Anthony Brino
The Centers for Medicare & Medicaid Services is proposing a number of new tweaks and more stringent requirements for Medicare Part D, hoping to save more than $1 billion over five years.
Risk management programs instituted by the Affordable Care Act may make older, higher-cost members more profitable for insurers than expected.
Medicare Advantage (MA) HMO plans may be offering more efficient care than Medicare Part A and B plans, a study published in the journal Health Affairs has found. According to researchers, MA HMO enrollees have fewer hip and knee replacements and use fewer benefits for outpatient surgeries and procedures, inpatient stays and emergency department visits.
More than half of all Medicare claims denial appeals are overturned by administrative law judges according to a recent report by the Office of Inspector General.
With Medicare enrollment and spending set to grow in the coming decades, the program needs to better spread risk and incentivize value and also needs a better statutory definition of cost-benefit considerations, researchers argue in the latest issue of the New England Journal of Medicine.
As the federal government evaluates state demonstrations for providing Medicare-Medicaid eligible Americans with better, more cost-effective care, a new study suggests that large savings will be elusive without specialized models and some improvisation.
America's Health Insurance Plans (AHIP) is fighting to prevent new prompt pay rules for self-funded insurance plans from taking effect that have the support of the American Medical Association and the Medical Association of Georgia, which have joined the state Insurance Commissioner in defending them.
Exceeding some Wall Street expectations, Minnetonka, Minn.-based UnitedHealth Group reported third quarter earnings of $1.50 a share and projected 2012 net earnings of $5.20 to $5.55 a share, up from July projections of around $5.
Massachusetts makes its first real foray into managed care with a demonstration plan focused on dual eligibles from ages 21 to 64. The plan emphasizes patient relationships with independent living support coordinators and community-based organizations.
A new Urban Institute report challenging the notion, and some evidence, that the Affordable Care Act will likely lead to a drop in employer coverage suggests that employer-sponsored health insurance may actually increase under the healthcare law.