Datapoint: Geisinger and Highmark to Launch New Venture in Pennsylvania

March 21, 2019

Geisinger Health System and Highmark, Inc. will launch a not-for-profit health care organization in central Pennsylvania, designed to serve both insurers’ members in four underserved PA counties. Plans include a large primary care center offering walk-in visits, pediatrics, lab testing and specialty services, including dermatology and cardiology. Pennsylvania is Highmark’s largest market, the home of 89% of its 3,958,396 members. Geisinger currently serves 554,942 members in the state.

Geisinger Health System and Highmark, Inc. will launch a not-for-profit health care organization in central Pennsylvania, designed to serve both insurers’ members in four underserved PA counties. Plans include a large primary care center offering walk-in visits, pediatrics, lab testing and specialty services, including dermatology and cardiology. Pennsylvania is Highmark’s largest market, the home of 89% of its 3,958,396 members. Geisinger currently serves 554,942 members in the state.

Both Payers, Providers Have Reasons to Resist Revealing Negotiated Prices

March 21, 2019

The Trump administration is considering requiring health care providers to disclose the prices they charge different health insurers for services — an idea meant to promote transparency and consumerism that experts say could also have the effect of complicating payer and provider rate negotiations.

By Leslie Small

The Trump administration is considering requiring health care providers to disclose the prices they charge different health insurers for services — an idea meant to promote transparency and consumerism that experts say could also have the effect of complicating payer and provider rate negotiations.

If the administration’s idea becomes a reality, hospital rates could face downward pressure as less favorable contracts with certain payers become public knowledge, thus incentivizing payers to renegotiate for lower rates, according to Wall Street analyst Ana Gupte. But on the flip side, “certain hospitals could demand higher rates if they find that a crosstown rival is receiving higher reimbursement” from a payer, which may be problematic for insurers, she wrote in a note to investors.

Ultimately, such a policy could “increase average rates or eliminate some of the lower rates that exist in the market,” Caroline Pearson, a senior fellow at NORC at the University of Chicago, tells AIS Health.

But would having more consistent rates that insurers pay for health care services truly be a bad thing?

“There’s certainly reason to think that we should have somewhat less variation in the rates, in [that] you actually sort of want to discourage monopolistic behavior and so you would like to give smaller health plans the benefit of having more competitive rates,” Pearson says. Thus, smaller insurers might benefit from greater rate transparency — but possibly at the expense of their larger peers.

In the end, both payers and providers would likely lobby against any proposed rule that shines a light on negotiated prices for health care services, Gupte wrote, reasoning that “we believe there is risk to both sides if these contracts were made public.”

Datapoint: Intermountain Healthcare to Launch At-Home Primary Care

March 20, 2019

Intermountain Healthcare, the hospital system that operates Utah’s largest insurer, SelectHealth, will expand its home health services to offer primary and palliative care to members in their homes, including checkups with primary care doctors. With these expanded benefits, Intermountain aims to reduce hospital admissions and the amount of time members spend in the hospital once admitted. SelectHealth currently serves 862,255 members in Utah and Idaho, and holds 31.7% overall market share in Utah.

Intermountain Healthcare, the hospital system that operates Utah’s largest insurer, SelectHealth, will expand its home health services to offer primary and palliative care to members in their homes, including checkups with primary care doctors. With these expanded benefits, Intermountain aims to reduce hospital admissions and the amount of time members spend in the hospital once admitted. SelectHealth currently serves 862,255 members in Utah and Idaho, and holds 31.7% overall market share in Utah.

Trump Officials Take Bold Steps on Medicaid

March 20, 2019

The Trump administration is pulling out all the stops to encourage red states to make conservative changes to Medicaid without congressional input. Administration officials are pushing ahead and granting approvals to states seeking to impose work requirements on Medicaid recipients, even in the face of legal challenges and large-scale losses in the number of people covered.

The Trump administration is pulling out all the stops to encourage red states to make conservative changes to Medicaid without congressional input.

Administration officials are pushing ahead and granting approvals to states seeking to impose work requirements on Medicaid recipients, even in the face of legal challenges and large-scale losses in the number of people covered.

Last week, the Centers for Medicare and Medicaid Services (CMS) granted Ohio’s request for work requirements, the ninth such approval since President Trump took office…..

Read the full article from The Hill

Pfizer Adds to Big Pharma’s Gene-Therapy Deal Streak

March 20, 2019

Pfizer Inc. PFE +0.26% has agreed to pay as much as €560 million ($636 million) for the rights to gene therapies under development at French company Vivet Therapeutics, as it seeks to build its pipeline in this cutting-edge treatment.

Pfizer Inc. PFE +0.26% has agreed to pay as much as €560 million ($636 million) for the rights to gene therapies under development at French company Vivet Therapeutics, as it seeks to build its pipeline in this cutting-edge treatment…..

Read the full Wall Street Journal article