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CMS Anticipates Telehealth Will Ramp Up Under New MA Rule

April 22, 2019

Telehealth services got a boost when CMS recently finalized policies giving Medicare Advantage (MA) plans the flexibility and financial incentive to include “additional telehealth benefits” in their core benefit packages — going beyond what is currently available to Medicare fee-for-service (FFS) beneficiaries. MA plans may employ this new, expanded approach to telehealth starting Jan. 1 if they have the time and inclination to factor it into their 2020 bids, which are due to CMS by June 3.

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Expert Urges Plans: Promote Telehealth for Specific Populations, Uses

April 22, 2019

What comes next for telehealth in the U.S.? Some Wall Street analysts recently underscored the possibility of significant uptake in the technology — with caveats. “The number of potential use cases for virtual medicine being explored is growing exponentially, but technical and regulatory challenges remain,” Jefferies analysts cautioned in a recent note to investors on key takeaways from the American Telemedicine Association’s mid-April conference in New Orleans.

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Virginia Law Bars Copay Accumulators as Programs’ Use Rises

April 22, 2019

Payers are continuing to implement copay accumulators and copay maximizers in an effort to counter copay assistance from pharmaceutical manufacturers. Research shows these programs target specialty drugs almost exclusively, so while they may provide short-term benefits to payers, in the long run they may result in higher downstream costs. As accumulators and maximizers come under fire from patient-advocacy groups and other stakeholders for their potential impact on patient outcomes, a new state law essentially banning these programs, as well as potential legal challenges, may pose difficulties for payers implementing them.

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Medicare for All Overshadows UnitedHealth’s Strong Earnings

April 22, 2019

With its diversified business portfolio and little involvement with the Affordable Care Act (ACA) exchanges, UnitedHealth Group seems an unlikely company to have its latest earnings report eclipsed by politics.Yet that is exactly what occurred on April 16, when UnitedHealth reported that its first-quarter 2019 revenues grew 9.3% year over year to $60.3 billion and that its adjusted net earnings per share (EPS) of $3.73 grew 23% year over year. Unlike past quarters, the usual headlines acknowledging the insurer’s financial performance were replaced by ones about CEO David Wichmann’s remarks surrounding Medicare for All proposals.

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Small-Group Market Offers More Plan Choices with Lower Premiums Than Individual Market

April 22, 2019

by Jinghong Chen The small-group health insurance market had, on average, more plan choices and lower premiums in 2018 compared to the individual market, according to a new Health Affairs study. The study shows that 39 states provided enrollees with access to both an HMO/Exclusive Provider Organization (EPO) plan and a PPO/Point-of-Service (POS) plan in […]

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