Medicare Advantage

Many Medicare Beneficiaries Face High Out-of-Pocket Costs for Dental and Hearing Care, Whether in Traditional Medicare or Medicare Advantage

Many Medicare beneficiaries face high annual out-of-pocket costs for dental and hearing care — services that generally aren’t covered in traditional Medicare, but typically are covered by Medicare Advantage plans though the scope and value of these benefits vary, finds a new KFF analysis. The analysis shows that, among beneficiaries who used each type of…More

Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage

This analysis builds on our prior work – Medicare and Dental Coverage: A Closer Look – by analyzing hearing and vision use, out-of-pocket spending and cost-related barriers to care among Medicare beneficiaries as well as hearing and vision benefits in Medicare Advantage plans. It also incorporates top-level findings from the analysis of dental services to …

Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage Read More »

Clover Health, MedArrive Team Up for In-Home Vaccination Effort

As of Friday, nearly 55% of the U.S. population was fully vaccinated against the COVID-19 virus. Despite a strong start, that figure now puts the nation behind several other countries as far as vaccination rates. A big part of the issue with the modestly increasing vaccination rates in the U.S. is widespread skepticism, often fueled …

Clover Health, MedArrive Team Up for In-Home Vaccination Effort Read More »

CMS suspends enrollment in UnitedHealthcare, Anthem MA plans

The agency has suspended enrollment in three UnitedHealthcare plans and one Anthem plan for 2022 because the plans did not spend enough of their premium incomes on medical benefits and claims. The payers can contest the suspension, though it is unclear if they plan to.

SCAN Health Plan Enters Several Markets, Opening New Doors for In-Home Care Providers

SCAN Health Plan has been serving numerous counties across California for decades. Now, the Medicare Advantage insurer plans to expand its footprint to two additional states, opening new doors to potential home care partners in the process. Founded in 1977, Long Beach, California-based SCAN Health Plan is one of the nation’s largest not-for-profit Medicare Advantage …

SCAN Health Plan Enters Several Markets, Opening New Doors for In-Home Care Providers Read More »

Justice Department Targets Data Mining in Medicare Advantage Fraud Case

The Justice Department has accused an upstate New York health insurance plan for seniors and its medical analytics company of cheating the government out of tens of millions of dollars. The civil complaint of fraud, filed late Monday, is the first by the federal government to target a data mining company for allegedly helping a …

Justice Department Targets Data Mining in Medicare Advantage Fraud Case Read More »

Ochsner Health Launches Fall Prevention Pilot Program to Medicare Advantage Members

What You Should Know:  – Ochsner Health and innovationOchsner (iO) have partnered with Bold, an evidence-based, digital exercise platform for older adults aimed at reducing falls and improving health outcomes. – The Bold platform is one of five interventions in the Ochsner Connected Stability pilot fall prevention and monitoring programs focused on helping Medicare Advantage …

Ochsner Health Launches Fall Prevention Pilot Program to Medicare Advantage Members Read More »

Sutter Health to pay $90M to resolve False Claims allegations

The California-based health system will pay a hefty price to resolve allegations that it knowingly submitted inflated diagnosis codes for certain Medicare Advantage beneficiaries to receive higher payments. Sutter Health does not admit any liability in the matter.

KHN’s ‘What the Health?’: Booster Time

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. As covid-19 cases in the U.S. continue to rise, the Biden administration is countering with new strategies. The latest efforts include preparing for vaccine boosters starting this …

KHN’s ‘What the Health?’: Booster Time Read More »

Payments to Medicare Advantage Plans Boosted Medicare Spending by $7 Billion in 2019

The federal government spent $321 more per person for beneficiaries enrolled in Medicare Advantage plans than for those in traditional Medicare in 2019, a gap that amounted to $7 billion in additional spending on the increasingly popular private plans that year, finds a new KFF analysis. The Medicare Advantage spending includes the cost of extra…More

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges

This analysis finds that Medicare spending for Medicare Advantage enrollees was $321 higher per person in 2019 than if enrollees had instead been coverage by traditional Medicare, leading to an estimated $7 billion in additional spending in 2019. It also examines the implications of expected growth in Medicare Advantage enrollment and payments per enrollee from …

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges Read More »

Why Doesn’t Medicare Cover Services So Many Seniors Need?

Sorry, Joe Namath. Despite what you keep saying in those TV ads, under Medicare, seniors are not “entitled to eliminate copays and get dental care, dentures, eyeglasses, prescription drug coverage, in-home aides, unlimited transportation and home-delivered meals, all at no additional cost.” But if Democratic lawmakers in Congress have their say, seniors could soon be …

Why Doesn’t Medicare Cover Services So Many Seniors Need? Read More »

Health Plan Investment in Social Determinants of Health Likely to Accelerate

In recent years, Medicare Advantage (MA) plans have increasingly turned their attention to addressing members’ social determinants of health (SDoH), with the home playing a crucial role. That’s according to a new report from NORC at the University of Chicago. NORC conducted the report on behalf of Better Medicare Alliance’s (BMA) Center for Innovation in …

Health Plan Investment in Social Determinants of Health Likely to Accelerate Read More »

CMS repeals MA rate disclosure requirement, boosts hospital payments by $2.3B

CMS has finalized its 2022 inpatient payment rule, which will not only repeal part of the price transparency requirements related to Medicare Advantage rates and increase payments to hospitals but will also require facilities to report Covid-19 vaccination uptake among its employees.

