Revenue Cycle and Payer News 7-5-2017

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Posted By: Roberta Mullin July 5, 2017

In the News…

Wellthie Announces Partnership with Conference Associates
Wellthie (@Wellthie) – an insurance technology company offering broker and carrier sales technology that simplifies insurance distribution for small businesses – has announced a partnership with Conference Associates (CAI), one of New York’s first and largest group insurance administrators. The partnership will provide all of Conference Associates’ brokers with access to the industry’s latest technology to help support their small business clients with a modern insurance shopping experience.

Availity Releases Survey on Payer-Provider Collaboration Gaps
A survey conducted by Availity (@availity), the nation’s largest real-time health information network, found that while payers and providers want to collaborate more closely on value-based care initiatives, such partnerships remain vulnerable to poor data transparency, competing business goals, and significant administrative burdens.

Trends in Healthcare Payments Annual Report
The Trends in Healthcare Payments Seventh Annual Report: 2016 is now available to download – free of charge. For the last seven years, InstaMed (@InstaMed) has released this report to objectively educate the market and promote awareness, change and greater efficiency through quantitative data from the InstaMed Network and qualitative data from healthcare providers, payers and consumers surveyed nationwide.

MACRA changes meet with favorable reaction from medical groups
The Centers for Medicare and Medicaid Services (@CMSGov) proposed changes to the MACRA rule for 2018 recently, and medical groups have reacted mostly favorably, praising the agency for suggesting payment rule changes that would allow more flexibility for small, independent and rural practices particularly.

Mayo’s Health Tradition insurer pulls two plans amid health care policy uncertainty
Due to the Republicans attempt to repeal the Affordable Care Act, Health Tradition, Mayo Clinic Health System’s insurance plan, will halt individual coverage Dec. 31 and will not write small employer group health plans under the ACA’s Small Business Health Options Program next year.

FTC and State Attorney General Challenge Physician Group Acquisition in North Dakota
The Federal Trade Commission has authorized a federal court action to block Sanford Health’s proposed acquisition of Mid Dakota Clinic, alleging that the deal would violate antitrust law by significantly reducing competition for adult primary care physician services, pediatric services, obstetrics and gynecology services, and general surgery physician services in the greater Bismarck and Mandan metropolitan area.

Investors itching to see a Cigna-Humana deal
Now that the federal government has quashed the two health insurance mega-mergers — Aetna’s $37 billion acquisition of Humana and Anthem’s $54 billion deal for Cigna — Wall Street analysts are anticipating that Cigna (@Cigna)  and Humana (@Humana) will pursue their own merger. If they combined, the result would be a giant insurer of employer and Medicare plans with $84 billion of annual revenue. Cigna has said it is broadly on the hunt, and Humana has shown it is willing to be acquired.

Predictive analytics may save healthcare budgets 15%, survey finds
Ninety-three percent of healthcare provider and payer executives agree predictive analytics are important to the future of their business, according to a Society of Actuaries report. For the “Predictive Analytics in Healthcare Trend Forecast” report, the Society of Actuaries surveyed 223 healthcare provider and payer executives about trends in the industry. Becker’s offers five survey insights.

California could lose $114 billion under GOP health bill, restructuring Medi-Cal likely required
According to health leaders, California risks losing $114.6 billion in federal funds within a decade for its Medicaid program under the Senate health care bill, a decline that would require the state to completely dismantle and rebuild the public insurance program that now serves one-third of the state.

Can Insurance Companies Incentivize Their Customers to Be Healthier?
Of all industries, insurance has a unique opportunity to align its commercial interests with preventive behaviors. Insurers, along with public services, can directly “monetize” better individual behavior as healthier or safer individual outcomes, lower claims costs, and improve risk pools, which can be translated into lower-priced premiums and a competitive advantage in the marketplace. Insurance is therefore a natural shared value industry — one that can employ the idea proposed by Harvard Business School professor Michael Porter and Mark Kramer of FSG in 2011. This new research report highlights how insurers are applying the model.