Insurance

Insurers May Be Underpaying Physicians

Insurers May Be Underpaying Physicians

There are not exact numbers as to how often or by how much insurance companies underpay, but experts say it occurs frequently enough that doctors should constantly monitor their reimbursements against each payer's contract.

AMA Proposes Policy Opposing Medicaid 'Lockout' Provisions

AMA Proposes Policy Opposing Medicaid 'Lockout' Provisions

The AMA policy came in response to recently approved state Medicaid waivers that block patients from Medicaid for up to six months for not meeting deadlines or paperwork requirements.

New Short-Term Health Plans Have Large Coverage Gaps

New Short-Term Health Plans Have Large Coverage Gaps

Short-term health plans are meant to be a low-cost alternative to Obama-era plans with high premiums, but they don't have to cover existing medical conditions and they provide limited benefits.

AMA Aims to Boost Affordability of ACA Marketplace Plans

AMA Aims to Boost Affordability of ACA Marketplace Plans

The American Medical Association (AMA) House of Delegates has adopted policy to increase the number of people who obtain coverage through the Affordable Care Act by making marketplace plans more affordable.

Alternative Payment Models Should Include Precision Medicine

Alternative Payment Models Should Include Precision Medicine

The American Medical Association has committed to working to integrate precision medicine into alternative payment models.

Trump White House Freezes Billions Earmarked for Insurers Through ACA

Trump White House Freezes Billions Earmarked for Insurers Through ACA

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The White House announced earlier this month a plan to freeze billions of dollars of risk-adjustment payments scheduled to go to insurers through the Affordable Care Act.

Medicaid-Insured Patients Less Likely to Receive Guideline-Recommended Treatment

Medicaid-Insured Patients Less Likely to Receive Guideline-Recommended Treatment

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Although the Affordable Care Act reduced the percentage of uninsured Americans from 20.3% to 12.6%, differences in quality of care still persist.

Decline in Medicare Recipients Who Die in Acute Care Hospitals

Decline in Medicare Recipients Who Die in Acute Care Hospitals

The proportion of deaths that occurred in an acute care hospital decreased from 32.6% to 19.8% among Medicare fee-for-service decedents.

Coverage Policies Compared for Back Pain Medications

Coverage Policies Compared for Back Pain Medications

Access to opioid alternatives can be expanded through coverage and reimbursement policies.

Continuous Medicaid Coverage Essential for People Living With HIV

Continuous Medicaid Coverage Essential for People Living With HIV

Implementing initiatives to maintain Medicaid enrollment and to expedite Medicaid reenrollment and having alternate resources available in gaps are important to ensure continuous antiretroviral therapy to optimize HIV outcomes.

CDC: Prevalence of No Insurance Varies by Occupational Groups

CDC: Prevalence of No Insurance Varies by Occupational Groups

The researchers observed a significant decrease in the prevalence of being uninsured among workers aged 18 to 64 years.

Rates of Major Depression Up Among US Insured, Especially Youth

Rates of Major Depression Up Among US Insured, Especially Youth

Diagnoses of major depression have increased since 2013, particularly among adolescents and millennials.

CDC: No Change in Level of Uninsured in United States in 2017

CDC: No Change in Level of Uninsured in United States in 2017

The uninsured rate in 2017 was similar to the uninsured rate in 2016.

Health Care for Undocumented Immigrants Is Complex

Health Care for Undocumented Immigrants Is Complex

Undocumented immigrants are not allowed to obtain Medicaid or Medicare coverage or purchase plans as part of the Affordable Care Act.

Recent Years Saw Increase in Burden of Prior Authorization

Recent Years Saw Increase in Burden of Prior Authorization

Eighty-six percent of physicians reported that prior authorization burdens increased over the past 5 years.

ACA Marketplaces Expand Coverage for People With Chronic Illness

ACA Marketplaces Expand Coverage for People With Chronic Illness

Insurers within the ACA marketplace covered a disproportionate share of non-elderly adults with high healthcare risks from 2014 to 2015.

Prior Authorizations and Clinical Outcomes: Repercussions for Patient Health

Prior Authorizations and Clinical Outcomes: Repercussions for Patient Health

Physicians report an increase in the burden of prior authorization over the last 5 years.

What the CVS-Aetna Merger Means for the Future of Health Care

What the CVS-Aetna Merger Means for the Future of Health Care

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The proposed CVS-Aetna merger is a $70 billion deal that may shape the future of health care for years to come.

ACA Dependent Coverage Provision May Increase Use of Prenatal Care

ACA Dependent Coverage Provision May Increase Use of Prenatal Care

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Preconception health care coverage has been linked to better access to health care for mothers and infants.

High-Deductible Health Plans Linked to Lower Health Care Utilization

High-Deductible Health Plans Linked to Lower Health Care Utilization

Emergency department visits declined by 14% among study participants were switched to a high-deductible health plan.

Prior Authorization Equals Current Frustration: Challenges in Practice

Prior Authorization Equals Current Frustration: Challenges in Practice

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Insurance companies believe that if there are enough hurdles to jump over — and if the hurdles are high enough — patients and physicians might stop running.

Trends in Spending Following ACA Implementation Examined

Trends in Spending Following ACA Implementation Examined

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Overall, implementation of the Affordable Care Act has been associated with reduced out-of-pocket healthcare spending.

The CVS/Aetna Merger: What It Means for the Future of Primary Care

The CVS/Aetna Merger: What It Means for the Future of Primary Care

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In the new partnership, Aetna will have access to data on pharmaceutical usage patterns that will allow the company to carefully parse the insurance risks it takes on.

Balancing Sustainability and Access to Care in Concierge Medicine

Balancing Sustainability and Access to Care in Concierge Medicine

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One of the major pitfalls of concierge medicine is that physicians must limit their practice to guarantee the accessibility offered by the model in exchange for the retainer.

Physicians Must Report on 1 Patient and 1 Measure for MACRA

Physicians Must Report on 1 Patient and 1 Measure for MACRA

Physicians must report on at least 1 patient and 1 measure by December 31, 2017 and submit the report to Medicare no later than February 28, 2018.

Requiring Insurers to Participate in Marketplace Could Improve Access

Requiring Insurers to Participate in Marketplace Could Improve Access

If the government required insurers that participate in Medicare or Medicaid to participate in the marketplaces in the same geographic area, there would be potential to improve access.

Observation Care Costs Increased Among Commercially Insured Patients

Observation Care Costs Increased Among Commercially Insured Patients

The cost of observation care has increased for commercially insured patients, but it is still lower than spending for short-stay hospitalizations

Value-Based Payment Modifier Program Not Linked to Differences in Practice Performance

Value-Based Payment Modifier Program Not Linked to Differences in Practice Performance

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The Value-Based Payment Modifier is not associated with differences in performance between practices serving higher-risk and lower-risk patients.

Cancer Survival Improvements Limited to Patients With Medicare, Private Insurance

Cancer Survival Improvements Limited to Patients With Medicare, Private Insurance

Improvements in cancer survival were limited to patients with private or Medicare insurance.

Medicaid's Best-Price Rule May Not Be Such a Big Problem

Medicaid's Best-Price Rule May Not Be Such a Big Problem

Researchers note that the best-price rule may be an impediment to some novel pricing arrangements in the private sector, but there are ways to avoid or mitigate its impact.

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