From Health Plan Week - Blue Cross and Blue Shield licensee Highmark Inc., based in Pittsburgh, recently launched its Highmark Cancer Collaborative, which brings together the insurer, Allegheny Health Network (AHN) Cancer Institute and the Johns Hopkins Kimmel Cancer Center to create a “replicable model for the creation and dissemination of best practices in cancer care.” Read more
From Health Plan Week - Selecting providers in a narrow network is like picking classmates to join your kickball team, according to Oscar Health network development leader John Pickett. In other words, the doctors’ abilities matter just as much as their relationship with the insurer and their willingness to spearhead a value-based care model. Read more
From Inside Health Insurance Exchanges - Beginning next January, health insurers in Colorado will be allowed to use telehealth providers to satisfy network adequacy requirements for certain specialties, according to a bulletin issued March 31 by the Colorado Division of Insurance. Given the increased reliance on narrow networks for insurance plans sold through the public exchanges, it would seem that telehealth could plug some of the gaps, meet state network-adequacy requirements and increase the number of specialists… Read more
From Medicare Advantage News - An insurer trade group’s new pilot project on verifying provider-directory information may not only improve the acknowledged inaccuracy of much current provider-directory information, but it also may reduce the need for burgeoning CMS efforts to crack down on directory errors in Medicare Advantage. However, neither the pilot unveiled by America’s Health Insurance Plans (AHIP) on March 22 nor the Provider Network Accuracy (PNA) monitoring pilot that CMS said in a March… Read more
From Specialty Pharmacy News - One year after the FDA approved the first biosimilar drug, Zarxio (filgrastim-sndz), the Sandoz, Inc. drug is making some headway within the short-acting granulocyte colony-stimulating factor class of drugs. But there are some lessons that other biosimilar manufacturers may want to take to heart as they attempt to break into the U.S. Read more
From Report on Medicare Compliance - Wyoming surgeon Razi Saydjari passed his meaningful-use audit with flying colors except when it came to the security risk assessment. He flunked that, according to the auditors hired by CMS to audit physicians and hospitals that had accepted payments to adopt certified electronic health records (EHRs). If they are out of compliance with any of the dozen or so core measures, CMS takes back the entire EHR incentive payment for… Read more
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