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… Read More »What Medicare Advantage Plans Want From Home-Based Care Providers
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… Read More »Provider-Convener Hybrid onehome Teams Up with MA Disruptor Devoted Health
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… Read More »Accra Names New COO; ConcertoCare Hires Chief Growth Officer
Medicare Advantage beneficiaries spend $1,640 less per year on healthcare than those enrolled in traditional fee-for-service Medicare plans, a new report shows. But, despite the difference in savings, satisfaction levels for both types of plans are similar.
Alignment Healthcare, an insurtech startup, has launched its IPO and plans to price its individual shares between $17 and $19. The company offers Medicare Advantage plans and says it uses predictive analytics technology to pinpoint seniors’ care needs.
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… Read More »‘This Is What Patients Want’: Home-Based Care Model Lowers Total Cost of Care by 44%
Insurance startup Alignment Healthcare filed preliminary paperwork with the Securities and Exchange Commission to go public. It’s another healthcare startup that is banking on the value of its technology in an IPO.
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… Read More »Payers Struggle with Provider Data Management Too
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… Read More »Top Clinical Conditions Targeted by Medicare Advantage Plans Under SSBCI
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… Read More »Signify Health Shares Soar More Than 33% in IPO, Valuing Company at Over $7.12B
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… Read More »In-Home Care Providers ConcertoHealth, Perfect Health Merge to Form ‘ConcertoCare’
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. … Read More »Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan
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… Read More »After Successful PDGM Transition, Humana Projects ‘Further Operating Model Advancement’ for Kindred at 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… Read More »Humana Teams Up with DispatchHealth to Deliver Hospital-Level Care in the Home
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… Read More »Number of MA Plans Offering SSBCI ‘Social Needs Benefit’ Up 568% in 2021
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… Read More »Encompass Health Building MA Momentum, Still Exploring ‘Strategic Alternatives’ for Home Health Business
Signify Health, a startup that provides in-home healthcare services and value=based payment programs, filed early paperwork for an IPO. The company plans to be traded on the New York Stock Exchange under the ticker “SGFY.”
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… Read More »Home-Based Care Ally Signify Health Files for $100M IPO
The company partners with independent practices, health centers and clinics to establish primary care-focused accountable care organizations.
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… Read More »Aledade Secures $100M for Value-Based Primary Care, Reaching $2.1B Valuation
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… Read More »CVS Health Launches Senior Medical Alert System, Symphony
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… Read More »A Dozen Facts About Medicare Advantage in 2020
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… Read More »Net Health Acquires Post-Acute Analytics Platform PointRight – M&A
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.… Read More »59% of Health Care CFOs See Home Care as Key Investment Area
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… Read More »12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup
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… Read More »MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers
On the heels of a $140 million funding round, insurance startup Oscar Health confidentially filed for an IPO.
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.
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… Read More »Health Insurer Financial Performance Through September 2020
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,… Read More »As Telehealth Surges, Are Seniors Being Left Behind?
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… Read More »5 Steps for Interoperability Excellence for Healthcare Providers
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… Read More »SCAN Group Takes on Telehealth’s ‘Digital Divide,’ Moves Further into the Home
The public comment period has just closed for the calendar year (CY) 2022 Medicare Advantage (MA) and Part D Advance Notice recently released by the Centers for Medicare & Medicaid Services (CMS). MA plans can expect an average 2.82% bump in revenue in 2022, according… Read More »CMS 2022 Advance Notice: 4 key takeaways for MA plans
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… Read More »Payer Credibility Helps Propel Home-Based Care Company Prospero Health into 16 New States
The health insurer and Michigan-based physician organization are partnering to expand access to in-network care for around 40,000 individual and group Medicare Advantage plan members. The partnership will go into effect Dec. 1.
CVS Health named a new CEO in its earnings call on Friday. Between plans to further integrate its pharmacy and insurance businesses, and discussion about how a Covid-19 vaccine would be distributed, here are four other things the company is preparing for in the coming… Read More »Four takeaways from CVS Health’s Q3 earnings
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… Read More »UnitedHealthcare Advances Home Strategy, Expects to Make 1.7M House Calls in 2020
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… Read More »Humana Accelerates Value-Based Care Strategy with Home Health Providers, Others
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… Read More »Perspectives: Home Health Insiders Sound Off on the 2020 Election
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… Read More »Medicare Advantage 2021 Spotlight: First Look
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… Read More »Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021
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… Read More »States with the Most ‘Primarily Health-Related’ Medicare Advantage Opportunities for Home Care Agencies
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… Read More »CMS Direct Contracting Model Options for Value-Based Care
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… Read More »More Than Half of All People on Medicare Do Not Compare Their Coverage Options Annually
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… Read More »Home Health Agencies Need to be ‘Best of the Best’ to Land MA Business
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… Read More »Medicare Advantage Enrollment Up 125% Among Dual-Eligible Beneficiaries
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… Read More »Number of MA Plans Offering In-Home Support Services to Increase by 93% in 2021
When it announced plans to go public through a blank-check company, Clover Health shared ambitious projections for its future membership. Much of that growth is pinned on plans to launch a direct contracting business.
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,… Read More »#Healthin2Point00, Episode 157 | The phrase is “Takeout Speculation”!
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… Read More »Humana, Fresenius Medical Care Expand Partnership to Improve Care Coordination for Medicare Advantage Members
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… Read More »Medicare Advantage Startup Clover Health Slated to Go Public in a $3.7 Billion SPAC Deal
Medicare Advantage startup Clover Health will go public in a blank-check acquisition led by billionaire Chamath Palihapitiya. The deal will value Clover at $3.7 billion.
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… Read More »Walmart to Offer Medicare Insurance Plans During 2020 Open Enrollment
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… Read More »Lower Flu Vaccination Rates Among Black, Hispanic, and Low-Income Seniors Suggest Challenges for COVID-19 Vaccination Efforts
The insurer plans to increase the footprint for its Medicare Advantage plans by 50%, adding plans in 300 additional counties.
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… Read More »Independence Blue Cross, Signify Launches Social Determinants of Health Network in Philly
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… Read More »Cone Health to Merge with Sentara Healthcare Totaling $11B in Assets
A recently unsealed whistleblower case filed by the Department of Justice accuses Cigna of fraudulently overbilling for its Medicare Advantage plans. Allegations claim the company submitted unsupported diagnoses that resulted in “billions” in overpayments.
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… Read More »COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever
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 (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… Read More »Humana’s Bruce Broussard: Consumer Demand for Home-Based Care Models Will Continue to Increase
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… Read More »Home Health Admissions Down 2.45%; MA Enrollment Up 4%
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… Read More »24 Hour Home Care Gets Candid About Logistical, Day-to-Day Aspects of MA Partnerships
Clover Health said it plans to triple its footprint in the next year, pending CMS approval. But the insurer has also posted a net loss in recent years.
GoHealth, an online insurance broker focusing on Medicare Advantage plans, went public on Wednesday for $914 million. The company will trade on Nasdaq under the ticker “GOCO.”
Oak Street Health, a Chicago-based company that operates primary care centers for Medicare patients, filed initial IPO paperwork on Friday. The company has not yet priced the offering, but it plans to use the proceeds to repay a loan and grow its business.
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… Read More »Leading During Disruption: How Synergy HomeCare’s New CEO Took Control Amid COVID-19 Chaos
Walmart quietly launched a new health insurance business. The company, called Walmart Insurance, was filed with the Arkansas Secretary of State last month.
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… Read More »Milliman Actuary: COVID-19 Adding Fuel to Medicare Advantage’s Home Care Fire