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N.C. Blues CEO Scandal Shows What Not to Do, Experts Say

October 21, 2019

In the wake of a scandal surrounding the news that Blue Cross and Blue Shield of North Carolina’s CEO was arrested in a drunken driving incident back in June, the insurer has officially called off its planned “strategic affiliation” with Cambia Health Solutions.

Experts tell AIS Health that the whole saga — which came to light months after Patrick Conway, M.D., was arrested after reportedly driving erratically and striking a vehicle with his daughters in the backseat of his SUV — didn’t have to be as much of big deal as it became. And, they say, other organizations can learn from Blue Cross and Blue Shield of North Carolina’s mistakes.

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Plans Add Acupuncture Benefits to Fight Opioids, Lure Seniors

October 21, 2019

Insurers seeking non-opioid alternatives to treat chronic pain increasingly are opting to cover acupuncture, despite scant medical evidence for its effectiveness. In many cases, plans are classifying acupuncture benefits as part of their wellness program instead of as medical benefits, and members don’t need a diagnosis to have sessions covered.

Blue Cross Blue Shield of Massachusetts (BCBSMA) will offer a new acupuncture benefit starting Jan. 1 for all members except for those in Medicare Advantage (MA) plans, and Cigna will offer limited acupuncture sessions to select MA members beginning in 2020. Independence Blue Cross has offered acupuncture in some products since January.

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Optum Unit Leads UnitedHealth To Strong Third-Quarter Results

October 21, 2019

UnitedHealth Group Inc., buoyed by strong sales at its Optum subsidiary, reported stronger-than-expected third quarter 2019 earnings and upgraded its full year earnings forecast slightly.

The company’s robust earnings bode well for other insurers going forward, says Evercore ISI analyst Michael Newshel, who wrote in his Oct. 15 investor note that UnitedHealth’s third-quarter results “provided relief on the fundamental concerns around MLRs [medical loss ratios] and initial 2020 outlooks.”

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Insurers May Benefit From Rulings Against Public Charge Regulation

October 21, 2019

A trio of federal court decisions on Oct. 11, which temporarily blocked the Trump administration’s so-called public charge rule, is good news for the managed care industry, according to one analyst. However, recent research suggests that confusion and fear surrounding the not-yet-implemented regulation is already leading to Medicaid coverage losses.

The rule, first proposed last October, significantly expanded the definition of a “public charge” — or a person likely to be dependent on the government — to include those enrolled in health, nutrition and housing programs. The practical implication is that individuals’ enrollment in programs like food stamps or Medicaid could negatively affect their ability to enter the U.S. or obtain a green card that allows them to stay here legally.

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Most Medicare Advantage Beneficiaries Will Have Access to High-Quality Plans in 2020, CMS Reports

October 21, 2019

by Jinghong Chen CMS reports 81.2% of Medicare Advantage Prescription Drug (MA-PD) enrollees will be in plans with a rating of four stars or more in 2020. Weighted by enrollment, about 27.6% of stand-alone Prescription Drug Plan (PDP) members will enroll in plans with four or more stars, up from 3.4% in 2019. Across the […]

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