report: A… Read more
From Report on Medicare Compliance - Prime Healthcare Services in California allegedly covered the bases when it came to ensuring many Medicare patients would be admitted as inpatients, not placed in observation, according to the False Claims Act complaint filed by the Department of Justice (DOJ) June 23. On the front end, Prime hospitals allegedly pressured emergency department (ED) physicians to admit patients without the medical necessity for an inpatient admission, even changing Milliman Care Guidelines. Read more
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