Justice Department joins False Claims lawsuits against Kaiser Permanente

The government has intervened in complaints alleging Kaiser Permanente entities defrauded Medicare out of “tens of millions of dollars” by knowingly submitting false diagnoses for Medicare Advantage beneficiaries. Kaiser denies the allegations, saying it is in compliance with program requirements.

Humana Sets Stage for Kindred Takeover, Remains Hopeful About a 2022 Return to Normalcy

Despite still reeling from COVID-19-related headwinds, Humana Inc. (NYSE: HUM) experienced better-than-expected results in its home and provider businesses during the second quarter of 2021. “Our strong operating performance this year is, in part, attributed to our strong partnerships with providers who are delivering high-quality care to our members,” Bruce Broussard, president and CEO of …

Humana Sets Stage for Kindred Takeover, Remains Hopeful About a 2022 Return to Normalcy Read More »

Lacking Dental Coverage, Many People on Medicare Forgo Dental Care, Especially Beneficiaries of Color

Many people enrolled in Medicare go without dental care, especially beneficiaries of color, according to a new KFF analysis of dental coverage and costs for people with Medicare. Almost half of all Medicare beneficiaries (47%) did not have a dental visit within the past year as of 2018, the analysis finds, with rates higher among…More

Medicare and Dental Coverage: A Closer Look

Medicare does not cover routine dental care and about half of Medicare beneficiaries do not have dental coverage. Some beneficiaries have dental coverage through other sources, including Medicare Advantage, but 47% of all beneficiaries have not been to the dentist in the past year and many older adults face high out-of-pocket costs for needed dental …

Medicare and Dental Coverage: A Closer Look Read More »

Anthem CEO Breaks Down myNEXUS Acquisition, Touts At-Home Care Capabilities

Anthem Inc. (NYSE: ANTM) continues to tout its positioning when it comes to home-based care. The Indianapolis-based insurer acquired myNEXUS — a convener that manages home-based care for payers — earlier this year. Anthem’s focus on how that acquisition improves its overall network since then reflects its home-based commitments. “We closed on the acquisition of …

Anthem CEO Breaks Down myNEXUS Acquisition, Touts At-Home Care Capabilities Read More »

UnitedHealth Group CEO: Future Growth Will Come from Home-Based Care Investments

UnitedHealth Group (NYSE: UNH) leaders highlighted key growth drivers for the company during a Thursday morning conference call on Q2 2021 financial results. Execs honed in on three main investment areas, with one being a continued bet on Optum, its in-home care provider. UnitedHealth Group has been one of the more active payers as far …

UnitedHealth Group CEO: Future Growth Will Come from Home-Based Care Investments Read More »

Study: Black, Hispanic beneficiaries driving MA enrollment growth

Enrollment in Medicare Advantage plans grew rapidly between 2009 and 2018, with the largest increases seen among Black, Hispanic and dual enrollee — that is enrolled in both Medicare and Medicaid — populations. This indicates that payers will need to play a key role in addressing health inequities.

Cano Health buys Doctor’s Medical Center for $300M

Senior-focused primary care provider Cano Health acquired Doctor’s Medical Center for $300 million, which adds around 54,000 new members and 18 medical centers to its roster. This is the second major acquisition for Cano Health in less than a month. The company bought University Health Care for $600 million in mid-June.

GuideWell Announces Strategic Investment in Home-Based Primary Care Provider PopHealthCare

Health plans — and the entities that own them — continue to invest heavily around in-home care. The latest example is GuideWell Mutual Holding Corporation, which announced a new “multi-year strategic investment” in subsidiary PopHealthCare on Wednesday. The company is not disclosing the exact size of the investment. “At GuideWell, we are committed to transforming …

GuideWell Announces Strategic Investment in Home-Based Primary Care Provider PopHealthCare Read More »

Cano Health’s $600M acquisition will add 24,000 MA members to its roster

Cano Health, which provides primary care services for seniors, bought Miami-based University Health Care for $600 million. University Health Care serves approximately 24,000 Medicare Advantage members, which will bring Cano Health’s membership to around 143,000.

Why Home Care Providers Should Stand Strong in Negotiations with MA Plans

Home care companies looking to lean into Medicare Advantage (MA) opportunities in their markets will have to plan prudently. That planning must be pretty comprehensive, too, as there’s no silver bullet to winning MA business. That’s according to ATI Advisory founder and CEO Anne Tumlinson, who spoke at the Home Health Care News Medicare Advantage …

Why Home Care Providers Should Stand Strong in Negotiations with MA Plans Read More »

How the Medicare Advantage Landscape Has Evolved for Home Care Providers

The Medicare Advantage (MA) opportunity isn’t one that has happened overnight for home care providers, with some industry insiders even describing it as a “slow burn.” In more recent years, a shift has begun to take place, however. Although MA has become a bigger piece of the overall Medicare program puzzle, home care only stepped …

How the Medicare Advantage Landscape Has Evolved for Home Care Providers Read More »

