Health Plan Weekly

Report Urges Better Network Adequacy for Cancer Patients

For the 1.3 million Americans living with blood cancers, their already daunting condition is not made any easier by the fact that private health plans — particularly those on the Affordable Care Act exchanges — ...
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Addressing High Cost of Childbirth Care May Be a Tall Order Chart: One in Six Families Spent Over $5K on Childbirth

Across the U.S., about 2 million individuals with private insurance are admitted to the hospital each year for childbirth. It’s the No. 1 cause of hospitalization in the nation, and it’s also the cause of signif...
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Biden Admin Backs New SEP, but Is Adverse Selection a Worry?

The Biden administration on June 28 made good on its previous pledge to roll back certain Trump-era regulations regarding the Affordable Care Act exchanges when it issued a proposed rule that CMS deemed a “continu...
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News Briefs

✦ Hospitalized COVID-19 patients covered by private insurance paid an average of $534 out-of-pocket on medical costs, while Medicare Advantage members paid a mean $680 within 90 days of discharge, according to a s...
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Cigna Doubles Down on Incentives to Spur Biosimilar Adoption

Cigna Corp. — which made headlines earlier this year when it indicated patients could receive a monetary award if they switch from a high-priced psoriasis drug to a cheaper biologic — now appears to be making th...
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Insurers Can Benefit From Value-Based SUD Contracts

Health plans will see the best results in treating substance use disorder (SUD) by adopting a risk-sharing, value-based contracting model with providers, experts say. According to executives from a health plan and a...
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Ruling Blocks Okla. MCO Program, But Fight May Not Be Over

In Oklahoma, the most recent state to implement a Medicaid expansion under the Affordable Care Act, the state Supreme Court recently struck down a plan pushed by Republican Gov. Kevin Stitt to implement a managed ca...
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As Physician Shortage Looms, Here’s How Payers Can Help With Chart: New Report Estimates 37K to 124K Physician Shortage by 2034

By 2034, the U.S. will be facing a shortage of 37,800 to 124,000 physicians, predicts a new report from the Association of American Medical Colleges (AAMC). While that estimate dropped slightly from what the AAMC pr...
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News Briefs

✦ The combined organization created by a merger between Tufts Health Plan and Harvard Pilgrim Health Care will now be known as Point32Health. “Inspired by the 32 points on a compass, Point32Health represents the...
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Execs Discuss How Pandemic Shaped Consumer Engagement

Of all the changes that the COVID-19 pandemic has made to the health care system, one of the most lasting might be the manner in which it has forced organizations of all types to rethink how they engage with consume...
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