health care utilization

TRICARE Program at a Glance

The U.S. Dept. of Defense recently awarded $136 billion in contracts for its TRICARE program that provides health care benefits to military service members, retirees and their families. The contract award for the West region went to TriWest Healthcare Alliance of Phoenix, which is partnering with Regence health plans and Health Care Service Corp. to administer the program. Humana Government Business Inc. will continue to serve the East region when the next contracts begin in 2024. Currently, Health Net Federal Services LLC, a subsidiary of Centene Corp., covers the West region with about 2.8 million beneficiaries, and Humana covers the East region with more than 6.8 million enrollees. In 2024, six states in the East region — Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin, with a total of 1.5 million beneficiaries — will transfer to the West region in order to balance out the number of beneficiaries served by the two regions.

0 Comments

TRICARE Program at a Glance

The U.S. Dept. of Defense recently awarded $136 billion in contracts for its TRICARE program that provides health care benefits to military service members, retirees and their families. The contract award for the West region went to TriWest Healthcare Alliance of Phoenix, which is partnering with Regence health plans and Health Care Service Corp. to administer the program. Humana Government Business Inc. will continue to serve the East region when the next contracts begin in 2024. Currently, Health Net Federal Services LLC, a subsidiary of Centene Corp., covers the West region with about 2.8 million beneficiaries, and Humana covers the East region with more than 6.8 million enrollees. In 2024, six states in the East region — Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin, with a total of 1.5 million beneficiaries — will transfer to the West region in order to balance out the number of beneficiaries served by the two regions.

0 Comments

News Briefs: Health Care Spending Growth Slows in 2021 After Pandemic Spike

U.S. health care spending grew 2.7% to reach $4.3 trillion in 2021, representing a slowdown in growth compared to the 10.3% increase recorded in 2020. That’s according to the 2021 National Health Expenditures Report from CMS’s Office of the Actuary, which attributed the spending-growth slowdown to a 3.5% year-over-year decline in health care expenditures from federal government that jumped in 2020 amid the COVID-19 response. The decline in government spending “more than offset” the impact of greater insurance coverage and higher health care utilization seen in 2021. The report also noted that private health insurance spending increased by 5.8% in 2021 to reach $1.2 trillion.

0 Comments

Plans, Community Orgs Need to Share Data to Tackle Social Determinants of Health

As health insurers rapidly expand their technology divisions and ally with tech companies to create population health and business insights, many health care leaders have expressed a hope that new technologies and insights can help tackle social determinants of health (SDOH). Those tools hold great promise, according to experts, but must be paired with old-school, community-based coalition building to be successful.

During a panel convened for a Dec. 6 Milliman Inc. webinar, health tech experts from organizations including Independence Blue Cross and Microsoft Corp. agreed that population health and equity insights can’t move the needle on SDOH if they aren’t paired with grassroots coalitions.

0 Comments

With Prescriber Interventions, Highmark Reduces Risky Opioid Use Among Members

The opioid epidemic — which by one measure peaked in 2017, when the Centers for Disease Control and Prevention (CDC) recorded 17,029 U.S. deaths involving prescription opioids — is far from over. In fact, CDC data show that deaths tied to prescription opioids, after declining in 2018 and 2019, came roaring back with the onset of the COVID-19 pandemic, and totaled 16,416 in 2020.

As the country continues to grapple with this stubborn issue, health insurers have learned they have a role to play in helping stop would-be opioid use disorder cases where many originate: with well-meaning doctors poised to write out a prescription. One such insurer is Pittsburgh-based Highmark, which is engaged in a multiyear partnership with a company called Wayspring to track providers’ prescribing habits and reach out to educate those who appear to deviate from the CDC’s recently updated clinical practice guidelines for prescribing opioids for pain.

0 Comments

For Privately Insured, Half of COVID Hospitalizations Cost Over $25K

A COVID-19 hospitalization cost more than $40,000 on average for people with large-employer health coverage in 2020, according to the Peterson-Kaiser Family Foundation Health System Tracker. Half of those hospital admissions cost over $25,000, and a quarter cost almost $39,000. About 38% of COVID-related hospitalizations in 2020 included an intensive care unit stay, and the average cost of such admissions was $65,569 — more than double the average amount paid for COVID admissions without an ICU stay.

0 Comments

Severe Flu Season Won’t Do Much Harm to Health Insurers’ Earnings Growth

Influenza cases and hospitalizations — which dipped in 2020 and 2021 as the public took steps like masking and staying home to slow transmission of COVID-19 — are back this year with a vengeance.

But while one equities analyst recently warned investors that such “heightened flu activity” could impact financial metrics for payers that haven’t priced for such a scenario, a credit rating analyst tells AIS Health, a division of MMIT, that insurers aren’t likely to take a major hit.

0 Comments

Studies Put Finer Point on Differences Between Medicare Advantage, Traditional Medicare

Among Medicare beneficiaries with complex care needs, those enrolled in Medicare Advantage had lower rates of hospital stays, emergency department (ED) visits and 30-day readmissions than those enrolled in traditional Medicare, according to a new JAMA study.

Based on an analysis of more than 1.8 million Medicare beneficiaries, the study found that MA beneficiaries enrolled in health maintenance organization plans and preferred provider organization plans both saw lower rates of hospitalizations and ED visits than traditional Medicare beneficiaries across all groups, but the difference was larger for those enrolled in HMO plans.

0 Comments

A Large Share of American Households Still Struggle With Paying Medical Bills

About 42% of working-age adults said they had problems paying medical bills or were paying off medical debt, according to findings from the 2022 Commonwealth Fund Biennial Health Insurance Survey. With 43% of the respondents inadequately insured, medical costs and debt remained a major concern for many Americans. Almost one-third of adults who were underinsured — whose coverage did not provide them with affordable access to health care — reported they were contacted by a collection agency regarding unpaid medical bills. Of those with medical debt, 56% said the amount reached $2,000 or more.

0 Comments

Spike in Remote Patient Monitoring During Pandemic Is Driven by a Fraction of Providers

Billing for remote patient monitoring (RPM) jumped by more than four times during the first year of the pandemic, according to a recent Health Affairs study. The increase was mostly driven by a handful of primary care providers. Using medical claims data from the OptumLabs Data Warehouse collected between Jan. 1, 2019 to March 31, 2021, the researchers found that there were 19,762 general RPM claims in March 2021, compared with 4,355 claims in February 2020. Continuous glucose monitoring, however, only saw a slight increase over the same period of time.

In addition, RPM claims were highly concentrated. The top 0.1% of primary care providers — identified by the researchers as “high-volume provider group” — accounted for 69% of all general RPM claims.

0 Comments