Reimbursement
Pushing the needle on value-based care will require buy-in from employers, says Susan Dentzer, president and CEO of APG.
These hospitals had an average operating margin of -8.6%, compared with -1.4% for all other hospitals, based on Medicare cost report data.
This year, 31 plans earned 5 stars, compared to 57 in 2023 and 74 in 2022.
Optum growth led the way, with the subsidiary's revenues growing 22% year-over-year to $56.7 billion.
Most of the selected diagnosis codes that Aetna submitted to CMS didn't comply with federal requirements, OIG says.
The modifications are in line with the industry as a result of the PHE ending in May, Aetna says.
The lawsuit was linked to past risk adjustment submissions from certain types of patient records, some dating back more than a decade.
While 80% of a commercial bill is the plan's responsibility, 20% is owed by patients, says PayMedix CEO Tom Policelli.
Coverage of digital medicine CPT codes varies wildly, which makes it difficult for physicians to reliably provide digital services.
At least 7.1 million Medicaid enrollees have been disenrolled as of September 20, according to KFF.