Innovaccer Unveils Health Plan Analytics Tool to Give a Comprehensive View of Over 700 Medicare Advantage Plans

What You Should Know:  –Innovaccer Inc., a leading healthcare technology company, recently launched its Health Plan Analytics tool, which provides a comprehensive view of health plan performance across the country.  –With this tool, payers can identify the quality parameters where they lag and determine the performance threshold to attain satisfactory ratings and enrollment. In addition, …

Innovaccer Unveils Health Plan Analytics Tool to Give a Comprehensive View of Over 700 Medicare Advantage Plans Read More »

Clover Health Announces In-Home Primary Care Expansion, Becomes New Target for Reddit Traders

Clover Health (Nasdaq: CLOV) announced Wednesday that it plans to scale its in-home primary care program, “Clover Home Care,” through the new direct-contracting model from the U.S. Centers for Medicare & Medicaid Services (CMS). The announcement came as Reddit’s investor community also targeted the health care company as its most recent cause. Headquartered in Nashville, …

Clover Health Announces In-Home Primary Care Expansion, Becomes New Target for Reddit Traders Read More »

Medicare Advantage vs. Medicare FFS: A Systematic Review

Medicare Advantage has grown over time. In 2020, nearly four in ten (39%) of all Medicare beneficiaries – 24.1 million people out of 62.0 million Medicare beneficiaries overall – were enrolled in Medicare Advantage (MA) plans. With MA enrollment growing, a key question is who provides higher quality care: Medicare fee-for-service (FFS) or MA? Who …

Medicare Advantage vs. Medicare FFS: A Systematic Review Read More »

Smaller MA Plans Are Leveraging the Home to Get Ahead

The Medicare Advantage (MA) market is controlled mostly by big payers, as the top 10 plans control over 75% of the market. Then there is a 50-foot cliff. Yet at the bottom of that cliff, there are the smaller MA payers who are often more willing to explore and innovate to stand out. Examples of …

Smaller MA Plans Are Leveraging the Home to Get Ahead Read More »

Home Care Providers Likely to See More Medicare Advantage Opportunities as Enrollment Grows

The Medicare Advantage (MA) program has carved out a larger role in the general Medicare universe over the last several years. The MA piece of the pie is projected to grow even further, giving home care providers plenty of opportunities to step into this space. The number of beneficiaries who have chosen MA in lieu …

Home Care Providers Likely to See More Medicare Advantage Opportunities as Enrollment Grows Read More »

Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2021

The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans, including stand-alone drug plans and Medicare Advantage drug plans. This analysis provides the latest data about Part D enrollment, premiums, and cost sharing in 2021 and trends over time.

Addus Focused on Sourcing New Home Health Acquisitions, Improving Applicant-Conversion Rates

The COVID-19 public health emergency has solidified the home as a viable and effective care setting. That, in turn, has led to meaningful opportunities for home-based care providers, especially those with diversified service lines. Addus HomeCare Corporation (Nasdaq: ADUS) is a prime example. The company’s leadership team discussed the pandemic and its lasting impacts during …

Addus Focused on Sourcing New Home Health Acquisitions, Improving Applicant-Conversion Rates Read More »

Zing Health Acquires Medicare Advantage Plan Provider Lasso Healthcare

What You Should Know: – Zing Health Enterprises, a physician-founded and led provider of Medicare Advantage health plans, has signed definitive documents to acquire Harrisburg, PA-based Lasso Healthcare Insurance Co. – Lasso Healthcare offers Medicare Advantage (MA) plans in 34 states and the District of Columbia. Its insurance offerings currently cover over 6,000 members. Lasso …

Zing Health Acquires Medicare Advantage Plan Provider Lasso Healthcare Read More »

Report: Payers saw higher gross margins, lower loss ratios in 2020, indicating profitability

Payers appeared to have a profitable 2020, with gross margins per member per month increasing, and administrative costs and medical loss ratios decreasing, a new report shows. But payers still have to contend with rebates their owe per the ACA medical loss ratio provision, which could amount to more than $2 billion.

Clover halves membership projections for direct contracting

When it planned to go public through a SPAC merger, insurance startup Clover Health told investors that it already had 200,000 direct contracting lives under contract for 2021. But in new guidance shared on Monday, the company now plans to end the year just 70,000 to 100,000 covered lives from direct contracting. 

Clover Health, Roundtrip to offer MA members non-emergency transport services

The health insurance startup and transportation service company are joining forces to offer Medicare Advantage members access to non-emergency medical transportation. With transportation being a key social determinant of health, Clover Health and Roundtrip are aiming to improve member experience and outcomes through the partnership.

Healthcare Marketing to Seniors: How to Create and Distribute on-Target Messaging

Is your “marketing to seniors” an audience turn-off? Are you inadvertently alienating the mature audience that you want to attract? Many people get genuinely upset—insulted, really—for a simple reason. This audience doesn’t like being included in the advertiser’s image of a “mature audience.” It seems to portray them as nearly over-the-hill, which is strongly contrary …

Healthcare Marketing to Seniors: How to Create and Distribute on-Target Messaging Read More »

Health Insurer Financial Performance in 2020

This analysis examines insurers’ financial data across markets through the end of 2020. It finds that average margins remained relatively high compared to recent years, suggesting many insurers remained profitable even as health spending rebounded and COVID-19 cases surged in the fall and winter.

