Archive


Category: Medicare Advantage

  • What Amazon’s $3.9B One Medical Acquisition Means for In-Home Senior Care

    Retail and technology giant Amazon (Nasdaq: AMZN) last month announced plans to acquire primary care innovator One Medical for an astounding $3.9 billion. The transaction doesn’t immediately affect senior-focused in-home care providers, but it’s another major stepping stone on the path toward disrupting the current U.S. health care system. What’s more, the deal reflects the […]

  • Homeward Raises $50M, Inks Value-Based Contract with Priority Health

    What You Should Know: – Homeward raises $50M Series B funding round co-led by ARCH Venture Partners and Human Capital. – The funding round also includes participation from General Catalyst, which led Homeward’s Series A funding, and Lee Shapiro and Glen Tullman, Co-Founders of 7wireVentures, one of the country’s most successful early-stage healthcare venture funds. […]

  • Medicare Advantage Reportedly Continues to Nets Savings Amid Calls For More Oversight

    Along with achieving better health outcomes, Medicare Advantage (MA) checks in at annual consumer savings of roughly $2,000. That’s according to a new report from the research and advocacy organization Better Medicare Alliance (BMA). This news, as well as other findings from BMA, come at a time when more home-based care providers are being vocal […]

  • Curana & Innovaccer Partner to Improve Outcomes for Senior Living Communities

    What You Should Know: – Today, Innovaccer Inc., the Health Cloud company, announced that Curana Health is partnering with Innovaccer to build a leading edge value-based care solution to support delivery of exceptional care quality at the lowest possible cost for one of healthcare’s highest risk populations: residents in senior living communities across the country. […]

  • Geisinger Taps Cohere Health to Streamline Prior Authorizations

    What You Should Know: – Today Geisinger Health Plan (GHP) and Cohere Health, a provider of utilization management (UM) technology, announced they are joining forces to streamline the prior authorization process for providers. – Cohere’s collaborative UM platform will help GHP support value-based care delivery, reduce administrative costs, and lead the nation in aligning quality improvement initiatives across all its lines of […]

  • 6 Success Strategies as CMS Drives More Accountable Care by 2030

    Siddharth Thakkar, VP, Product and Marketing at IKS Health For the better part of a decade, the shift toward value-based care in the U.S. has been driven by the establishment of the Center for Medicare and Medicaid Innovation (CMMI). Working to develop, test and evaluate new payment and delivery models in Medicare, Medicaid and the […]

  • UnitedHealth Group Exec: MA Plans, Providers Need to Bridge Gap With Communication

    The relationship between Medicare Advantage plans and home health care agencies has not changed much over the last few years. They are often filled with bitterness, yet and lack communication. What has changed is how vocal home health providers have been about the issue. Providers went from shying away from the topic, to discussing it […]

  • House Lawmakers Call Out ‘Bad Actors’ Within Medicare Advantage

    House lawmakers are pushing for more oversight of Medicare Advantage (MA) plans in light of concerns over higher spending, improper claim denials and access to treatment. A number of lawmakers on the House Energy and Commerce Committee’s oversight subcommittee examined the issue during a hearing that centered around the MA program on Tuesday. “I am […]

  • Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging

    Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Witnesses sharply criticized the fast-growing health plans at a hearing held by the Energy and Commerce subcommittee on oversight and investigations. […]

  • ‘It’s About Being in the Home’: Signify Moves Away from Telehealth

    As home-based care providers struggle to gather quality and reliable data across their platforms, Signify Health (NYSE: SGFY) feels like it is positioned to keep growing because of the data-driven insights it does have. These data points should not only help Signify grow, but will improve outcomes for its patients, Steve Senneff, Signify’s president and […]

  • The No Surprises Act: How Payers Can Stay Compliant

    Michael Gardner, Chief Strategy Officer at Virsys12 As the healthcare system continues to evolve to adopt a more patient-centric approach, surprise billing has become a topic discussed by consumers and policymakers. Surprise billing can occur when a patient unknowingly receives care from providers that are outside their network. This can result in balance billing, the […]

  • The Case For and Against Home Care Provider-Medicare Advantage Relationships

    Shifting health care payer trends have home-based care providers stuck between two battling business decisions: “adapt or die,” or sustainability. Those two decisions may look like one in the same to outsiders, but for home care operators grappling with whether to engage with Medicare Advantage (MA), they sometimes posit providers on different sides of the […]

