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Vivante Health
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Explore more posts
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Jeff Gasser
If you click on the link you will see a report called Expense Distribution. I know this report more than you can imagine. It's based on paid claims. It shows that for this plan half the members were essentially self-insured as individuals. If I was the CEO of this company, you can bet I would make sure the rates my employees were paying for their own care were reasonable. If not, I'd be personally liable. #deerhold #ContractRateExplorer #MRFInsights
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Matthew Rechin
As revenues recover, it's clear that many hospitals are still grappling with rising costs. However, the hospitals that stand out are those embracing technology to drive efficiency and operational improvements, significantly reducing staff burnout. 🌟 Healthcare professionals entered this great profession to care for patients, not to be bogged down with manual tasks. That's why leading hospital systems are implementing comprehensive applications to enhance people, processes, and automation. This approach ensures cost-effective, top-of-license performance, ultimately benefiting both staff and patients. 💼❤️💡🔧 #GetReady #HealthcareInnovation #TechInHealthcare #OperationalExcellence #PatientCare
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Osato Chitou, Esq., MPH
#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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Christopher Algera
For all the plan sponsors/administrators out there -- we found this article in Benefits Pro helpful/timely regarding this year's #RxDC reporting for 2023. The earlier you can confirm how you're going to handle the submission, the better! As the author notes, "...no good faith relief is available for this third reporting submission. In addition, no deadline extension is available, even though June 1, 2024, falls on a Saturday." Click below to read the entire article. #knowledgeshare #news #PharmacyBenefitAdministration https://okt.to/VjYh5i
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Mike Behringer
What are the biggest changes you are expecting in the next 12 months? We have been speaking with lots of people and have been to many conferences. What we're seeing is a big push to get OP CDI to the front of the line, along with a huge risk adjustment push. We are also being asked, at the highest rate ever, to perform targeted audits of existing hospital coding staff as well. How about you? What changes are you expecting and/or seeing? Would love to start the conversation. #whyisnorwoodeverywhere #changeisgood #changehappens #riskadjustment #opcdi
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Katharine Cummings MBA BSN RN
The strategic adoption of technology is no longer a luxury, but a necessity for healthcare facilities striving to deliver high-quality care and remain competitive. By leveraging financing options, Like CCA Financial, to implement large technology projects with Elo Touch Solutions, healthcare facilities can overcome financial barriers and unlock the transformative potential of innovative solutions! Reach out to me to learn more about how Elo is collaborating with other healthcare vendors to provide thoughtful and dynamic solutions! #eloiseverywhere #elohealthcare #collaboration #healthcaretechnology
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Todd Guren
Individual insurance markets such as ACA Marketplace (aka Obamacare) and Medicare Advantage have annual regulatory changes that means plans annually evaluate expansion, exiting, or scaling back their footprint. BCBS Kansas City exited the Medicare Advantage market with their 32k members which caused me to think about those scenarios. This is not a post about the impact to the BCBS KC members nor how BCBS KC made the decision since it's a tough one and I have the same view from the balcony as my favorite Muppets, Waldorf and Statler. 𝐇𝐚𝐭𝐞 𝐭𝐡𝐞 𝐆𝐚𝐦𝐞, 𝐧𝐨𝐭 𝐭𝐡𝐞 𝐏𝐥𝐚𝐲𝐞𝐫𝐬: Regulatory and price change is a constant and individual members are making annual decisions. It's more like a cyclone than tail winds and head winds which means plans have to decide their threshold or risk being whipped around by the wind. 