In the News…
Anthem to Acquire HealthSun
Anthem, Inc. (@AnthemInc) announced that the company has entered into an agreement to acquire HealthSun, one of the fastest-growing integrated Medicare Advantage health plans and healthcare delivery networks in Florida. HealthSun currently serves approximately 40,000 members through its Medicare Advantage plans in Miami-Dade and Broward counties.
$32M MA Settlement Involved Alleged ‘Rented Network’ Scheme
AIS Health reports that as the Dept. of Justice pursues two whistleblower lawsuits against UnitedHealth Group (@UnitedHealthGrp) and investigates other insurers’ alleged “upcoding” practices that lead to higher-than-deserved Medicare Advantage payments, a recent $32.5 million settlement between a Florida-based MA plan operator and the federal government reflects the DOJ’s growing scrutiny over MA plans’ risk adjustment practices. But the settlement is also significant in that it resolves the alleged manipulation of requirements around provider network adequacy, which has become a focus of CMS in recent years.
Who is UnitedHealth Group?
After UnitedHealth Group’s subsidiary Optum (@Optum) recently purchased the Advisory Board for $1.3 billion, Modest Money took a harder look at one of the nation’s largest insurers and started to piece together their plan to become the complete healthcare package.
Insurers Come Out Swinging Against New Republican Health Care Bill
According to The New York Times, the health insurance industry, after cautiously watching Republican health care efforts for months, came out forcefully last Wednesday against the Senate’s latest bill to repeal the Affordable Care Act, suggesting that its state-by-state block grants could create health care chaos in the short term and a Balkanized, uncertain insurance market.
Health plans want consumers to have access to the health care they need, AHIP’s Matt Eyles tells @CNN . #GrahamCassidy pic.twitter.com/BAVi2SO7id
— AHIP (@AHIPCoverage) September 22, 2017
Health benefits manager CareCentrix explores sale: sources
CareCentrix Inc, (@CareCentrix) a U.S. benefits manager majority owned by private equity firm Summit Partners, is exploring a sale that could value it at around $1 billion, including debt, people familiar with the matter said on Friday. CareCentrix partners with healthcare payers to administer their benefits programs for patients who need post-acute care, which can range from treatment in skilled nursing facilities to home healthcare.
Leading Insurtech Company, Wellthie, Launches Broker Platform for Medical + Ancillary Sales
Wellthie (@Wellthie) – an insurance technology company offering leading broker and carrier sales technology that modernizes insurance distribution for small businesses – has launched Wellthie Small Group, the first-of-its-kind platform to bring a comprehensive Small Group benefits marketplace together with dynamic sales optimization tools to empower top-performing brokers and agents nationwide. Responding to national demand, Wellthie has expanded its shopping, quoting, and enrollment platform to new markets and additional lines of coverage, including medical and top ancillary products like dental, vision, and value-added products.
How Can We Help Stabilize The Health Insurance Marketplace?
With Senate committee hearings on the individual insurance market in full swing and two competing health care bills being pushed — one proposed by liberal Bernie Sanders, the other from conservatives Lindsey Graham and Bill Cassidy — now is a good time to think about how we can work together to increase the effectiveness of the health insurance marketplace. But according to Insurance News Net, the question isn’t “can’t we all just get along?” It’s “how can we stabilize the market so that it benefits both agents and their clients?”
Patient Satisfaction with Billing Drives Collections, Referrals
According to Health First Financial there is no question, clinical care plays a key role in a patient’s overall satisfaction with a provider. In fact, clinician-to-patient communication is one of the top-ranking categories in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. But a patient’s revenue cycle experience can outweigh the clinical experience. A TransUnion Healthcare survey found that patients who had a positive billing and payment experience gave higher marks for the actual care received compared to patients who had issues with their billing.