Health Populi

JUNE 27, 2022

Declines in preventive care services like cancer screenings and blood glucose testing concern employers, whose continued to cover health insurance for employees during the pandemic. But Castlight expects a flat-line in PMPM spending for 2022, leveling out at $4,232 per member/per month for commercially-insured employees.

COVID-19 125

COVID-19 Health Insurance Medicaid Medicaid 125

Jane Sarashon

FEBRUARY 4, 2024

Furthermore, health plan members now see themselves as medical bill payers, seeking value and consumer-level services for their health insurance premium investment. According to the online Merriam-Webster dictionary , the first use of the phrase “health insurance” occurred in 1901. Retail health-meets-Medicare.

US Department of Health and Human Services 75

US Department of Health and Human Services Health Insurance Medicare Medicare 75

Healthcare Law Blog

JANUARY 25, 2023

Introduction: Defining Interprofessional Consultation In a January 5, 2023, letter to state health officials, the Centers for Medicare & Medicaid Services (“CMS”) clarified a Medicaid and Children’s Health Insurance Program (“CHIP”) policy on the coverage and payment of interprofessional consultations (the “Guidance”).

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Health Populi

MAY 20, 2021

Year-on-year, different spikes and ups-and-downs call out for special mention, such as: Pharma’s 13-point steep dive to 38% between 2017 and 2018, dramatically recovering by 9 points in the last year to 47% [with the wild card here of whether U.S. to approve Medicare’s negotiation of drug prices with pharmaceutical companies].

COVID-19 127

COVID-19 COVID-19 Vaccine Health Insurance Medicare 127

Health Populi

SEPTEMBER 24, 2019

Among stresses facing people at least 50 years of age, health care costs rank top of mind compared with other issues like long-term care, health insurance, Social Security, taxes, and being read to retire. For Medicare, two-thirds of future retirees wish they understood the health plan better.

Health Insurance 116

Health Insurance Medicare Medicare Hospitals 116

Healthcare Law Blog

MARCH 25, 2022

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger insurers. New Mexico Health Connections v. United States Dep’t of Health & Human Servs. ,

ACA 52

ACA US Department of Health and Human Services Health Insurance Medicaid 52

Jane Sarashon

JULY 18, 2024

Following the BLS report on the CPI for June 2024, PwC published their new annual report from PwC titled Behind the Numbers 2025 tells us that commercial health care spending is expected to grow some 8.0% for Individual health plans — increasing from 7.5% for Group plans and 7.5% and 7.0%, respectively.

Doctors 59

Doctors Prescription Drug Pricing Hospitals Health Insurance 59

Health Populi

NOVEMBER 1, 2018

Among people who have health insurance, managing the costs of their medical care doesn’t rank as a top frustration. Instead, attending to health and wellbeing, staying true to an exercise regime, maintaining good nutrition, and managing stress top U.S. health-insured adults in July 2018.

Health Insurance 73

Health Insurance Doctors Medicaid Medicaid 73

Health Populi

JULY 11, 2019

This research organization will develop medicines targeting older adults — which makes sense because Clover Health’s target consumer market is Medicare Advantage beneficiaries. Health Populi’s Hot Points: These three transactions represent non-drug companies’ drug company gestures.

Department of Veterans Affairs 91

Department of Veterans Affairs Medicare Medicare Health Insurance 91

Bill of Health

JULY 26, 2022

Iora Health was acquired by ONEM in September 2021 for approximately $2.1 Amazon now has an important foothold in the Medicare market. This is not meant to be a victory lap as the stars of the Iora Health story were squarely the management team, particularly the founding CEO, Rushika Fernandopulle. Amazon Health Insurance?

US Department of Health and Human Services 174

US Department of Health and Human Services Health Insurance HIPAA Medicare 174

Health Populi

OCTOBER 17, 2019

adults in September 2019 on issues concerning health care costs, shopping, value, saving and spending. points in 2018 to 57.9 While two-thirds of consumers say they understand their insurance coverage, only one-half of them can correctly answer questions about the definition of premiums and deductibles. households.

Health Insurance 61

Health Insurance Medicare Medicare Governance 61

Health Populi

JULY 26, 2022

Goldman Sachs and Morgan Stanley put the deal together , with Morgan having led ONEM’s acquisition of Iora Health last year. Iora Health has focused on the Medicare-enrolled population, distinct from ONEM’s target patient market of younger, employed consumers. bn and MGM Studios for $8.5 bn and MGM Studios for $8.5

Health Insurance 165

Health Insurance Doctors Medicare Medicare 165

Healthcare Law Today

FEBRUARY 6, 2023

As of 2019 almost 95% of such persons had Medicare coverage and about half of those also had some sort of supplemental health insurance coverage. 2 See Trust for America’s Health: The State of Obesity: Policies for a Healthier America, 2022 (September 2022). See 2020 Profile of Older Americans (Published May 2021).