  • CareMax Acquires Steward Health’s Medicare Value-Based Care Business for $25M

    What You Should Know: – CareMax, a tech-enabled provider of value-based care to seniors announced an agreement to acquire the Medicare value-based care business of Steward Health Care System for a combination of cash and stock. – CareMax will pay $25 million in cash and issue 23.5 million shares of CareMax’s Class A common stock […]

  • Amedisys Working on Reimbursement Pilots, ‘Hunting for a Nice Home Health Deal’

    Home health and personal care services provider Amedisys Inc. (Nasdaq: AMED) is experimenting with a new model that better fits the Medicare Advantage-heavy environment of today. The Baton Rouge, Louisiana-based Amedisys has started to pilot a new model that takes into account the case rate on a per admission basis, which will hopefully drive down […]

  • ‘Medicare Advantage on Steroids’: Advocates Push Back on ACO REACH Model

    Home health care providers and Medicare-for-all advocates certainly agree on their general disliking of Medicare Advantage (MA). The one problem is that these advocates are also fervently against direct contracting in traditional Medicare. And that is an area where many home-based care providers believed they could enter into new, value-based care arrangements either with the […]

  • Olive Partners with Magenta to Revolutionize Risk Adjustment Process

    What You Should Know: – Olive, the automation company creating the Internet of Healthcare, today announced its partnership with Magenta Care Continuum, a HIPAA-compliant health records vault that includes care gap analytics. – Through the Olive Library, payers and providers can access Magenta’s solutions to help close care gaps, improve billing and claims occurrence and ensure compliance and […]

  • What HHVBP Means for Managed Care, SNF Utilization

    With the nationwide rollout of the Home Health Value-Based Purchasing (HHVBP) Model inching closer, home health agencies are feeling confident about their ability to adapt. Not only are operators confident, but some are even excited about what HHVBP might translate to in terms of improved managed care relationships and further diversion away from skilled nursing […]

  • Fixing the ‘Toxic’ Home Health-Medicare Advantage Relationship

    The home health industry’s battle with Medicare Advantage (MA) plans for fair rates has gone from a few stakeholders saying “the quiet part out loud” earlier this year to nearly every major provider in the country talking about the issue with regularity. My colleagues and I have covered the topic extensively. But we’ve moved beyond […]

  • Payment ‘Patchwork’ Limiting Near-Term Scalability of Home-Based Palliative Care

    Home-based palliative care is an untapped business opportunity for many home health and hospice providers in the U.S., but multiple factors continue to hinder near-term scalability. Data on the availability of home-based palliative care is limited, so it’s difficult to pinpoint just how large the market really is. Experts familiar with the space have previously […]

  • 3 Senior Living Providers Merge to Form Curana Health

    What You Should Know: – Three leading organizations that provide healthcare services to senior living communities – Elite Patient Care, Provider Health Services, and AllyAlign Health – have joined forces to form Curana Health. Curana Health’s mission is to improve the health, happiness, and dignity of senior living residents. The Curana Health ACO is a value-based […]

  • OIG: MA Plans Inappropriately Shifting Care into the Home, Denying Providers Payment

    Medicare Advantage (MA) organizations have limited beneficiaries’ access to necessary care. They have also denied payments to providers for services that are covered under Medicare rules, as well as MA billing rules. That’s according to a report released Thursday by the Office of Inspector General (OIG). The report examined data over the course of one […]

  • Encompass Health Focused on Home Health Hiring, Medicare Advantage Relationships

    Encompass Health reported a strong financial first quarter for 2022 despite continued staffing constraints in its home health business. On Wednesday, Encompass Health reported total revenue of $1.33 billion for Q1 2022, up 8.4% compared to $1.23 billion in Q1 2021. Its home health revenue checked in at $224 million, up 2.3% from $220 million […]

  • Probe finds Medicare Advantage plans deny needed care to tens of thousands

    Medicare Advantage Organizations (MAOs) delayed or denied payments and services to patients, even when these requests met Medicare coverage rules, according to a report released by federal investigators on Thursday. The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) reviewed a random sample of 250 prior authorization denials and […]