𝐊𝐧𝐨𝐰 𝐰𝐡𝐞𝐧 𝐭𝐨 𝐟𝐨𝐥𝐝 𝐭𝐡𝐞𝐦, 𝐤𝐧𝐨𝐰 𝐰𝐡𝐞𝐧 𝐭𝐨 𝐡𝐨𝐥𝐝 𝐭𝐡𝐞𝐦: At some point, the regulatory conditions get more favorable and plans that exited consider re-entering. It's always more costly to re-enter than you think due to acquisition costs, regaining market trust, and you have to offer lower-prices/richer benefits than the plans that stayed. 𝐍𝐞𝐯𝐞𝐫 𝐜𝐨𝐮𝐧𝐭 𝐲𝐨𝐮𝐫 𝐦𝐨𝐧𝐞𝐲 𝐰𝐡𝐢𝐥𝐞 𝐲𝐨𝐮'𝐫𝐞 𝐬𝐢𝐭𝐭𝐢𝐧𝐠 𝐚𝐭 𝐭𝐡𝐞 𝐭𝐚𝐛𝐥𝐞: What about staying in the market and shrinking your service area? There's often regulatory rules against this approach, fixed costs don't go down, and your market will still consider that to be an exit. While this can be an appealing middle ground, it doesn't usually pencil out. Also, I just quoted more Gambler lyrics since it's fun. The opening line doesn't really have anything to do with the commentary. 𝐔𝐩𝐬𝐢𝐝𝐞>𝐃𝐨𝐰𝐧𝐬𝐢𝐝𝐞? This is the only truly helpful information that I am offering. A talented CFO that I worked with drilled into my skull that you also have think of if the upside is greater than the downside for staying in the market. To simply paraphrase, if there's a 50% change of making $1 million, but losing $10 million, well to quote my new favorite song, 𝘛𝘩𝘦𝘳𝘦'𝘭𝘭 𝘣𝘦 𝘵𝘪𝘮𝘦 𝘦𝘯𝘰𝘶𝘨𝘩 𝘧𝘰𝘳 𝘤𝘰𝘶𝘯𝘵𝘪𝘯'/𝘞𝘩𝘦𝘯 𝘵𝘩𝘦 𝘥𝘦𝘢𝘭𝘪𝘯'𝘴 𝘥𝘰𝘯𝘦 https://lnkd.in/gKMjhjGW
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DJ Sullivan, MBA, MHA
HSG Advisors Dashboard is changing the game for healthcare leaders. It provides information they've never had access to and makes it actionable so leaders can make informed decisions about competitor dynamics, service line growth, access point strategies, and much more! Ready to see a demo? Set up a time on my calendar. https://lnkd.in/gAvyUkny #healthcareconsulting #healthcareleaders #hospital #hsgdashboard #healthsystem #claimsdataanalytics
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2 Comments -
Ron DiGiaimo
VERY frustrating healthcare insurance cost forecast from JP Morgan! Yet complicated authorizations, time consuming denials on standard of care and growing unworthy appeals are abundant in the offices of providers and Hospitals. Please check out this report that discussed the expected costs and continued rise in insurance premium costs despite record breaking profits for the commercial insurance industry. 1. UnitedHealth Group: $22.4 billion Total net earnings in 2023 were $22.4 billion, up 11.2% year over year. UnitedHealthcare's total earnings from operations in 2023 were $16.4 billion, up 14.2% year over year. 2. CVS Health: $8.3 billion Total net income in 2023 was $8.3 billion, up from $4.3 billion in 2022. Aetna reported nearly $5.6 billion in adjusted operating income for 2023. 3. Elevance Health: $6 billion Total net income in 2023 was nearly $6 billion, up 1.6%. The insurance division reported a total operating gain of $6.9 billion in 2023, up 14.4%. 4. Cigna Group: $5.2 billion Total net income in 2023 was nearly $5.2 billion, down 23% year over year. The insurance side of the business, Cigna Healthcare, reported an operating income of $4.2 billion in 2023. 5. Centene: $2.7 billion Total net income in 2023 was $2.7 billion, up 124% year over year. In the fourth quarter, net income was $45 million, compared to a loss of $219 million year over year. 6. Humana: $2.5 billion Total net income totaled nearly $2.5 billion in 2023, down 11.3%. The company's insurance segment reported an operating income of $2.7 billion in 2023. #physicians #hospitals #healthcare #insurers https://lnkd.in/gst6CS9y https://lnkd.in/g6su6SuJ
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John Austin, MD, MSHA, FACS,CHCQM
As people transition into Medicare they need to take a close look at the limitations of Medicare Advantage Plans, (MAP) part of Medicare Part C. The concept was that insurance companies can manage your money better than you can! Make no mistake about it, it’s not CMS’s money and it’s not the insurance’s money. It’s the cumulative capital you paid all your working career in federal tax withdrawals. The only way MAP are profitable is by rationing the care you receive. It’s capitated care. Once in a MAP you have to go to their physicians, go to their contracted facility, and have administrative delays placed on all your choices for ancillary services. All patients eligible for Medicare should choose the traditional A & B plans. You choose all your providers, service facilities, and have near instant approval for ancillary services.