US Department of Health and Human Services 52

US Department of Health and Human Services Electronic Medical Records Medicare Medicare 52

HIT Consultant

NOVEMBER 24, 2022

The regulations may provide an opportunity for health insurers to attract new members – and retain existing ones – with hearing loss. Health plans could, for example, consider covering OTC hearing devices as part of the hearing benefits package provided to their Medicare Advantage plan members. Expanding membership.

FDA 94

FDA Public Health Fraud Medicare 94

Health Populi

DECEMBER 4, 2019

With new rules emanating from the White House this month focusing on health care price transparency, health care costs are in the spotlight at the Centers for Medicare and Medicaid Services.

Medicaid 83

Medicaid Medicaid Medicare Medicare 83

Health Populi

AUGUST 24, 2020

Ranking top for great or high harm, three in four physicians said that the, “loss of health insurance because of employment changes caused by COVID-19” would cause great harm to patients. Furthermore, nine in ten companies plans to offer virtual care for telemental health, a fast-growing aspect of virtual care.

COVID-19 154

COVID-19 Telemedicine Doctors Medicare 154

Hall Render

AUGUST 10, 2023

On August 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its Final Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) PPS rule for fiscal year (“FY”) 2024 (“Final Rule”). The Final Rule increases the rate for IPPS payments by 3.3% in FY 2024 but applies a 0.2%

Hospitals 40

Hospitals Medicare Medicare Medicaid 40

Health Populi

FEBRUARY 14, 2018

of health spending per person. Three factors will drive healthcare costs to 2026: prices for medical goods and services, changes in income growth, and shifting enrollment from private health insurance to Medicare — driven by the aging of Boomers. That equates to 18.4%

Health Insurance 79

Health Insurance Medicare Medicare Medicaid 79

C&M Health Law

DECEMBER 21, 2022

If the proposed rule is finalized, covered entities would have to comply within 24 months after the effective date of the final rule, and small health plans would have 36 months to comply. HHS also adopted the NCPDP Batch Standard Medicaid Subrogation Implementation Guide, Version 3, Release 0 (Version 3.0)

HIPAA 52

HIPAA Medicaid Medicaid Health Insurance 52

Health Populi

JUNE 13, 2018

The 6% trend is equal to that of 2018, illustrating a flat scenario, roughly the same trend seen in 2016 at 6.2%. Even with moderating medical trend growth, the Centers for Medicare and Medicaid Services (CMS) expect that healthcare spending will account for 20% of the U.S. That’s one-half the high point at nearly 12% in 2007.

Medicaid 63

Medicaid Medicaid Health Insurance Medicare 63

Health Law RX

DECEMBER 21, 2023

Department of Health and Human Services (HHS) Office for Civil Rights (OCR) is signaling that it is cracking down on healthcare organizations that fail to identify and address cybersecurity vulnerabilities as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA Rules).

HIPAA 52

HIPAA Ransomware Compliance Medicaid 52

Health Populi

MAY 14, 2019

The mainstreaming of SDoH speaks to the awareness that health is made where we live, work, play, pray, learn and shop… beyond the health”care” system of hospitals, doctors’ offices, and prescription drug dispensaries. adults between 18 and 64 years of age in December 2018.

Health Insurance 103

Health Insurance Public Health Hospitals Medicaid 103

Health Populi

OCTOBER 24, 2022

Add into this picture a CCS Insight analyst’s forecast last week that Apple could enter the health insurance market in 2024. health care system not seen since the 1968 creation of Medicare, coupled with decreased reimbursement due to health care reform.

COVID-19 54

COVID-19 Prescription Drug Pricing Health Insurance Health Care Reform 54

HIPAA Journal

JULY 24, 2023

The False Claims Amendment Act in 1986 lowered the bar for proof of fraud and increased the fines the OIG could impose, while the Health Insurance Portability and Accountability Act ( HIPAA ) in 1996 established the Health Care Fraud and Abuse Control (HCFAC) Program. What is the HHS OIG Exclusions List?

Fraud 52

Fraud Medicare Medicare Medicaid 52

Health Populi

MAY 15, 2018

Disparities in Americans’ health vary among people living in each of the 50 states. These differences in health status generally fall into two regions: north and south, found in the Commonwealth Fund’s 2018 Scorecard on State Health System Performance. Ultimately, the Fund asserts, where you live matters.