  • Despite Focus on Home Health, Humana Remains Flexible in Personal Care, Hospice

    Humana Inc. (NYSE: HUM) has been vocal about its plan to develop its health care services capabilities in three phases. The first phase is building the capabilities; the second phase includes enhancements to align its capabilities with value-based principles, and the third is integrating these capabilities in select local markets. With the divestiture of its […]

  • BCBS of Michigan Launches Joint Venture with Honest Medical Group

    What You Should Know: – Blue Cross Blue Shield of Michigan (BCBSM) today announced a joint venture with Nashville-based Honest Medical Group to offer physicians comprehensive operational, clinical, and financial support for shared accountability Medicare contracts. – The joint venture is the first of its kind for BCBSM and aligns with the organization’s continued expansion of Blueprint for Affordability, its member-focused, […]

  • Home Care Providers Take Note As Medicare Advantage Grows, Creates Savings for Seniors

    Compared to fee-for-service Medicare, seniors save close to $2,000 on average in total annual health care spending with Medicare Advantage (MA). That’s according to a new study — based on 2019 Medicare Current Beneficiary Survey data — from Better Medicare Alliance, which features an analysis conducted by the Washington, D.C.-based research and consulting firm ATI […]

  • KHN’s ‘What the Health?’: News You Might Have Missed

    Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. It’s been extra busy on the health policy beat lately, so a congressional recess provides a chance to explore some of the important stories that people might […]

  • Next Generation of Risk Adjustment: Uniting Health Plans and Providers

    Shahyan Currimbhoy, VP at Edifecs Aaron Fulner, Sr. Director at Edifecs Up until now, risk adjustment has been addressed as a mechanism to accurately represent the overall risk profile of a health plan’s membership. A function that will still facilitate a health plan’s payment for taking on at-risk populations is about to go through its first major transformation – the use of risk adjustment data to drive value-based […]

  • Vytalize Health Raises $50M for Value-Based Care Platform for Seniors

    What You Should Know: – Vytalize Health raises over $50 million to advance its value-based care platform for seniors helping primary care doctors strengthen relationships with their patients through data-driven, holistic, and personalized care. – Led by Enhanced Healthcare Partners, the financing round signals an enormous opportunity for Vytalize Health to accelerate the adoption of […]

  • Ending COVID-19 Emergency Declarations Will Bring an End to Flexibilities that Aided Patients, Providers, Insurers, and Public Programs in Responding to the Pandemic

    When the federal government ends COVID-19 emergency declarations that were declared in the early days of the pandemic, it will bring to a close several changes that were enacted temporarily to enable the U.S. health care system to better deal with the crisis. A new KFF resource details a number of those flexibilities and lays…More

  • Over 4 Million MA Beneficiaries Have At-Home Care Access Through Supplemental Benefits

    New data relating to Special Supplemental Benefits for the Chronically Ill (SSBCI) has been released. And while there are plenty of kinks to work through before these benefits become a significant revenue driver for home-based care agencies, their increasing popularity is undoubtedly encouraging. The Centers for Medicare & Medicaid Services (CMS) unveiled a pathway for […]

  • MedPAC Got It Wrong (pt 3)

    By GEORGE HALVORSON This is the third part of former Kaiser Permanente CEO George Halvorson’s critique of Medpac’s new analysis of Medicare Advantage. Part 1 is here. Part 2 is here. Eventually I’ll be doing a summary article about all the back and forth about what Medicare Advantage really costs!-Matthew Holt Risk status and RAF […]

  • More Data Shows Home Health Admissions Stabilizing, But Short of Pre-Pandemic Heights

    Though home health admissions have begun to stabilize, providers are still seeing admissions that are lower than pre-pandemic levels. That’s according to the 2021 post-acute care industry trends report from Atlanta-based analytics and metrics firm Trella Health. The report examines a number of topics including Medicare Advantage enrollment and home health admissions, as well as […]

  • MedPAC Got It Wrong (pt 2)

    By GEORGE HALVORSON This is the second part of former Kaiser Permanente CEO George Halvorson’s critique of Medpac’s new analysis of Medicare Advantage.Part 1 is here. The final part will be published on THCB later this week. Eventually I’ll be doing a summary article about all the back and forth about what Medicare Advantage really […]

  • MedPAC Got It Wrong (pt 1)

