Healthcare Finance Staff
As consumers increasingly are being asked to pay a larger share of their health bills, a coalition of insurers, pharmaceutical companies and provider and consumer advocacy groups launched a new push for greater transparency about the actual costs of services.
Employer health plans have seen significant benefit design changes in the past few years, due to rising healthcare costs and the Affordable Care Act. As actuaries analyze historical medical cost trend in order to forecast future trends and analyze the impact of benefit design changes, the effect of the member behavioral phenomena known as "benefit rush," "benefit hush" and "trend crush" should be considered.
In their ongoing efforts to manage costs and improve profits, many health plans are turning to the area of claims payment integrity, seeking opportunities to reduce annual claims expense by millions of dollars.
The Blue Cross Blue Shield brand may bring the idea of a consistent kind of health insurance, as the winner of one "health plan brand of the year" poll. But in Medicare Advantage satisfaction ratings, that is not the case.
Just as rival Humana exits the market, UnitedHealth Group is growing its portfolio of retail health clinics, in another step towards insurer-owned healthcare delivery.
Moving beyond the 2014 "land grab," insurers in 2015 relied upon tried and true direct marketing approaches for member acquisition. Like the first open enrollment period, it seems for many, this was effective.
A 2008 federal law was supposed to ensure that when patients had insurance benefits for mental health and addiction treatment, the coverage was on par with what they received for medical and surgical care. But until now, the government had only spelled out how the law applied to commercial plans.
For the third year, regulators have revamped reimbursement reductions into an average increase for Medicare plans serving America's growing senior populations, though not without requiring more work and oversight.
Horizon Blue Cross Blue Shield of New Jersey is on the trail of all things data, with a new executive position given a charge of making sense of it all, plus some other major comings and goings.
The likes of Lowe's and Walmart are moving ahead with the providers of excellence bundled payment model, applying it to a costly surgical treatment that's being marketed to an aging workforce with a low back pain epidemic.