The commercial market has struggled to adopt value-based care, but HealthPartners has had some success, according to Mark Hansberry, senior vice president and chief marketing officer of the company. During a conference, he shared five rules for scaling value-based care, including creating trust and providing real-time data.

For the gridlock in mental healthcare to be resolved, 100% of mental healthcare providers must practice measurement-based care, utilizing validated rating scales to monitor and measure longitudinal outcomes for every patient. And payers then must offer reimbursement that appropriately rewards providers for delivering high-quality, effective care, and incentivize proactive mental health management.

Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.

When Medicaid expansion was first enacted, it was a hot topic debate between Democrats and Republicans. But more and more states are starting to expand Medicaid, including several conservative states.

Pharmaceutical industry observers say CVS Health’s creation of Cordavis, a new biosimilar drugs company, is part of a strategy to make its move into this market as profitable as possible.

Solera Health recently launched a program that aims to help patients who are interested in GLP-1s gain access to lifestyle change support. It also provides educational materials on GLP-1s.

In rural areas, the share of eligible beneficiaries enrolled in MA plans nearly quadrupled from 11% in 2010 to 40% in 2023, according to new research from KFF. This represents 400,000 rural MA beneficiaries in 2010 and 1.8 million in 2023.

A new survey from Alignment Health found that economic instability, food insecurity, lack of support and transportation access are the biggest social barriers for seniors.

Medicare Advantage beneficiaries with a cancer diagnosis spend $3,996 on out-of-pocket costs and premiums annually, versus $6,091 for traditional Medicare beneficiaries with cancer, a new report found.

The CEO of Providence Health Plan visits the Payer’s Place and addresses the future of payment models.

The Centers for Medicare and Medicaid Services has announced two value-based care alternative payment models set to launch in July 2024, one focused on dementia and one on primary care.

The current dual-system model is inefficient, wasteful, and inconvenient. There is a clear need to integrate workers’ comp and medical benefits programs to cut down on costs and alleviate the hassle of dealing with separate care silos. It’s possible, and its time has come.

After five years of enrolling in a Medicare Advantage plan, 48.3% of non-dually enrolled beneficiaries left their contract and 53.4% of dually enrolled beneficiaries did, a new study found.

Amgen and the Federal Trade Commission are settling the lawsuit the regulator filed to block the pharmaceutical giant’s $28 billion Horizon Therapeutics acquisition. As part of the settlement, Amgen agrees not to “bundle” its products with Horizon’s drugs in negotiations with health plans.

While the recent rollbacks of authorization requirements by insurers are a positive step forward, there is still work to be done in streamlining processes and reducing administrative burdens in the healthcare industry.

Some states may not be following federal requirements for the Medicaid renewal process, resulting in many individuals being wrongly removed from coverage, CMS said. Children may especially be affected.

In a new lawsuit, Bon Secours Mercy Health Virginia alleges that Anthem Health Plans of Virginia owes the health system more than $93 million in outstanding unpaid and underpaid claims.

Even with my “VIP” access to the healthcare system as a physician who practiced in my community, I’m still struggling to coordinate my care as a cancer patient. I believe patients need more from their payers, providers, and digital health collaborators when it comes to care coordination and navigation.

A new study found that between 16.2% and 17.7% of Medicare Advantage enrollees reported using post-acute care services, compared to 22.4% to 24.1% of traditional Medicare enrollees.

Next year REACH ACOs will have to show success in developing and maintaining comprehensive health equity plans, and by kicking the can down the road they risk not knowing enough about their patient population in terms of what works better and what doesn’t. ACOs can pay in the effort of continuous iteration now or they can pay in poor health outcomes for their patients and the resulting increased costs. The choice is theirs, but one they each have to make.

Cigna removed 25% of medical services from prior authorization requirements. This represents more than 600 codes, and includes 100 surgical codes, nearly 200 genetic testing codes, durable medical equipment, orthoses and prosthetics and other services, said Dr. Scott Josephs, chief medical officer of Cigna Healthcare.

For the sixth year in a row, the Medicare Shared Savings Program created overall savings, CMS announced. When compared to clinician groups of a similar size not participating in the program, participating ACOs performed better on quality measures, including measures for diabetes, breast cancer and colorectal cancer screenings, tobacco screenings and depression screenings.

In a new agreement, Interwell Health will provide care to Humana Medicare Advantage HMO and PPO members with chronic kidney disease in 13 states. It will also serve patients with end-stage kidney disease across the country.

Two Florida families allege that tens of thousands of Floridians are being terminated from Medicaid coverage without sufficient information as to why. This comes as the U.S. continues the unwinding of the Medicaid continuous enrollment requirement, which stopped states from disenrolling Medicaid enrollees during the Covid-19 public health emergency.

Carrie Kincaid, Senior Vice President, Market Development at Priority Health discusses how Priority Health is addressing the gaps in rural healthcare.

A new KFF analysis compared list prices for Ozempic, Wegovy, Rybelsus and Mounjaro. It found that the U.S. has much higher list prices for these drugs than other peer countries while also having the highest rate of obesity.

Blue Shield of California is cutting many of its ties with CVS Caremark (though not all) and adding four additional partners for its prescription drug benefits. These partners include Mark Cuban Cost Plus Drug Company and Amazon Pharmacy. The changes are needed to disrupt the current broken system, said Salina Wong, senior director of clinical pharmacy programs at Blue Shield of California.

U.S. Representative Frank Pallone, Jr. (D-New Jersey) announced that he is looking into high prior authorization denial rates by Medicaid managed care health plans. It follows a report by the Office of Inspector General that found that Medicaid MCOs denied one out of every eight prior authorization requests in 2019.

Immune checkpoint inhibitors are effective cancer treatments, but are expensive. Understanding the least-costly settings for administering treatments, leveraging genomic testing and following evidence-based guidelines can help health plans optimize cancer care, according to Evernorth Research Institute.

In-home provider MedArrive can now connect members of its payer customers, particularly Medicaid plans, to Heartbeat Health for virtual cardiovascular services, the companies announced Tuesday.