    By GEORGE HALVORSON This is the first part of former Kaiser Permanente CEO George Halvorson’s critique of Medpac’s new analysis of Medicare Advantage. The rest will be published on THCB later this week. Eventually I’ll be doing a summary article about all the back and forth about what Medicare Advantage really costs!-Matthew Holt MedPac just […]

  • Medicare Advantage 2022 enrollment on the rise

    Fierce Healthcare reports that in 2022 Medicare Advantage enrollment is continuing to grow at the expense of traditional fee-for-service Medicare. They write that: Medicare Advantage plans signed up another 2.3 million beneficiaries for the 2022 coverage year, with the program now making up 45% of all Medicare enrollment, a new study found. …total 2022 enrollment […]

  • Rural Health Startup Homeward Emerges with $20M to Support Rural Communities

    What You Should Know – Homeward, a new company focused on improving access to high-quality, affordable primary and specialty care in rural communities launches with an initial $20M investment. – The organization is rearchitecting care for rural Americans who have a 23% higher mortality rate than those in urban communities. Homeward – a San Francisco, CA-based mobile, in-person, […]

  • Medicare Advantage Poses Challenges to Health CareCost Effectiveness and Equity

    BY NIRBAN SINGH AND AMY HELBURN Introduction Medicare Advantage (Advantage), originally conceived in 1997 during the Clinton Administration as ‘Medicare + Choice’, has progressively grown and become an established health insurance option for those 65 and older. According to data collected and aggregated by the Kaiser Family Foundation, Advantage has more than doubled in total […]

  • Medicare Advantage Benefits in 2022 Target Home as a Setting, Diabetes as a Condition

    Medicare Advantage (MA) supplemental benefits adoption has been slow by some measures and rapid by others.  A new report from the consulting firm Milliman offers a look into that dynamic and shows exactly where each of those benefits stands in 2022. Among the primarily-health related benefits, in-home support services (IHSS) remains the most popular benefit […]

  • What the Pandemic Taught Us About Value-based Care

    By RICHARD ISSACS You’ll recall that we ran a long piece (pt 1, pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson earlier this year. Here’s a somewhat related piece from the current head of the Permanente Medical Group about what actually happened there and elsewhere during the pandemic–Matthew Holt The COVID-19 […]

  • NourishedRx Raises $6M to Accelerate Intelligent Food-for-Health Platform

    What You Should Know: – NourishedRx, a digital health company raises $6M in seed funding led by S2G Ventures with additional investors Route 66 Ventures, Connecticut Innovations, Primetime Partners, and other individual investors. – The company will utilize the funding to expand its high-tech, a high-touch platform to provide personalized, culturally relevant food solutions to […]

  • Leveraging A More Impactful Analytics Strategy to Improve Your Health Plan Member CX

    Suzanne Cogan, General Manager, SPH Analytics, a Press Ganey Solution Healthcare organizations are increasingly eager to leverage analytics technologies, including machine learning and artificial intelligence (AI), in new ways. One telling sign of this is that the global predictive analytics healthcare market, which was valued at $1.8 billion in 2017, is projected to reach more […]

  • Why MA Plan Zing Health Wants Partners That Will Be Its ‘Representatives in the Home’

    Coming off a major expansion that took place last year, Zing Health has now set its sights on reducing social isolation. The Medicare Advantage (MA) provider looks to accomplish this through its partnership with Papa – and maybe other home-based care providers in the not-too-distant future. “COVID, if nothing else, demonstrated that social isolation is […]

  • Are Medicare Advantage Insurers Covering the Cost of At-Home COVID-19 Tests?

    The Biden Administration’s requirement for private insurers to cover the cost of at-home rapid COVID-19 tests for their enrollees does not apply to Medicare. Medicare Advantage plans (offered by private insurers) have the option to cover at-home tests but are not required to do so. This policy watch examines whether some of the largest private […]

  • Offering Personalized, At-Home Benefits in MA Remains ‘Key Part’ of Anthem’s Strategy

    Anthem Inc. (NYSE: ANTM) believes that its dedication to supplement benefits – including at-home care offerings – is strengthening its value proposition among other health plans. “In Medicare Advantage (MA), our continuing work to strengthen Anthem’s value proposition helped drive another strong annual election period,” Gail Boudreaux, the president and CEO of Anthem, said on […]