Health Insurance 74

Health Insurance Health Outcomes ACA Public Health 74

Health Populi

MARCH 19, 2019

Payors have begun to recognize the value of nudging consumers toward over-the-counter products under Medicare Advantage plans. To that point, IRI’s Kristin Hornberger presented new data on retail health market performance in 2018. Consumer health as a category was $45 billion in 2018, growing at 2.1%.

Health Insurance 63

Health Insurance Hospitals Medicare Medicare 63

Florida Health Care Law Firm

DECEMBER 9, 2021

On January 1, 2022, a new federal law, “ Requirements Related to Surprise Billing, Part I ” (“The Rule”), goes into effect for health care providers and facilities and for providers of air ambulance services. The Rule will restrict excessive out-of-pocket costs to consumers which resulting from surprise billing and balance billing.

Medical Billing 40

Medical Billing Medicare Medicare Compliance 40

Health Populi

MARCH 1, 2018

To optimize communication strategies for attracting Medicare Advantage enrollment , a Mid-Atlantic health plan studied the media and social consumption patterns for older people, learning that the target population was more tech-savvy than presumed.

Health Insurance 82

Health Insurance Medicaid Medicaid Public Health 82

Health Populi

JANUARY 18, 2019

As the Harvard Chan-POLITICO study points out, prescription drug costs are top-of-mind for health consumers in America. Research published in JAMA Internal Medicine in December 2018 found that as out-of-pocket costs for insulin have increased over the past few years, many patients use less insulin than needed.

Prescription Drug Pricing 66

Prescription Drug Pricing Health Insurance Doctors Medicare 66

Jane Sarashon

JULY 29, 2022

” Well beyond our individual genetic codes, our health is made where we live, work, play, pray, learn, and shop… also well beyond hospitals and doctors’ offices in-between appointments, and often paid-for out-of-pocket quite separate from peoples’ health insurance plans. billion in 2018.

COVID-19 72

COVID-19 Health Insurance Telemedicine Doctors 72

Health Populi

FEBRUARY 11, 2019

That wand has begun to initiate its magic in the physician community, based on a wonderful essay in JAMA published 20 December 2018 titled, Social Determinants of Health in the Digital Age: Determining the Source Code for Nurture. Yet it’s older people who are more at-risk for SD0H challenges. .”

Medicare 95

Medicare Medicare Doctors Health Insurance 95

CMS.gov

AUGUST 23, 2018

Person-Centered Strategies: Health Savings Accounts. Thu, 08/23/2018 - 12:29. CMS Deputy Administrator and the Director of the Center for Consumer Information and Insurance Oversight. August 23, 2018 By Randy Pate, CMS Deputy Administrator and the Director of the Center for Consumer Information and Insurance Oversight. .

Health Insurance 42

Health Insurance Medicare Medicare 42

Health Populi

OCTOBER 8, 2018

It’s National Health IT Week in the US, so I’m kicking off the week with this post focused on how digital health can bolster economic development. As the only health economist in the family of the 2018 HIMSS Social Media Ambassadors, this is a voice through which I can uniquely speak. GDP, in 2018.

Hospitals 61

Hospitals Health Insurance Health Outcomes Telemedicine 61

Healthcare Law Blog

APRIL 24, 2023

On April 17, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the U.S. Department of Health and Human Services (“HHS”) Notice of Benefit and Payment Parameters for 2024 Final Rule (the “Notice”) that includes standards for issuers and Marketplaces, and requirements for agents, brokers, web-brokers and others.

Medicaid 52

Medicaid Medicaid Compliance Health Insurance 52

Compliancy Group

AUGUST 19, 2022

The original request for records was submitted in writing by a former ACPM patient on November 13, 2018. The patient stated that he needed the requested medical records to appeal an unfavorable decision made by his health insurance company for the payment of a bill related to treatment provided by ACPM. No Response.

HIPAA 52

HIPAA COVID-19 Compliance Health Insurance 52

Health Populi

JULY 16, 2018

HealthyCapital develop a Health Management Retirement Index to calculate an individual’s percentage of retirement healthcare costs that can be funded by savings from improved health. Health Populi’s Hot Points: In the U.S.,

Health Insurance 54

Health Insurance Medicaid Medicaid Doctors 54

Health Populi

MAY 20, 2024

In the past year, the growth of prescription drug utilization and spending has much to do with the use of GLP-1 agonists to treat diabetes and obesity, along with immunology therapy, and lipid meds, along with specialty medicines now accounting for over half of spending — up from 49% in 2018.

FDA 71

FDA Medicaid Medicaid Medicare 71