From Health Plan Week - There is no hiding the fact health insurers are in a state of flux when it comes to strategizing over Affordable Care Act (ACA) exchanges. Major plans like UnitedHealth Group and Humana Inc. are exiting most marketplaces for 2017, and once staunch exchange supporter Aetna Inc. is rethinking its level of participation as the losses from individual policies grow to the hundreds of millions of dollars per year (story, p. 1). Read more
From Health Plan Week - The Blue Cross Blue Shield Association (BCBSA) on July 28 unveiled a suite of newly branded products to serve what it says is a thriving international private medical insurance business for multinational employers and people traveling overseas. The move comes at a time health insurers doing business in the international market segment say employers are looking to tighten their budgets for overseas benefits even as the demand for the products… Read more
From AIS's Value-Based Care News - Mount Sinai Health System is pushing hard to move into bundled payments as part of its overall strategy to transition toward full risk for populations, and as part of this effort, has realized just how much it needs its physicians to lead the process. Read more
From Medicare Advantage News - As CMS carries out a new policy of reviewing Medicare Advantage plans’ entire provider networks for adequacy if they request service area expansions, MAN has learned that plans are dealing with a stricter-than-ever exceptions process and in some cases are having to drop legacy counties in order to expand. Read more
From Specialty Pharmacy News - As knowledge around biomarkers continues to grow, more tests identifying them are hitting the market. But rather than drilling down on only certain specific genes, some industry stakeholders maintain that a broader approach through a complete genomic profile, which allows for a more precise description of a person, is a more effective strategy for value-based medicine, particularly in oncology. Read more
From Report on Medicare Compliance - Some compliance officers feel they’re not adequately valued by senior leaders and the board, who may view the job as limited to responding to government mandates, including regulations and audits. “They feel like they are seen as cops and naysayers, and left out of executive meetings,” says Margaret Hambleton, vice president and chief compliance officer at Dignity Health in California. “They may put blinders on — ‘management only thinks of me… Read more
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