  • RecoveryOne, Cigna Offers Virtual Physical Therapy for Medicare Advantage Customers

    What You Should Know: – RecoveryOne, a digital health innovator dedicated to improving health outcomes for recovery from musculoskeletal (MSK) injuries of all types and reducing costs, announced an expansion of its partnership with Cigna to offer its virtual physical therapy and broad MSK solution for Medicare Advantage (MA) customers as an in-network benefit.  – This new benefit builds on the […]

  • Evaluating Home Care’s Progress in Medicare Advantage

    Many of the in-home supplemental benefits offered by Medicare Advantage (MA) plans are new. But whether they are through the primarily health-related pathway, which began in 2019, or through Special Supplemental Benefits for the Chronically Ill (SSBCI), which came a year later, these benefits are still being experimented with. Generally, the plans offering these new […]

  • UnitedHealth Group Hints at Big Home-Based Care Plans

    UnitedHealth Group (NYSE: UNH) was the first health care titan to report its 2021 year-end results, doing so Wednesday morning. The Minnetonka, Minnesota-based company showed few signs of a pandemic-driven slowdown and hinted at big home-based care moves on the horizon. “Our broad home-based clinical care initiatives at Optum and UnitedHealthcare are central to improving […]

  • Why In-Home Care Providers Shouldn’t Scrap MA Strategies Over Lagging Results

    Medicare Advantage (MA) has been viewed over the last few years as a new space for home-based care providers to generate revenue. Changes have allowed MA plans to pay for additional at-home services, whether through primarily health-related benefits or Special Supplemental Benefits for the Chronically Ill (SSBCI). Those changes aren’t major on the surface, and […]

  • Medicare Advantage Is a Superior Program (Part two)

    By GEORGE HALVORSON Former Kaiser Permanente CEO George Halvorson has written on THCB on and off over the years, most notably with his proposal for Medicare Advantage for All post-COVID. He wrote a piece in Health Affairs last week arguing with the stance of Medicare Advantage of Don Berwick and Rick Gilfillan (Here’s their piece pt1, pt2). Here’s […]

  • ‘We Are Making Very Bold Moves’: CVS Health Targets Home Health, Primary Care Investments

    In December, CVS Health (NYSE: CVS) shared its strategy for “revolutionizing” the consumer experience through its primary care, payer, digital and omnichannel health services offerings, including home health care. President and CEO Karen Lynch doubled down on that agenda while speaking at the 40th Annual J.P. Morgan Healthcare Conference Tuesday morning. “As I said in […]

  • Medicare Advantage Is a Superior Program (Part one)

    By GEORGE HALVORSON Former Kaiser Permanente CEO George Halvorson has written on THCB on and off over the years, most notably with his proposal for Medicare Advantage for All post-COVID. He wrote a piece in Health Affairs last week arguing with the stance of Medicare Advantage of Don Berwick and Rick Gilfillan (Here’s their piece pt1, pt2). Here’s […]

  • Zing Health Secures $25M to Accelerate SDOH-Driven Medicare Advantage Plans

    What You Should Know: – Medicare Advantage provider Zing Health raises $25M from Town Hall Ventures and Leavitt Equity Partners, two leading investors focused on growing innovative healthcare businesses. Zing Health Holdings, a Chicago-based physician-led Medicare Advantage insurance company focused on serving vulnerable populations underserved by traditional insurance models, today announced that Town Hall Ventures and Leavitt […]

  • SCAN Health Plan Teams Up with MedArrive to Help Homebound Seniors

    SCAN Health Plan and MedArrive are teaming up to provide COVID-19 booster and flu shots to homebound seniors throughout California’s Los Angeles and Orange counties. The partnership comes as concerns around the Omicron variant grow. Led by former Uber Health CEO Dan Trigub, MedArrive uses telehealth technology, emergency medical services (EMS) professionals and other resources […]

  • In-Home Support Services Becoming Top Medicare Advantage Benefit

    In-home support services are the most popular — and arguably impactful — supplemental benefit offered by Medicare Advantage (MA) plans under the primarily health-related category. That statement was supported by recently unveiled figures from ATI Advisory. It’s now being emphasized even further, thanks to a new data brief commissioned by the Better Medicare Alliance (BMA) […]