Tech-Enabled Benefits Manager CareCar Raises $3M, Sets Sights on Home Care

As the breadth and depth of what Medicare Advantage (MA) plans can offer has grown, the actual management of supplemental benefits has gotten more complex. That includes the coordination of in-home care benefits, transportation services and more. In response to the more complicated landscape, more and more startups are popping up that help health plans …

Tech-Enabled Benefits Manager CareCar Raises $3M, Sets Sights on Home Care Read More »

Top 5 Medicare Advantage plan changes coming for 2022

The greatest uncertainty is members’ health status, which could impact MA organizations’ bidding submission process for 2022. Fortunately, fully vaccinated members are likely to resume in-person care this year, which means MA plans can expect a more consistent and reliable stream of data to form financial projections.

Why Humana Believes It Can Do Home Health Care Better

Humana Inc. (NYSE: HUM) believes it can deliver home health services better than traditional providers do today. More than any other reason, that’s fundamentally why it’s accelerating its in-home care strategy by acquiring 100% of home health giant Kindred at Home for a “bargain” purchase price of $5.7 billion — the company’s largest acquisition ever. …

Why Humana Believes It Can Do Home Health Care Better Read More »

Votive Health Raises $2.5M to Help Home-Based Care Providers Make Value-Based Arrangements

Votive Health — a technology startup that facilitates payer-provider integration — formally announced its launch and first funding round on Wednesday. The company raked in $2.5 million in a round led by Flare Capital Partners, with Chrysalis Ventures and OCA Ventures as co-investors. San Luis Obispo, California-based Votive Health is a technology-enabled network manager that …

Votive Health Raises $2.5M to Help Home-Based Care Providers Make Value-Based Arrangements Read More »

Time to Say Goodbye to Some Insurers’ Waivers for Covid Treatment Fees

Just as other industries are rolling back some consumer-friendly changes made early in the pandemic — think empty middle seats on airplanes — so, too, are health insurers. Many voluntarily waived  all deductibles, copayments and other costs for insured patients who fell ill with covid-19 and needed hospital care, doctor visits, medications or other treatment. …

Time to Say Goodbye to Some Insurers’ Waivers for Covid Treatment Fees Read More »

Humana Health Plan Overcharged Medicare by Nearly $200 Million, Federal Audit Finds

A Humana Inc. health plan for seniors in Florida improperly collected nearly $200 million in 2015 by overstating how sick some patients were, according to a new federal audit, which seeks to claw back the money. This story also ran on NPR. It can be republished for free. The Health and Human Services Office of …

Humana Health Plan Overcharged Medicare by Nearly $200 Million, Federal Audit Finds Read More »

3 Strategies to Up-Level Medicare Advantage Enrollment Before it is Too Late

Trey Keller, VP of Product Management at Edifecs Aaron Fulner, Sr. Director at Edifecs With a new administration looking to reshape healthcare policy and additional special enrollment periods already underway, now is the time to ensure Medicare enrollment systems are ready for the unpredictability, and potential opportunities, ahead. While Medicare is the fastest growing segment …

3 Strategies to Up-Level Medicare Advantage Enrollment Before it is Too Late Read More »

What Medicare Advantage Plans Want From Home-Based Care Providers

Medicare Advantage (MA) has provided tailwinds for home-based care providers, as the overall MA member population has grown substantially over the last decade. In 2020, there were over 24 million MA members in the U.S., over double the amount there were in 2010 and nearly five times the amount in 2005, according to Centers for …

What Medicare Advantage Plans Want From Home-Based Care Providers Read More »

Provider-Convener Hybrid onehome Teams Up with MA Disruptor Devoted Health

onehome — a home-focused post-acute care company that operates under a full-risk model — is gearing up for a major expansion push. And it’s doing so with the support of one of the most innovative Medicare Advantage (MA) plans in the country. The Miramar, Florida-based onehome announced Monday that it’s partnering with next-generation MA plan …

Provider-Convener Hybrid onehome Teams Up with MA Disruptor Devoted Health Read More »

Accra Names New COO; ConcertoCare Hires Chief Growth Officer

Accra executive lands promotion Accra has promoted Susan Morgan to the role of chief operating officer. The Minnetonka-based Accra is the largest provider of home care services in Minnesota. Among its offerings, the nonprofit company delivers assisted living, home health and mental health services, caring for more than 9,000 clients statewide. Previously, Morgan served as …

Accra Names New COO; ConcertoCare Hires Chief Growth Officer Read More »

‘This Is What Patients Want’: Home-Based Care Model Lowers Total Cost of Care by 44%

A new report from Washington, D.C.-based health care consulting firm Avalere Health is shining a brighter light on home-based care and its ability to drastically lower total cost of care. Released Tuesday, the report takes a comprehensive look at Hartford, Connecticut-based CareCentrix, a health-at-home solutions company that manages care for 17.5 million members through its …

‘This Is What Patients Want’: Home-Based Care Model Lowers Total Cost of Care by 44% Read More »

