April

Pandemic’s Threat to Mental Health Requires Payer Outreach

April 27, 2020

As the COVID-19 pandemic continues to cut a devastating path — medically, socially and economically — across the U.S., signs are emerging that the situation is beginning to take a heavy toll on people’s mental health.

A Kaiser Family Foundation poll conducted March 25 to 30 found that 47% of people who were sheltering in place reported negative mental health effects resulting from worry or stress related to the coronavirus. Similarly, a survey released March 25 by the American Psychiatric Association found that 36% of Americans said the coronavirus is having a serious impact on their mental health.

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Insurers Help Volunteers Fight Virus, Redeploy Clinical Staff

April 27, 2020

Health insurers are encouraging their own on-staff clinicians to volunteer on the front lines of the fight against COVID-19, offering to continue salaries and benefits for those who sign up to help fight the pandemic that has now claimed more than 46,000 American lives. At the same time, plans are shifting clinical staff members away from cancelled in-person care management and quality improvement activities and toward telephonic care management activities designed to ensure certain members get the help they need, says Michael Lutz, a senior consultant with Avalere Health.

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MA Plans Should Pivot Due to COVID, Election Impact This Fall

April 27, 2020

Bids for the 2021 Medicare Advantage and Part D plan year are due June 1, and new research on the 2020 Annual Election Period (AEP) suggests that seniors are flocking to MA plans primarily because of enhanced supplemental benefits such as over-the-counter (OTC) allowances and dental coverage, as well as $0 premium options, with notable growth in $0 PPO selections. But while lessons from the prior AEP can inform benefit design and marketing approaches for the next enrollment cycle, plans this fall will be challenged by the double whammy of a presidential election and a predicted second outbreak of COVID-19, industry experts observed during a recent webinar hosted by Gorman Health Group (GHG), a Convey Health Solutions company.

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Study Flags Anesthesiologists’ Role in ASC Surprise Billing

April 27, 2020

An April 15 study published in Health Affairs found surprise billing occurred in 8% of procedures at ambulatory surgery centers (ASCs), and the average balance of each bill increased by 81% between 2014 and 2017. According to the study, bills for anesthesia administered either by physicians or certified registered nurse anesthetists (CRNAs) comprised 69% of the studied surprise bills.

Experts tell AIS Health that a very small number of anesthesiology practitioners drive most of the surprise billing and price distortion in ASCs, and only legislation can solve the problem.

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Care Management Shifts to Remote Monitoring Due to Coronavirus Crisis

April 27, 2020

As COVID-19 spreads nationwide, insurers have dramatically cut back on in-person care management of their highest-risk chronically ill members while ramping up their capacity for remote monitoring via telehealth. This move — however necessary — likely will lead to repercussions in future months, some analysts warn.

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MLR Rebates May Reach $2.7 Billion in 2020

April 27, 2020

by Jinghong Chen Insurers that participate in the individual, small-group and large-group markets are projected to issue a record high $2.7 billion in medical loss ratio (MLR) rebates to their customers this year — nearly doubling the $1.4 billion in rebates issued last year, according to a recent Kaiser Family Foundation analysis. Almost 75% of […]

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