Mar 19, 2021 | Managed Care Friday
90%: Amount of hospitals undertaking artificial intelligence initiatives, up from just 53% in 2019, according to a new report published by Sage Growth Partners. While many of these programs are still in the planning or early implementation phase, it’s clear that healthcare executives understand the benefits of this technology and are using AI to make health systems better for both patients and providers, particularly in the wake of the pandemic. Doctor Amazon?: The online retailer runs health clinics near worksites in Dallas-Fort Worth, Phoenix, Louisville and, more recently, Michigan and...
Mar 12, 2021 | Managed Care Friday
$4,229: The average total savings when using bundled payment programs for surgeries, according to a new study published by Rand on March 1st. The study looked at one payer’s program in which procedures including knee and hip replacements, spinal fusion and bariatric weight loss surgeries used a set bundled payment for all care within a 30-day period. More Than A Feeling: Nonprofit Atrius with more than 30 primary care medical offices and 715 physicians in the Boston area is now an Optum company. High Life: Highmark Health, which increased membership recently through its acquisition of...
Mar 5, 2021 | Managed Care Friday
200,000: Highmark’s increase in membership now that state regulators approved an affiliation agreement with HealthNow New York last week. They will be the primary Blue plan in western and northeastern NY, plus in central and western Pennsylvania, West Virginia and Delaware. If you’re doing managed care contracting and looking to expand your healthcare business in this region, Highmark matters – it can help you take a young model to another state, or on the flip side put pressure on payment and utilization. Cancer Care Bundle: Memorial Sloan Kettering in New York is partnering with Carrum...
Feb 26, 2021 | Managed Care Friday
5: The number of chronic conditions that cost employers $2.5B over 2 years, according to a new study published by UnitedHealthcare’s Center for Advanced Analytics, using claims issued by the Health Action Council’s 57 employer members. Asthma, diabetes, hypertension, mental health/substance abuse, and back disorders were the top offenders and the study found that more than 60% of workers experience at least 1 of these conditions. This probably comes as no surprise to most employers, who are increasingly turning to new programs and strategies, including digital health options, to help manage...
Feb 19, 2021 | Managed Care Friday
3D: Beginning in April, Harvard Pilgrim Health Care will provide reimbursement for digital breast tomosynthesis (3D mammography) for commercial members in all states the plan covers. Harvard Pilgrim recently merged with Tufts Health Plan, although the two will keep their products separate for the time being. Lab Disruption: United is planning to launch a Designated Diagnostic Provider program in July 2021 and there is already pushback against the health insurer’s plan. The program is designed for commercial members and will only cover outpatient lab services when delivered by freestanding or...
Feb 12, 2021 | Managed Care Friday
20%: The difference in reimbursement rates for ABA providers now that BCBS of Texas will begin tiering them for ABA therapy, effective April 2021. RBTs, Board Certified Assistant Behavior Analysts or clinicians with a bachelor’s degree will receive the existing rate, while clinicians with less than a bachelor’s degree and no RBT certification will receive 20% less. BCBAs and master’s level clinicians will receive an increase in rate of 20%. Gender Policy Winners: A new policy on gender surgery is likely a boost to mental health provider volume. Aetna is updating its commercial policies to...