  • EasyHealth Secures $135M to Redesign Medicare Experience

    What You Should Know: – Easyhealth raises $135M to redesign Medicare with its end-to-end Medicare experience to help 50 million Medicare members find the best plan and support them through their healthcare journey. EasyHealth, an LA-based company connecting coverage and care with an end-to-end Medicare experience, today announced it has raised $135M in equity and […]

  • 14% of MA Plans Will Offer Primarily Health-Related In-Home Support Services in 2022

    More Medicare Advantage (MA) plans are offering in-home support services as supplemental benefits. That’s according to a new report from Washington, D.C.-based research and advisory firm ATI Advisory. The report included interviews with health plans, providers and advocates to gauge the progress on uptake for primarily health-related benefits and Special Supplemental Benefits for the Chronically […]

  • La inscripción de Medicare es temporada abierta para estafadores

    Encontrar el mejor plan médico privado, o de medicamentos, de Medicare entre docenas de opciones es lo suficientemente difícil sin incluir estrategias de venta engañosas. Sin embargo, funcionarios federales dicen que están aumentando las quejas de personas mayores engañadas para que compren pólizas sin su consentimiento, o atraídas por información cuestionable, que pueden no cubrir […]

  • Medicare’s Open Enrollment Is Open Season for Scammers

    Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. Yet federal officials say complaints are rising from seniors tricked into buying policies — without their consent or lured by questionable information — that may not cover their drugs or […]

  • Researcher: Medicare Advantage Plans Costing Billions More Than They Should

    Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found. Richard Kronick, a former federal health policy researcher and a professor at the University of California-San […]

  • Signify Health Believes It Can Save Itself From Industry-Wide Staffing Struggles

    Signify Health Inc. (NYSE: SGFY) believes that it will be more suited to deal with workforce shortages than other, more traditional home-based care providers. In fact, it has built a platform that’s flexible and tech-driven specifically to deal with the future in mind – a future that will include workforce issues and a shift to […]

  • Oak Street Health stock drops on DOJ investigation

    In its earnings statement, the company disclosed that it received a civil investigative demand from the Department of Justice. Specifically, the agency was looking for information on Oak Street’s relationships with third-party marketing agents and transportation services. 

  • A Record 3,834 Medicare Advantage Plans Will be Available in 2022, Up 8 Percent From 2021, While the Number of Medicare Part D Stand-Alone Plans is Decreasing Mainly Due to Firm Consolidations

    A record 3,834 Medicare Advantage plans will be available across the country as alternatives to traditional Medicare for 2022, a new KFF analysis finds. That’s an increase of 8 percent from 2021, and the largest number of plans available in more than a decade. At the same time, the number of Medicare Part D stand-alone…More

  • Medicare Advantage 2022 Spotlight: First Look

    For 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by nine firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 59 percent will charge no premium in addition to the monthly Medicare […]

  • Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2022

    This issue brief provides an overview of the Medicare Part D prescription drug benefit market for 2022, with a primary 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 […]

  • Aging-in-Place Marketplace Opening New Medicare Advantage Doors for Home Care Agencies

    Insurtech company The Helper Bees recently launched an aging-in-place provider marketplace. With the rollout of this new platform, the company is positioning itself as a go-between for aging-in-place services providers, such as personal care agencies, and Medicare Advantage (MA) plans. Broadly, Austin, Texas-based The Helper Bees works with large insurance companies to help these organizations […]

  • Democrats’ Plans to Expand Medicare Benefits Put Pinch on Advantage Plans’ Funding

    “Did you think we wouldn’t notice?” an older woman says, speaking into the camera. “You thought you could sneak this through?” an older man later adds. Others warn that Washington is “messing with” their Medicare Advantage health coverage and trying to raise their premiums. But the television ad, paid for by Better Medicare Alliance, a […]

  • DOJ accuses Kaiser Permanente of Medicare Advantage fraud in new complaint

    The California-based health system and insurer has bilked CMS out of “hundreds of millions of dollars” by submitting claims that were altered to make patients appear sicker than they were, a new complaint filed by the DOJ alleges. Kaiser denied these allegations saying it is confident in its compliance with Medicare Advantage program requirements.

