From Medicare Advantage News - As publicly traded carriers with multiple lines of business reported third-quarter 2016 earnings from mid-October through Nov. 1, Medicare Advantage products largely helped insurers offset losses in the Affordable Care Act (ACA) exchange marketplaces and/or stagnation in the Medicaid segment. And insurers that have enjoyed rapid Medicaid growth due to expansions under the ACA are now looking to expand their MA footprint after seeing improved performance in those products. Read more
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 more
From Inside Health Insurance Exchanges - California-based Consumer Watchdog Group filed a proposed class-action lawsuit against Anthem Blue Cross of California alleging the insurer is misleading customers and is automatically re-enrolling them into inferior plans. Anthem spokesperson Daryl Ng tells HEX the suit is “without merit.” The suit, filed Nov. 1 by Shernoff Bidart Echeverria, alleges that Anthem violated federal and state law by sending policy renewal notices without adequately warning members that the new policies don’t… Read more
From Medicare Advantage News - 2017 star quality ratings data for Medicare Advantage and Part D plan sponsors posted by CMS on Oct. 12 showed great gains by Prescription Drug Plans (PDPs), which had fallen in their average overall star rating last year. And while the new ratings indicate stable performance among MA Prescription Drug (MA-PD) plans, the results were mixed for some large MA insurers who were banking on payment incentives and high stars… Read more
From Specialty Pharmacy News - With Republican Donald Trump being declared the next U.S. president and the Republicans retaining control of Congress, the future of the Affordable Care Act (ACA) is highly uncertain. So by extension, it’s unclear what might happen to the Biologics Price Competition and Innovation Act (BPCIA), which was contained within the ACA and established the 351(k) abbreviated approval pathway for biosimilars. “On day one of the Trump Administration, we will ask Congress… Read more
From Report on Medicare Compliance - A slew of program-integrity measures, including the Medicare-Medicaid 60-day overpayment refund rule, could disappear if President-elect Donald Trump and the Republican-controlled Congress repeal and replace the Affordable Care Act, as they have pledged to do. Read more
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