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1 Comment -
SafeRide Health
Need a refresher on all the changes happening with Medicare Advantage? CMS recently announced the 2025 rate change—and insurance advocacy groups aren't happy about it, saying the base rate fails to account for higher utilization rates and healthcare costs. Then there's the new final rule announced this month, with a host of upcoming changes, and a proposed upcoming rule that will change how CMS determines Star ratings that are so crucial for MA plans. Read our latest blog for a roundup of MA changes. https://hubs.li/Q02vr2DV0
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Marc Mertz
The California Office of Health Care Affordability has recently approved a requirement that all healthcare providers report their annual operating expenses. If those expenses increase more than 3.5% (eventually lowering to 3%) in a year, that provider will be fined, ironically increasing their expenses. The state claims this regulation is aimed at protecting consumers from high healthcare costs. This is the same State of California that recently raised all healthcare workers' minimum wage to $25 per hour (up from $15.50). For our health system, that results in a $30 million annual cost increase and a 7.5% increase in our salary costs. This is also the same state that passed an unfunded mandate that requires our system to spend about $1 billion to replace a hospital building that they feel is at risk from damage in an earthquake. And it’s also the same state that increased the cap on medical malpractice lawsuits…and has authorized utility companies to raise their rates 15% per year. So, with all of these unfunded requirements and policies that dramatically increase providers' costs beyond their control, how exactly does the state suggest that we limit our expense growth to 3% per year? Healthcare cost inflation has already been running at more than 5% before any of these new requirements took effect. Perhaps if California wants to get serious about reducing the cost of healthcare they might look at the managed care plans. The most recent data I could find from the California Health Care Foundation indicates that California managed care companies made $222 billion in 2020. What direct value did these companies provide to the health of our communities? Meanwhile, hospitals and physicians are providing direct patient care and struggling to survive- especially systems like Kaweah Health that serve a high percentage of Medi-Cal (Medicaid) and Medicare patients. On a side note, the governor did sign a new managed care organization tax into law this year, which was promised to increase Medi-Cal reimbursements to providers, but all signs suggest that he now intends to use those proceeds (nearly $7 billion) to fill holes in his budget's general fund deficit and will not be providing Medi-Cal rate increases. I would humbly suggest that if the state is genuinely concerned about its residents' cost of living, they might look at the state income tax (highest in the country), its gas prices (highest in the country), the essentially unaffordable housing costs, or countless other factors that will have a larger impact on individuals' pockets than beating up healthcare providers with laws that don't make any sense. #hospitals #california #healthcare
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19 Comments -
Doctor's Choice
📊👨⚕️ As the U.S. faces a primary care shortage, Direct Primary Care (DPC) is emerging as a viable solution, growing at an impressive rate of 36% annually. This subscription-based healthcare model eliminates the traditional insurance billing system, allowing doctors to maintain smaller patient lists and provide more attentive care. This shift not only enhances doctor-patient relationships but also offers employers a potential strategy to reduce healthcare costs. 🏥💼 Professionals in healthcare and HR: How do you view the adoption of DPC in corporate health strategies? Could this be the future of primary care? #DirectPrimaryCare #Medicare #Employeebenefits #Medicarecoverage #HRInnovation #HRChallenges #DoctorsChoiceusa
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John Holstein
Insurers continue making major inroads into the provider community, moves no one anticipated even just a couple of years ago. The landscape continues to evolve with very few insurers literally dominating many markets in covered lives. As physician practices get absorbed, is there any reason to not believe this will lead to ever restrictive provider networks, resulting in limited choices for patients? All the while insurers continue with high deductible plans, forcing more and more of the financial responsibility for care on to those same patients. 7 providers being acquired by payers https://lnkd.in/eQBK5db6
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CalOptima
CalOptima Health CEO Michael Hunn participated in Becker's Healthcare Payer Issues Roundtable in Chicago, a national event that draws together payers from around the country. Hunn participated in the following two panels: Strategies for Health Plan CEOs in an Evolving Health Care Landscape and The CEO’s Guide to Navigating Disruption and Rethinking Business Models. #BeckersPayer #HealthCare #CommunityHealth #HealthandWellness
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Amber Owens, MBA
2-midnight rule could affect 20% of Medicare Advantage patients: CMS' expansion of the two-midnight rule, which could affect more than 20% of Medicare Advantage patients this year, has led to increased inpatient volumes and revenue growth in the first quarter, according to a report published May 13 by Strata Decision Technology. http://dlvr.it/T6sWVt
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