  • Home-Focused Primary Care Startup Patina Health Raises $57M

    Patina Health – a primary care startup focused on delivering care in the home – announced a Series A funding round of $57 million early Tuesday. The company came out of stealth with the announcement, detailing its plans as well as its lead investors: Andreessen Horowitz and GV, the latter of which is Google’s (Nasdaq: […]

  • Bill aiming to streamline MA prior authorization gains House majority support

    The bill, if enacted into law, will establish an electronic prior authorization process and require Medicare Advantage plans to report on their use of prior authorization and the rate of approvals or denials to CMS. It has 227 co-sponsors in the U.S. House, indicating strong support from both Republicans and Democrats.

  • Why Kaiser Permanente Wants to Be Known for Home Care

    Kaiser Permanente is one of the largest health systems and health plans in the entire U.S. And while home-based care has always been a part of the system’s integrated model, it now has its own division, “Care at Home,” underneath the massive brand’s umbrella. Angel Vargas has been enlisted to lead the budding enterprise. He […]

  • Health Care Executives Share Provocative Takes on the Future of Home-Based Care

    Two weeks ago, Home Health Care News hosted our flagship FUTURE Conference in downtown Chicago. Since then, I’ve been reflecting on the event’s panels as well as my on-background conversations to get a better feel for where the health care world — and home-based care, in particular — is headed. Value-based care and the shift […]

  • Why Minnesota’s Largest Medicare Advantage Provider Is Investing in Lifespark

    With enrollment up and more plans launching each year, Medicare Advantage (MA) organizations have had to figure out how to differentiate themselves in an increasingly competitive field. For many, MA differentiation has meant embracing in-home care and actually acquiring, or investing in, provider partners. The latest example of this trend took place Tuesday, with Minneapolis, […]

  • Devoted Health raises $1.1B, sending valuation soaring past $12B

    Though the Medicare Advantage-focused insurance technology startup is smaller than rivals like Clover Health in terms of membership and revenues, this latest financing round places it ahead of, or at least on par with, several larger competitors with regard to total funds raised.

  • SCAN Health Plan Launches ‘Embrace’ I-SNP, Hopes to Set New Standard of Care

    SCAN Health Plan is launching a new care delivery model that it hopes will set a new standard within the Medicare Advantage (MA) space. A subsidiary of SCAN Group, the Long Beach, California-based SCAN Health Plan announced its new model of care on Wednesday. Moving forward, the model will be made available to all SCAN […]

  • Anthem MA Plans to Offer New In-Home Support Benefit in 2022

    Newer supplemental benefits like access to in-home support services or a personal care helper have helped Anthem Inc. (NYSE: ANTM) attract and retain Medicare Advantage (MA) members over the past couple of years. Perhaps it’s no surprise then that the Indianapolis-based Anthem and a number of its affiliated health plans are adding on to their […]

  • What Home Care Operators Can Expect from MA Plans in 2022

    October is normally a pretty eventful time for home health and home care operators. This year will certainly be no different, particularly when it comes to emerging Medicare Advantage (MA) opportunities. As Medicare-certified home health agencies await the final payment rule that comes out at the end of October, home care companies will be closely […]

  • 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

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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

  • 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 […]

  • 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 […]

  • Alignment Healthcare to expand to 16 new markets in 2022

    The insurtech company, which went public in March, is planning to expand to 16 new markets across Nevada, North Carolina and Arizona next year. It will also add new plan options to its portfolio, including a virtual-first PPO.

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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, […]

  • 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, […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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. […]

  • 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 […]

  • 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. […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • Alignment Healthcare aims to raise up to $516M in IPO

    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.

  • ‘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 […]

  • Four takeaways from Alignment’s IPO filing

    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.

  • 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 […]

  • 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 […]

  • 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 […]

  • 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, […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • Value-based care platform Signify Health files for IPO

    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.”

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • CMS 2022 Advance Notice: 4 key takeaways for MA plans

    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 to Part II of the notice, up from 1.66% for […]

  • Four takeaways from CVS Health’s Q3 earnings

    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 months.

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • #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 […]

  • 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 […]

  • 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 […]

  • 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) […]

  • 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 […]

  • Whistleblower lawsuit accuses Cigna of Medicare Advantage fraud

    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.

  • 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.

  • 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 […]

  • Oak Street Health files for IPO

    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.

  • 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 […]

  • 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 […]