October

UnitedHealth, Anthem Lead Shift to Less Costly Care Sites

October 28, 2019

Insurers, led by UnitedHealth Group and Anthem, Inc., among others, are clamping down on sites of care for services such as outpatient surgery, imaging, infusions and colonoscopies in an effort to cut costs by utilizing less-costly free-standing facilities instead of hospital-based outpatient departments.

The trend could lead to a ripple effect in the form of changes in ownership and reimbursement of stand-alone facilities, particularly ambulatory surgery centers (ASCs) but also other types of facilities, insiders believe.

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

Already a member? Click Here to login.

States Try Health Care Rate Setting — With Mixed Results

October 28, 2019

As Congress tries to tackle the issue of surprise medical bills and as Medicare for All proposals remain a hot topic during the Democratic presidential debates, a common concept unites the two issues: limiting how much health care providers get paid.

Though Medicare for All proposals vary, in general they would standardize the rates at which providers are reimbursed for delivering health care services — likely lowering rates relative to what they are now. Meanwhile, the leading strategy floated by Congress to settle payment disputes in surprise-billing cases would involve setting a benchmark rate that draws upon negotiated in-network payments for similar services (HPW 9/23/19, p. 1).

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

Already a member? Click Here to login.

Anthem, Centene Offer Update on Medicaid Rate Woes

October 28, 2019

During their recent third-quarter earnings calls, Centene Corp. and Anthem, Inc. sought to assure investors and analysts that they have a handle on the Medicaid payment rate issue that has dogged some insurers this year.

On Centene’s Oct. 22 call, CEO Michael Neidorff touted the firm’s new Medicaid contracts in Iowa, New Mexico and Pennsylvania, saying “our new business more than offset the enrollment and revenue headwinds caused by ongoing eligibility redeterminations in certain states.”

The redetermination process can result in a Medicaid population with a higher risk profile, Neidorff explained, but he noted that the company views it as a “temporary issue as we continue to work with our state partners to appropriately adjust our rates.”

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

Already a member? Click Here to login.

Medicaid Spending Expected to Grow 6.2% Next Year

October 28, 2019

by Jinghong Chen Medicaid enrollment in fiscal year 2020 is expected to remain flat, while total program spending is projected to grow at more than twice the 2019 rate, according to the Kaiser Family Foundation’s 50-state Medicaid budget survey. Among the 40 states with risk-based managed care organizations (MCOs), as of July 1, 33 states […]

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

Already a member? Click Here to login.

News Briefs

October 28, 2019

✦ The average premium for the second-lowest-cost silver plan (also known as the benchmark plan) on HealthCare.gov will drop by 4% in 2020, CMS revealed on Oct. 22. That compares with a 1.5% year-over-year decrease for the average benchmark plan premium between 2018 and 2019 — the first year since the implementation of the Affordable Care Act that the average premium declined. Six states saw double-digit percentage declines in average benchmark plan premiums: Delaware (20%), Nebraska (15%), North Dakota (15%), Montana (14%), Oklahoma (14%) and Utah (10%). CMS also said that there will be 175 issuers on the federal health insurance exchange in 2020, up from 155 in 2019.

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

Already a member? Click Here to login.