Neda Long

Cigna, eviCore, and Excellus Blue Cross Blue Shield plans have announced coverage for closed-loop #spinalcordstimulation. IPSIS, as part of the Multisociety Pain Workgroup, provided medical directors with substantial evidence of the efficacy of #SCS therapy. https://lnkd.in/ewDH_JVm #IPSISAdvocacy #neuromodulation #InterventionalPainMedicine #PainMedicine #InterventionalPainManagement #PainManagement

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To better understand the presence of consolidation in the U.S. health care system, the AAMC Research and Action Institute has published a new data snapshot that compares the market share of providers and insurers to show the implications of consolidation across these two industries. The authors found that, despite concerns from policymakers and the public, the largest health systems by total inpatient hospital discharges have, on average, far less market share – a combined 43.1% of the market share in each state – compared to the top three large-group insurers, which hold an average of 82.2% of the market share in each state. Read more: https://ow.ly/qNWF50RuaGb

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Really strong kickoff to the "Big Six Payor" earnings yesterday morning by UnitedHealth Group and the market loved it as it jumped to an all time high this afternoon and is up 10% since the earnings call. They grew revenue 6.5% to almost 99 billion and below are the key takeaways along with a more in-depth look. 🏥 Optum Performance:  - OptumHealth: Revenue grew by 13% to $27 billion with improved margins. Digital engagement rose from 62% to over 75%, reducing readmission rates by 10%. Finally showing margin growth for a business with a great growth potential in value-based care for the Medicare population. - OptumRx: Revenue increased by 13% to over $32 billion, driven by strong customer response to chronic care solutions and mobile infusions. Adjusted scripts handled jumped to 400 million from 380 million a year ago. 🔍 Medicare Advantage: CEO Andrew Witty highlighted a Milliman study showing a 4% cost saving for Medicare Advantage over traditional Medicare. UNH is focusing on delivering additional value through services like dental, vision, and hearing. 💡 AI Integration: UNH is leveraging AI to drive efficiency and reduce costs. OptumHealth managed a 40% increase in high-risk patients without additional headcount, also driving the enhanced patient engagment. OptumRx saw significant onboarding improvements with 9% less spending than last year due to AI enhancements. Looking to build some AI enabled workflows in OptumInsight to sell to downstream customers which could be great for top line. 🔐 Cybersecurity: Despite challenges from the Change Healthcare cyberattack, UNH is using the incident to innovate and enhance their system security. Some of their customers shopping Change Healthcare to other potential providers is forcing them to innovate internally. 🌟 With strong tailwinds, lower interest rates from the Federal Reserve, AI-driven growth opportunities, OptumHealth showing signs of being able to scale, UNH is well-positioned for a strong 2024/2025. Great kickoff to the earnings season! Below is a more in depth look at their earnings call. #healthcare #ai

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Payors may want to revisit their #healthequity strategies over the second half of 2024 to ensure they are positioned to succeed within the #MedicareAdvantage health equity index. While payor performance in the recently added health equity index will not impact Star Ratings calculations until 2027, HealthPayerIntelligence explains how data from this year will inform those 2027 ratings: https://hubs.la/Q02DXtmK0

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In win for #healthinsurers and #members, CMS will recalculate 2024 Medicare Advantage star ratings. After recent wins in court, Federal judges told Medicare to recalculate star ratings for SCAN’s plans and one Elevance plan. The new CMS guidance would recalculate quality ratings industrywide, likely increasing bonus payments for many insurers. As health insurers assessed poor financial performance and lower star ratings, member benefits were in the crosshairs. While this won't save all those extra benefits members have come to enjoy, they will hopefully save some of the most critical. Want to learn more about the latest trends in #MedicareAdvantage? Forrester clients can check out our published and upcoming research, including a data deep dive on individuals aging into and enrolled in #Medicare and Medicare Advantage (link in comments). #starratings #qualityratings #CMS #healthcare #memberexperience

