From Health Plan Week - Health insurers are touting the success of their value-based care arrangements for 2016 in which providers and plans work together on unique offerings both for individual consumers on and off public exchanges and group markets. But at the same time, value-based care proponents question if these efforts will really have an impact on the overall cost and reimbursement structure that continues to bedevil the health care system. Read more
From Health Plan Week - Industry sources tell HPW that UnitedHealth Group is on the verge of buying Helios, a privately owned provider of workers’ compensation and PBM services to large health insurers and third-party administrators (TPAs), handling more than 7 million prescriptions per year. While the reported price tag of $1.6 billion to $1.7 billion raised a few eyebrows, sources say the logic of such a move, if it comes to pass, makes sense… Read more
From Inside Health Insurance Exchanges - As part of a 2014 undercover investigation, 11 out of 12 fictitious insurance exchange applications easily glided through the eligibility verification process. On Oct. 23, less than 10 days before the 2016 open-enrollment period began, federal investigators told a House subcommittee that fraudulently obtaining coverage and federal subsidies hasn’t gotten any more difficult. Read more
From Medicare Advantage News - Both Medicare and Medicaid managed care insurers and their trade groups are stepping up verbal attacks on what they consider as excessive increases in prescription drug costs in recent months. Read more
From Specialty Pharmacy News - Media reports about Valeant Pharmaceuticals International Inc. and the business practices of pharmacy Philidor Rx Services LLC have put specialty pharmacies in the spotlight — but not in a good way. Read more
From Report on Medicare Compliance - Hospitals and physicians again have a foot in the door for short inpatient stays because of a new exception to the two-midnight rule in the final 2016 outpatient prospective payment system (OPPS) regulation issued on Oct. 30. However, if they use the new exception liberally, hospitals may find themselves back in the crosshairs of the recovery audit contractors (RACs). Read more
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