Payers Struggle with Provider Data Management Too

Eric Demers, CEO of Madaket Health Provider data management is usually discussed from the provider perspective: the busy staff, the needless paperwork amid a pandemic, the faxing, emailing and uploading of data. In these scenarios, the health plans are often painted as the villains for their bureaucratic processes and unique requirements. But the reality is …

Payers Struggle with Provider Data Management Too Read More »

Top Clinical Conditions Targeted by Medicare Advantage Plans Under SSBCI

The number of health plans offering some kind of innovative supplemental benefit skyrocketed in the past year, reflective of health care’s increasingly strong focus on the home and social determinants of health. That’s according to a new data brief from actuarial consulting firm Milliman, commissioned by the Better Medicare Alliance (BMA). “This analysis provides unique …

Top Clinical Conditions Targeted by Medicare Advantage Plans Under SSBCI Read More »

Signify Health Shares Soar More Than 33% in IPO, Valuing Company at Over $7.12B

What You Should Know: – Shares of Signify Health, a value-based care billing platform for in-home and bundled health services jumped more than 33% in its initial public offering (IPO), valuing the company at over $7.12B. – Today, Signify Health’s CEO Kyle Armbrester will also join the ranks among the youngest CEOs to ever take …

Signify Health Shares Soar More Than 33% in IPO, Valuing Company at Over $7.12B Read More »

In-Home Care Providers ConcertoHealth, Perfect Health Merge to Form ‘ConcertoCare’

Two in-home care providers — ConcertoHealth and Perfect Health — announced Wednesday that their organizations have merged. Together, the companies will operate under the name “ConcertoCare.” Aliso Viejo, California-based ConcertoHealth is a value-based care provider organization that delivers a variety of home-based care services. The company’s teams consist of complex care physicians, complex care nurses, …

In-Home Care Providers ConcertoHealth, Perfect Health Merge to Form ‘ConcertoCare’ Read More »

Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan

What You Should Know: – Anthem, Inc. has entered into an agreement with InnovaCare Health, L.P., to acquire its Puerto Rico-based subsidiaries, including MMM Holdings, LLC (“MMM”) and its Medicare Advantage (MA) plan MMM Healthcare, LLC as well as affiliated companies and Medicaid plan.   – MMM is Puerto Rico’s largest MA plan and one …

Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan Read More »

After Successful PDGM Transition, Humana Projects ‘Further Operating Model Advancement’ for Kindred at Home

Humana Inc. (NYSE: HUM) continues to make significant investments when it comes to building a home-based care strategy. Currently, the Louisville, Kentucky-based company’s in-house home-based care business lines include Humana At Home and Kindred at Home, the largest home health provider in the U.S., according to LexisNexis. The insurer complements those capabilities with a wide …

After Successful PDGM Transition, Humana Projects ‘Further Operating Model Advancement’ for Kindred at Home Read More »

Humana Teams Up with DispatchHealth to Deliver Hospital-Level Care in the Home

To better care for its members with multiple chronic conditions, health insurance giant Humana Inc. (NYSE: HUM) is teaming up with DispatchHealth to offer advanced hospital-level care in the home. While the news comes roughly two months after federal health care policymakers paved the way for hospital-at-home Medicare reimbursement, the Humana-DispatchHealth agreement is something the …

Humana Teams Up with DispatchHealth to Deliver Hospital-Level Care in the Home Read More »

Number of MA Plans Offering SSBCI ‘Social Needs Benefit’ Up 568% in 2021

In September, the U.S. Centers for Medicare & Medicaid Services (CMS) released high-level data suggesting a huge expansion of new Medicare Advantage (MA) supplemental benefits for 2021. CMS followed that up with specific information on MA supplemental benefits under the “primarily health-related” pathway a month later, catching home care providers’ attention due to strong numbers …

Number of MA Plans Offering SSBCI ‘Social Needs Benefit’ Up 568% in 2021 Read More »

Encompass Health Building MA Momentum, Still Exploring ‘Strategic Alternatives’ for Home Health Business

All eyes have been on Encompass Health Corp. (NYSE: EHC) since the company first announced it would be “exploring strategic alternatives” for its home health and hospice segment in December. At the time, Encompass Health said it was exploring a number of options for its home health and hospice business. Specific options cited by the …

Encompass Health Building MA Momentum, Still Exploring ‘Strategic Alternatives’ for Home Health Business Read More »

Home-Based Care Ally Signify Health Files for $100M IPO

It appears some health care companies are still opting to go public the old-fashioned way. Signify Health — a value-based care platform that uses advanced analytics and other technology to shift health services toward the home — filed an S-1 on Tuesday, indicating its intention of going public. The move comes roughly a year and …

Home-Based Care Ally Signify Health Files for $100M IPO Read More »

Aledade Secures $100M for Value-Based Primary Care, Reaching $2.1B Valuation

What You Should Know: – Aledade raises $100 Million in Series D funding to help more primary care practices thrive in value-based care. – The new funding will power the growth of a nationwide network of more than one million patients by further expanding into Medicare Advantage Contracts. Aledade, a Bethesda, MD-based provider of value-based …

Aledade Secures $100M for Value-Based Primary Care, Reaching $2.1B Valuation Read More »

