The CDC will focus on hospital beds and admissions to determine a community's COVID-19 risk level, but hospitals are concerned about pulling back safety precautions during an ongoing pandemic.
The California Supreme Court upheld a lower court's decision to cut a $4.25 million malpractice award for pain and suffering to the $250,000 state limit for noneconomic damages.
Most Americans live in places where healthy people, including students in schools, can safely take a break from wearing masks under new U.S. guidelines released Friday.
A new study from Kaiser Permanente saw mortality rates drop, while the gap between Black and white patients declined, as screening for colorectal cancer increased more than 80% for both demographics in a 19-year study.
Teladoc Health and Amwell, two of the largest telehealth companies, outlined their growth strategies to investors this week. Teladoc posted $2 billion in revenue for 2021—up 85.8%—while Amwell posted $252.8 million, up 3.1%.
Teladoc Health and Amwell, two of the largest telehealth companies, outlined their growth strategies to investors this week. Teladoc posted a $2 billion in revenue for 2021, up 85.8%, and Amwell posted $252.8 million, up 3.1%.
For-profit plans grabbed 85% of new enrollees last year, according to analysis by The Chartis Group.
More older adults bought into Medicare Advantage last year than ever before, with private insurers capturing another 3% of the market from traditional Medicare, a new study says.
Medicare Advantage companies added 2.3 million enrollees in 2021, with 1.3 million of those individuals switching from traditional, fee-for-service Medicare, according to a report released on Thursday by The Chartis Group. At least half of the eligible population in 11 states are now enrolled in Medicare Advantage plans, up from three states last year, the report said.
"There was pretty dramatic growth of MA at traditional Medicare's expense," said Nick Herro, co-author of the report and a principal at The Chartis Group.
Forty-five percent of all beneficiaries—or 28 million individuals—are now enrolled in Medicare Advantage plans. Enrollment in special needs plans is driving the growth, with SNP membership growing 20% year-over-year to 4.5 million enrollees, representing 16% of all Medicare Advantage lives. By 2025, report authors expect half of all eligible individuals to choose private insurers to manage their Medicare, with special needs individuals who are eligible for both Medicaid and Medicare accelerating private health plans' dominance over the traditional, fee-for-service program. National health plans are the largest investors in this space, Herro said.
"The space is attractive because the population is more medically complex," he said. "There's this macro theme of value-based care delivery, care management and coordinated risk that really converges on the duals population and the profile of those individuals in those products."
"SNP product interest is increasing by national plans," report authors wrote. "This, coupled with robust Medicaid enrollment and eligibility growth, will propel the products forward and lead Medicare Advantage growth."
For-profit plans continue to capture the lion's share of new enrollees, with 85% of all members going to private insurers. In 2021, UnitedHealthcare obtained a third of all new enrollment, while Centene acquired 15% of new beneficiaries and CVS Health's Aetna nabbed 14% of all enrollees, according to the report. Despite these plans' dominance, the national Medicare Advantage landscape remains competitive, with the number of competitive offerings growing in several states, thanks to for-profit plans trading share year-over-year through aggressive pricing and plan design in local markets.
Report authors pointed to Humana as an example of this phenomenon, with the insurer's market share declining the most year-over-year, despite the nation's second-largest Medicare Advantage carrier adding 315,000 new members.
Not-for-profits and Blue Cross Blue Shield plans likewise ceded more of their market share to for-profit plans. Report authors pointed out that private insurers' share of enrollment has grown 11.3% since 2019, while Blues plans have grown 5.5% and not-for-profits have grown 4% during that time frame. Kaiser Permanente can serve as an example of this trend, according to report authors, with the not-for-profit's hold on the market declining at the second-fastest rate in 2021.
"In a market that's growing 9% per year, you can lose share and still feel good about it," Herro said. "If you're growing at 4 or 5% a year, that's actually by most accounts, a very successful growth rate."
Insurtechs also grew their influence in the lucrative market last year, capturing 1.3% of all new enrollees in 2021, up from 0.9% the year before. Bright Health Group and Devoted Health led the way among startup insurers, with the two companies representing two-thirds of growth among this cohort. As these companies continue to expand their geographic footprint and grow through targeted mergers over the new fest years, young health plans "could quickly change the competitive landscape" and grab share from the for-profits, Herro said.
He added that the Blues and not-for-profits could learn from the insurtech's go-to-market strategy.
"These plans very confidently moved into many markets very quickly, developed attractive products, marketed them correctly and you see the benefit of that," Herro said.
Neidorff plans to retire this year, but the insurer will have several executives step in to run Centene's day-to-day operations during his absence.
Providers, patient advocates and some lawmakers are taking aim at health insurers, arguing that low payments and restrictions on coverage limit access.
The federal judge ruled that some parts of the rule give too much power to insurers in the arbitration process and that HHS did not offer enough notice before it was implemented.
The acquisition is the home health, hospice and personal care company's second home health purchase this month.
The new ACO model will incorporate health equity requirements, make changes to risk adjustment policies and more.
In addition to its annual awards, the association will present a President's Award for the first time since 2015 as well as two lifetime achievement awards.
A shakeup of top leadership at Beaumont has begun following the completion of the merger between Beaumont Health and Spectrum Health earlier this month.
The virtual care company is worth more than $1 billion after a nearly $200 million Series E funding round.
Washington was the first state to introduce a public option for health insurance, but the rollout hasn’t been smooth. Other states with public options in the works are taking notice.
In the past, health plans sometimes have said they would pay for emergency care even if it’s out of network. The No Surprises Act now makes this a legal requirement in every state. The provider and insurer are supposed to negotiate a reasonable payment, leaving the patient out of the equation.
But what if the insurance company denies that the care is for an emergency? Or the hospital doesn’t supply the paperwork to prove it?
The electronic health records giant posted a 4.7% revenue increase last year as it prepares for its pending acquisition by Oracle.
The governor said the new law will help customers understand the "back end" pricing of prescription drugs and "lower inflated prices."
The condition, formally known as multisystem inflammatory syndrome in children, involves fever plus symptoms affecting at least two organs and often includes stomach pain, skin rash or bloodshot eyes.
CMS says it's working on broader ACO transformation efforts and will announce additional proposals soon.
A patient was charged more than $3,500 for a CT scan, which amounted to over 11 times the Medicare reimbursement rate, according to the lawsuit.
Patient lawsuits, unsuccessful so far, argue hospitals should have notified them about their practice of charging thousands of dollars in facility fees onto emergency department bills.
Northeast Ohio's three big healthcare systems — Cleveland Clinic, MetroHealth and University Hospitals — are working with a variety of community partners on a project to train workers quickly for entry-level positions that offer a path to career advancement.
The court had already turned down two emergency applications that sought to stop the mandate from going into effect.
The trial of an Ohio doctor accused in multiple hospital deaths began Tuesday with the defendant turning down a possible last-minute plea deal.
Holy Name Medical Center designed an electronic health record system it plans to market to peers, joining a growing number of hospitals that see technology as a business opportunity.
While more health systems are investing in hospital-at-home programs, how widely they are adopted and their ultimate success will depend on billing and reimbursement strategies.
As surgeon general, Murthy called out early on COVID misinformation and disinformation, urging Americans to follow tested public health guidance and get vaccinated and boosted.
Total confirmed cases reported Saturday barely exceeded 100,000, a sharp downturn from around 800,850 five weeks ago on Jan. 16, according to Johns Hopkins University data.
Wright Lassiter III, president and CEO of Henry Ford Health System, joins The Check Up to discuss the innovative ways the health system is dealing with labor shortages.