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#Questionforgroup Sales and marketing is often a healthcare compliance officer's biggest headache. How would the oversight plan look for the insurer that acquires an insurance broker? CVS Health has acquired #medicareadvantage broker Hella+Health. The broker firm guides consumers through the Medicare plan selection process via the company’s wholly-owned, licensed insurance agency. The company provides the following services: #Medicare eligibility and coverage coaching, Medicare plan shopping, and tracking changes to the Medicare market or an individual Medicare plan. The acquisition comes around the time that CVS Health revealed a somewhat sour Q1 2024 report, largely due to its Medicare Advantage business. The healthcare company cut its operating income by more than half due to its lower Medicare Advantage #starratings and higher Medicare utilization. Net income dropped to $1.12 billion, a steep decline from $2.14 billion in 2023. While the broker states it doesn't push certain plans, it does derive revenue through commissions. If Hella+Health is obliged to receive a reward for a sales quota under its contract with a company, the reward is donated, the company states. #CVSHealth saw its total revenues for the Health Care Benefits segment increase, in part due to #Medicare growth. Aetna, a CVS Health Company Medicare Advantage plan enrollment grew from 3.38 million enrollees at the end of March 2023 to 4.20 million by the end of the first quarter of 2024.

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The inaugural U.S. Health Insurance Experience Study by JD Power unveils challenges in health plan digital experiences. Discover insights on functionality gaps and opportunities for improvement. https://bit.ly/3W1Qv7i Fierce Healthcare #payments #HealthPlans

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Recent data from eHealth and Retirable’s report shows that the top financial concern of retirees is healthcare costs. Dive into the latest insights from this report at Medical Economics. https://bit.ly/4aUbdKj

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MMIT provides organizations across healthcare with the market insights they need. Take a look at what we captured in the latest update of the Directory of Health Plans. https://ow.ly/j56u50SAMze

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Meet Real Time's Carlie Siegel at the 2024 National Medicare Advantage Conference, where leaders from #HealthPlans, #MedicareAdvantage Plans, and #ManagedCareOrganizations will gather to discuss strategies that focus on quality improvement, compliance, operations, innovation, and more! Ask how our live #PostAcuteAnalytics solution helps #payers drive #ValueBasedCare collaboration with post-acute partners. https://bit.ly/4aq5Dzy #InterventionalAnalytics #PopulationHealth #PostAcuteCare

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Motherhood can be a joyous time, and women should be able to navigate pregnancy, birth and new motherhood with the right support for their health. But for many Black women, this vulnerable time can be filled with barriers to the right care.     We know that with culturally competent support, such as doulas and accessible educational resources, we can help improve maternal health outcomes and make sure that all women feel supported during pregnancy and beyond.     Mothers and infants receiving doula care are four times less likely to have low birth weight and two times less likely to experience birth complications. This care can also help women fully experience the joy and excitement during this new phase of life.     Learn more about how CVS Health is supporting maternal health for all women. #BlackMaternalHealthWeek https://lnkd.in/eb3xrtk2 

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Even more alarming, the CDC estimates that 1 in 3 adults with severe Chronic Kidney Disease (CKD) are unaware they have it… With our complimentary Comprehensive Data Analytics, Specialty Care Management can identify potential claimants before they escalate into multimillion-dollar claims, not only protecting the financial integrity of self-insured health plans, but also enhancing member wellbeing and preventing the need for dialysis with proven, clinical intervention. What’s more, our programs can be implemented off-cycle, are TPA agnostic, and carry zero initiation, PEPM, or other ancillary fees, common amongst competitors. Let’s get to work — https://lnkd.in/eF689G5r #ChronicKidneyDisease #RenalDialysis #CostContainment #SpecialtyCM

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Amidst increasing pressures, Medicare Advantage plans and provider organizations can take data-driven steps to achieve mutually beneficial outcomes for all. In this joint article with our HealthScape Advisors, a Chartis Company colleagues, we explore the 4 ways payers and providers can navigate sticky issues and find common ground: https://bit.ly/3ybAJwO

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