March

Even for Amazon, Differentiation Is Key to Telehealth Market

March 26, 2021

The new landscape for telehealth is revealing itself as the COVID-19 pandemic gradually winds down. Existing players are striving to differentiate themselves in an increasingly crowded market, and Amazon.com, Inc. is rolling out a big bet on telehealth and in-home care.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

ACA Exchange Insurers Could Be Gaming MLR Rebate System

March 26, 2021

Health insurers on the Affordable Care Act (ACA) exchanges are consistently overestimating the amount they spend on enrollee benefits as part of their medical loss ratio (MLR) reporting, resulting in “hundreds of millions of dollars in underpaid policyholder rebates,” according to new research. Health policy experts tell AIS Health that the findings could fuel greater regulatory scrutiny on individual market carriers, which are increasingly making a profit on the exchanges and had to shell out less than usual in claims last year due to routine-care deferral during the COVID-19 pandemic.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Bundled Payment Program for Employer Plans Reduces Costs

March 26, 2021

A bundled payment program run by San Francisco-based digital health company Carrum Health resulted in an average per-episode savings of more than $16,000 per orthopedic or surgical procedure performed by a provider in the bundled program, a RAND Corp. analysis found.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Medicare Advantage Startup Alignment Joins IPO Trend

March 26, 2021

Orange, Calif.-based Alignment Healthcare, Inc. just became the third startup insurer in recent months to go public. Banking on the strong value proposition of Medicare Advantage, Alignment said it already has a “national expansion strategy” that it will put into action next year, but some experts question whether the measured growth the insurer has achieved primarily in California can be duplicated in other markets. The insurer on March 25 announced the initial public offering of 27.2 million shares of its common stock at $18 per share and on March 26 was expected to begin trading on the Nasdaq Global Select Market under the symbol “ALHC.”

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

A Closer Look at States’ Telehealth Regulations

March 26, 2021

by Jinghong Chen
The telehealth boom caused by the COVID-19 pandemic has led policymakers to make an array of changes to telehealth regulation and payment structure. As of February 2021, 43 states and Washington D.C. have a law addressing commercial health plan coverage of telehealth services, according to Foley & Lardner’s 2021 50 State Survey of Telehealth Commercial Insurance Laws. Still, only 22 states maintain laws expressly addressing payment and reimbursement rates for telehealth, with 14 of them offering reimbursement parity relative to in person clinical care. In addition, the survey reports that coverage of store-and-forward telehealth and remote patient monitoring services has grown.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

News Briefs

March 26, 2021

✦ Anthem, Inc. will acquire myNEXUS, Inc., “a comprehensive home-based nursing management company,” the insurer said on March 24. The provider-facing myNEXUS platform facilitates authorization by a payer for home nursing services. “Bringing the right level of whole person care into the home has been demonstrated to improve outcomes, reduce readmissions and improve members’ and their family’s experience of wellbeing,” said Prakash Patel, M.D., Anthem executive vice president, and president of its Diversified Business Group. myNEXUS currently serves 1.7 million Medicare Advantage members across 20 states, according to the release, and “combines an advanced analytic rules engine, with a clinical staff of over 250 clinicians to effectively plan for and to optimize home care” and “has established a nationwide network of high performing home health providers and nurse agencies.” Read more at https://bit.ly/3cmWjAK.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.