CVS Health Launches Senior Medical Alert System, Symphony

What You Should Know: – Today, CVS Health announced Symphony, a medical alert system designed to keep seniors safe and connected at home. – Symphony consists of a collection of in-home and wearable devices that offer a new at-home experience by connecting a suite of sensors that can monitor for falls, motion, and room temperature …

CVS Health Launches Senior Medical Alert System, Symphony Read More »

A Dozen Facts About Medicare Advantage in 2020

Medicare Advantage enrollment has grown rapidly over the past decade, and Medicare Advantage plans have taken on a larger role in the Medicare program. More than 24 million Medicare beneficiaries (36%) are enrolled in Medicare Advantage plans in 2020. This data analysis provides updated information about Medicare Advantage enrollment trends, premiums, and out-of-pocket limits. It …

A Dozen Facts About Medicare Advantage in 2020 Read More »

Net Health Acquires Post-Acute Analytics Platform PointRight – M&A

What You Should Know: –  Net Health acquires post-acute market analytics platform PointRight to deepen the company’s analytics capabilities, post-acute presence, and support for SNF networks. Net Health, a provider of cloud-based software for specialty medical providers across the continuum of care, today announced that it has acquired PointRight Inc., a leading provider of analytics …

Net Health Acquires Post-Acute Analytics Platform PointRight – M&A Read More »

59% of Health Care CFOs See Home Care as Key Investment Area

The majority of health care financial leaders view home care as a key area of investment. That’s according to a recent survey from BDO, a Chicago-based accounting, tax, financial advisory and consulting organization. Released Monday, the survey includes the responses of 100 CFOs at U.S. health care organizations, including home health providers, with revenues ranging …

59% of Health Care CFOs See Home Care as Key Investment Area Read More »

12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup

Dr. Paul Hain, Chief Medical Officer of GoHealth Telehealth is Here to Stay in 2021 Prior to the pandemic, telehealth was a limited ad-hoc service with geographic and provider restrictions. However, with both the pandemic restrictions on face to face interactions and a relaxation of governmental regulations, telehealth utilization has significantly increased from thousands of …

12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup Read More »

MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers

Under the Trump administration, federal health care policymakers have long been vocal about the ability of Medicare Advantage (MA) to lower costs and improve outcomes among vulnerable populations. A recent report from the Washington, D.C.-based Better Medicare Alliance (BMA) and consulting firm Avalere Health is now putting hard numbers on that claim, particularly around home …

MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers Read More »

Intermountain, UnitedHealthcare create ACO for Medicare Advantage members

The health system and payer will coordinate care for eligible Medicare Advantage patients through the ACO, with the aim of improving health outcomes and reducing costs. The ACO expands a long-standing relationship between the two entities.

Health Insurer Financial Performance Through September 2020

In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related care returned in the summer and fall.

As Telehealth Surges, Are Seniors Being Left Behind?

Anne Davis, Director of Quality Programs & Medicare Strategy at HMS A global health crisis has thrust us into a scenario in which lives quite literally depend on the ability to virtually connect. Telehealth has rapidly emerged as a vital tool, enabling continuity of care, allowing vulnerable individuals to access their physician from home, and …

As Telehealth Surges, Are Seniors Being Left Behind? Read More »

5 Steps for Interoperability Excellence for Healthcare Providers

Shanti Wilson, Consultant, Freed Associates  As if 2020 couldn’t be any more challenging for healthcare providers, new federal rules on interoperability and patient access, granting patients direct access to their healthcare data, begin taking effect this November and continue into 2022. These rules, while ultimately beneficial to patients, bring an additional level of operational complexity to …

5 Steps for Interoperability Excellence for Healthcare Providers Read More »

SCAN Group Takes on Telehealth’s ‘Digital Divide,’ Moves Further into the Home

As mission-driven organizations, SCAN Group and SCAN Health Plan have leaned into trying to solve some of health care’s biggest problems. In particular, keeping seniors independent and healthy at home has been a major area of focus. SCAN Group is a nonprofit organization focused on helping older adults age in place. Founded in 1977, Long …

SCAN Group Takes on Telehealth’s ‘Digital Divide,’ Moves Further into the Home Read More »

Payer Credibility Helps Propel Home-Based Care Company Prospero Health into 16 New States

Home-based care company Prospero Health announced Tuesday it is expanding into 16 additional states to serve 8,000 new patients in 2021. That vastly increases the company’s footprint. Previously just in 10 states, the move now puts Prospero into 26 states total, allowing it to serve 25,000 patients on behalf of its partners, namely the Medicare …

Payer Credibility Helps Propel Home-Based Care Company Prospero Health into 16 New States Read More »

UnitedHealthcare Advances Home Strategy, Expects to Make 1.7M House Calls in 2020

A number of major Medicare Advantage (MA) carriers are expanding their supplemental benefit offerings shaped around in-home care next year. UnitedHealthcare, the insurance arm of UnitedHealth Group (NYSE: UNH), is among them. Overall, UnitedHealthcare partners with more than 1.3 million physicians and care professionals across the U.S., plus another 6,500 or so hospitals and other …

UnitedHealthcare Advances Home Strategy, Expects to Make 1.7M House Calls in 2020 Read More »

