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MA Insurers Ramp Up Supplementary Benefits Offerings in 2020

October 7, 2019

Despite being able to offer an expanded array of supplemental benefits to Medicare Advantage (MA) customers for the first time in 2019, few insurers took advantage of that opportunity (HPW 6/11/19, p. 1). One year later, health plans appear to be increasingly embracing the new flexibilities — though one expert is dubious that such perks will ever be available to MA beneficiaries on a truly broad scale.

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As ASCs Grow, Payers Want to See Outcomes, Quality Measures

October 7, 2019

Payers and providers increasingly are shifting procedures from hospital-based settings to ambulatory surgical centers, leading to relatively fast growth in the number of procedures performed annually at ASCs nationwide.

However, most ASCs to date have focused more on price than on quality and outcomes, and that will need to change for them to grab much more market share, even though their generally lower per-procedure costs make them attractive, observers say.

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UPMC, Clover Execs Share How Tech Enhances MA Offerings

October 7, 2019

As players in the Medicare Advantage (MA) market, UPMC and Clover Health could not be more different. Pittsburgh-based integrated delivery system UPMC serves about 190,000 people in MA and dual-eligible plans through its insurance division, which is just one among a slew of holdings that make it a payer/provider powerhouse in Pennsylvania. Startup Clover Health, which is based in San Francisco and serves about 40,000 members, brands itself as a “Medicare Advantage technology company” and is focused solely on that line of business.

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Trade Groups Warn Against CMS Price Transparency Plan

October 7, 2019

Insurer and hospital organizations are urging the Trump administration to abandon or substantially revise proposed rules that would require hospitals to publicly disclose payer-specific negotiated rates for all “items and services” they offer, including procedures, supplies and facilities fees.

In comments on the proposed CMS rule, which were due Sept. 27, trade groups warned that the rule would reduce access to care while increasing regulatory burden and potentially raising prices. They also said the proposal is likely illegal, hinting that it would face legal challenges if implemented.

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Average Family Employer-Based Plan Premium Hits $20,000 in 2019

October 7, 2019

by Jinghong Chen This year, the average annual premiums for employer-sponsored health insurance rose to $7,188 and $20,576 for single coverage and family coverage, respectively, according to the Kaiser Family Foundation 2019 Employer Health Benefits Survey. Since 2009, average family premiums have risen more quickly than workers’ earnings and overall inflation. The survey also found […]

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