Susan Morse
ACOs have left because of a surprise risk adjustment that pushed some from receiving bonus payments to paying penalties, expert says.
The Office of the Insurance Commission will impose some or all of a remaining $900,000 suspended fine if the insurer does not meet compliance plan.
The at-risk model has grown, but for some accountable care organizations obtaining financial benchmarks remains elusive. ACOs that have exited the program in the past said metrics are too high.
The platform gives providers patient data to earn incentives from risk-based contracts.
Insurers in the individual market are starting work on setting premium rates for this October without federal cost-sharing reduction funds or a reinsurance program.
States qualify by having at least 85 percent of their Medicaid population in managed care or by reducing provider payments rates.
Insurers get no federal funds for cost-sharing reduction payments or a reinsurance program to help stabilize the individual market.
As Congress debates appropriations legislation with the Friday deadline looming, cost-sharing reduction payments and reinsurance face uphill battle for inclusion.
The insurer claims ER physician staffing firm is charging 'outrageous' rates, while Envision blames UnitedHealthcare for out-of-network charges.
The joint venture currently offers employers with employees in northern California self-insured commercial products with effective dates as early as April 1.