Humana Accelerates Value-Based Care Strategy with Home Health Providers, Others

Humana Inc. (NYSE: HUM) continues to shift its operations toward value-based care payment models, both with internal service lines and with external provider partnerships. The Louisville, Kentucky-based insurance giant is also doubling down on social determinants of health at the same time. Those are just a couple key takeaways from a Tuesday conference call with …

Humana Accelerates Value-Based Care Strategy with Home Health Providers, Others Read More »

Perspectives: Home Health Insiders Sound Off on the 2020 Election

The ongoing expansion of Medicare Advantage (MA), a federal minimum-wage hike and additional support for front-line health care workers during the COVID-19 public health emergency. These are just a few of the industry-shaping topics that home health insiders are following going into Election Day this Tuesday. While each presidential election is important, 2020 will help …

Perspectives: Home Health Insiders Sound Off on the 2020 Election Read More »

Medicare Advantage 2021 Spotlight: First Look

For 2021, the average Medicare beneficiary has access to 33 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by eight firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 54 percent will charge no premium in addition to the monthly Medicare …

Medicare Advantage 2021 Spotlight: First Look Read More »

Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021

This issue brief provides an overview of the Medicare Part D prescription drug benefit plan landscape for 2021, with a focus on stand-alone drug plans. It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income beneficiaries, and information about the national Part D drug plans …

Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021 Read More »

States with the Most ‘Primarily Health-Related’ Medicare Advantage Opportunities for Home Care Agencies

With hundreds of plans reportedly offering in-home support services in 2021, the coming year is certain to bring more Medicare Advantage (MA) opportunities for home care agencies. But some home care operators will have more opportunities than others due to geographic variability across the MA landscape. To find leads, agency leaders will need to understand …

States with the Most ‘Primarily Health-Related’ Medicare Advantage Opportunities for Home Care Agencies Read More »

CMS Direct Contracting Model Options for Value-Based Care

Vanessa Kuhn, Director of Health Policy, PatientPing The Centers for Medicare and Medicaid Innovation (CMMI) created the Direct Contracting Model to expand opportunities for more diverse providers and healthcare organizations to participate in value-based care arrangements for Medicare fee-for-service (FFS) beneficiaries. The goal of the new model is to create the next generation of risk-sharing …

CMS Direct Contracting Model Options for Value-Based Care Read More »

More Than Half of All People on Medicare Do Not Compare Their Coverage Options Annually

This analysis shows that more than half of Medicare beneficiaries do not compare coverage options annually during the open enrollment period, despite the fact that Medicare Advantage and Part D plans often change from one year to the next, which could lead to unexpected and avoidable costs for beneficiaries who do not review their options …

More Than Half of All People on Medicare Do Not Compare Their Coverage Options Annually Read More »

Home Health Agencies Need to be ‘Best of the Best’ to Land MA Business

As Medicare Advantage (MA) enrollment explodes and plans begin to offer more benefits to members, home health and home care agencies alike need to prove their value in order to gain new business. Specifically, home health providers need to demonstrate how they can lower costs and potentially add members for MA plans. “The important thing …

Home Health Agencies Need to be ‘Best of the Best’ to Land MA Business Read More »

Medicare Advantage Enrollment Up 125% Among Dual-Eligible Beneficiaries

In-home care providers with a mission to serve particularly vulnerable populations often target “dual eligibles,” or individuals signed up for both Medicare and Medicaid benefits. The focus on dual-eligible populations is partly driven by mission and values, but it’s also supported by reimbursement. While in-home care providers sometimes struggle operating purely in the Medicaid long-term …

Medicare Advantage Enrollment Up 125% Among Dual-Eligible Beneficiaries Read More »

Number of MA Plans Offering In-Home Support Services to Increase by 93% in 2021

The U.S. Centers for Medicare & Medicaid Services (CMS) last month released new Medicare Advantage (MA) figures highlighting a massive expansion of plans offering home-focused supplemental benefits in 2021. The agency shared additional data on Wednesday — and it now appears the ongoing home care MA movement is even bigger than originally anticipated. “These benefit …

Number of MA Plans Offering In-Home Support Services to Increase by 93% in 2021 Read More »

#Healthin2Point00, Episode 157 | The phrase is “Takeout Speculation”!

Today on Health in 2 Point 00, Jess and I gossip about the wild rumor that UnitedHealthcare is acquiring Amwell. On Episode 157, we discuss Lark raising $55 million in a Series C along with a deal with Anthem to be their preferred DPP provider, Medicare Advantage plan Clover going public with a valuation of …

#Healthin2Point00, Episode 157 | The phrase is “Takeout Speculation”! Read More »

Humana, Fresenius Medical Care Expand Partnership to Improve Care Coordination for Medicare Advantage Members

What You Should Know: – Humana Inc. and Fresenius Medical Care North America (FMCNA) today announced an agreement to broaden their collaboration toward improving the health of eligible Humana Medicare Advantage members – The agreement between Humana and Fresenius Medical Care North America goes into effect Jan. 1, 2021. Humana Inc. and leading renal care …

Humana, Fresenius Medical Care Expand Partnership to Improve Care Coordination for Medicare Advantage Members Read More »

Medicare Advantage Startup Clover Health Slated to Go Public in a $3.7 Billion SPAC Deal

Clover Health recently announced that it will go public through a merger with a special purpose acquisition company (SPAC), Social Capital Hedosophia Holdings Corp. III. “Going public will enhance our ability to execute on our mission of improving every life, providing significant capital for the company to scale and improve health outcomes for seniors across …

Medicare Advantage Startup Clover Health Slated to Go Public in a $3.7 Billion SPAC Deal Read More »

Walmart to Offer Medicare Insurance Plans During 2020 Open Enrollment

What You Should Know: – Walmart announced it will begin selling Medicare insurance plans during this year’s annual enrollment period, Oct. 15 through Dec. 7. Today, Walmart announced the launch of Walmart Insurance Services, LLC, a licensed insurance brokerage, which will assist people with enrolling in insurance plans—and simplify what’s historically been a cumbersome, confusing …

Walmart to Offer Medicare Insurance Plans During 2020 Open Enrollment Read More »

Lower Flu Vaccination Rates Among Black, Hispanic, and Low-Income Seniors Suggest Challenges for COVID-19 Vaccination Efforts

People 65 and older, who have been hardest hit by COVID-19 in terms of hospitalizations and deaths, are also at high risk of severe flu illness and are more likely to die of the flu than younger people. This analysis explores variation in the rate of flu vaccination among adults ages 65 and older covered …

Lower Flu Vaccination Rates Among Black, Hispanic, and Low-Income Seniors Suggest Challenges for COVID-19 Vaccination Efforts Read More »

Independence Blue Cross, Signify Launches Social Determinants of Health Network in Philly

What You Should Know: – Independence Blue Cross and Signify Health launches social determinants of health network, CommunityLink to connect data from multiple CBOs to integrate social directly into medical care in the Philadelphia area. – CommunityLink represents one of the first examples nationwide of combining in-home health with social care. Independence Blue Cross (Independence) …

Independence Blue Cross, Signify Launches Social Determinants of Health Network in Philly Read More »

Cone Health to Merge with Sentara Healthcare Totaling $11B in Assets

What You Should Know: – Cone Health has signed a letter of intent to merge with Norfolk, Virginia-based Sentara Healthcare for a combined $11B in assets. – The merger creates one large health system totaling of 17 hospitals – 11 Sentara hospitals in Virginia and one in Elizabeth City, N.C., and five Cone Health hospitals in …

Cone Health to Merge with Sentara Healthcare Totaling $11B in Assets Read More »

COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever

Irv Lichtenwald, President & CEO of Medsphere Systems Corporation In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need to provide healthcare for all in the event of calamity …

COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever Read More »

Primary care startup Oak Street Health goes public for $328M

Oak Street Health, which operates primary care centers for Medicare patients, went public on Thursday for $328 million. Its capitation payment model has helped the company continue on where many clinics have struggled during the Covid-19 pandemic.

Humana’s Bruce Broussard: Consumer Demand for Home-Based Care Models Will Continue to Increase

Humana’s (NYSE: HUM) long-standing home- and community-based focus served the insurer well in Q2 2020 — a quarter dominated by the COVID-19 emergency. The coronavirus pushed more senior care into the home, boosting business for Louisville, Kentucky-based health insurance giant. As a result, the insurer doubled down on home-based care initiatives in Q2 2020 and …

Humana’s Bruce Broussard: Consumer Demand for Home-Based Care Models Will Continue to Increase Read More »

Home Health Admissions Down 2.45%; MA Enrollment Up 4%

Home health admissions saw a slight decline in volume during the fourth quarter of 2019. Meanwhile, referral trends appear to be holding steady. That’s according to recent data from PlayMaker Health, a post-acute growth platform that serves hundreds of organizations across the country. Specifically, Q4 saw a 2.45% decline in home health admissions, nationally. The …

Home Health Admissions Down 2.45%; MA Enrollment Up 4% Read More »

24 Hour Home Care Gets Candid About Logistical, Day-to-Day Aspects of MA Partnerships

While the Medicare Advantage (MA) home care opportunity continues to expand, cynics have been quick to criticize it. Some say the opportunity is too small to be worthwhile — and that it’s more of a trendy talking point than a viable business option for most home care providers. In 2020, only 619 of more than …

24 Hour Home Care Gets Candid About Logistical, Day-to-Day Aspects of MA Partnerships Read More »

Leading During Disruption: How Synergy HomeCare’s New CEO Took Control Amid COVID-19 Chaos

Securing stockpiles of personal protective equipment (PPE), doubling down on company-wide training efforts and implementing educational initiatives are just some of the responsibilities that home care leadership teams have taken on during the COVID-19 crisis. While most home care agencies were navigating the public health emergency over the past few months, Synergy HomeCare’s CEO had …

Leading During Disruption: How Synergy HomeCare’s New CEO Took Control Amid COVID-19 Chaos Read More »

Milliman Actuary: COVID-19 Adding Fuel to Medicare Advantage’s Home Care Fire

The coronavirus could be the match that finally sparks the Medicare Advantage (MA) boom for home care. The explosion has been a long time coming. It all started when the Centers for Medicare & Medicaid Services (CMS) first expanded the scope of MA supplemental benefits in April 2018. The move opened the door for MA …

Milliman Actuary: COVID-19 Adding Fuel to Medicare Advantage’s Home Care Fire Read More »