Health Plan Weekly
-
OIG: CMS Paid MA Insurers Billions for Questionable Use of In-Home Assessments
Medicare Advantage insurers received an estimated $4.2 billion in risk-adjusted reimbursement in 2023 for diagnoses gleaned from home visits designed to assess members’ care needs, according to a new report by the HHS Office of Inspector General. These assessments were often administered by third-party vendors hired by the insurers and led to no treatment, according to OIG. While MA plans are allowed to use chart reviews and HRAs as sources of diagnoses for risk adjustment purposes, the Oct. 21 report builds on OIG’s documented concerns regarding misuse of health risk assessments and HRA-related chart reviews for the purposes of risk adjustment.
-
Deal or No Deal? Cigna, Humana Reportedly Resume Talks, But Analysts Remain Skeptical
After scuttling merger talks early this year, The Cigna Group is again potentially looking to acquire Humana Inc., according to an Oct. 18 Bloomberg report. The article mentioned the companies have held “informal discussions” about a tie-up but noted “the discussions are in early stages,” citing people familiar with the matter.
Wall Street analysts, meanwhile, are not surprised the companies have resumed talks. However, they are skeptical a deal could be consummated due to antitrust concerns, especially if Kamala Harris wins the presidential election and current antitrust leadership remains in place.
-
Nonprofit Medicaid Plans Ask Feds to Step In to Fix ‘Inadequate’ Pay Rates
With the Medicaid unwinding process winding down, two health insurer trade groups are sounding the alarm about how the resulting changes in the Medicaid risk pool are putting financial stress on nonprofit and regional health plans. To address the situation, both the Alliance of Community Health Plans (ACHP) and Association for Community Affiliated Plans (ACAP) say they want the federal government to push states to raise the payment rates to private Medicaid plans.
“This is an issue that is impacting much of managed care across the country,” says Jennifer McGuigan Babcock, senior vice president for Medicaid policy at ACAP. “We have heard…anecdotally from our plans that should changes not be made for 2025, and potentially for 2026 rates, there will be significant problems.”
-
Survey Findings, New State Law Shine Spotlight on IVF Coverage
Only around one-quarter of large employers offer in vitro fertilization (IVF) coverage to employees, according to a recent KFF survey. But a similar survey from the benefits consulting firm WTW revealed that 67% of respondents offer such coverage.
Despite these dueling outcomes, IVF coverage and other fertility benefits are emerging as a hot topic for employer benefits, experts say.
KFF’s 2024 Employer Health Benefits Survey revealed that 27% of respondents from companies with 200 or more employees (considered “large employers”) offer IVF coverage, and 30% were unsure of their fertility offerings. It was the first time KFF included the question in the survey, so no data is available on how this has changed over the years.
-
News Briefs: Elevance Plans to Buy Home Care Firm CareBridge
Carelon, the health services division of Elevance Health, Inc. intends to acquire home health company CareBridge. Elevance announced its intent during its Oct. 17 earnings call. CareBridge provides home- and community-based health care services for people with chronic and complex conditions. CareBridge, which operates in 17 states and Washington, D.C., employs 500 people and serves 115,000 patients. “Carelon is expanding its capabilities to manage a growing proportion of healthcare spending, supporting the long-term growth of the business and by extension, the value it creates for health plan customers,” said Elevance CEO Gail Boudreaux. Terms of the acquisition have not been disclosed. In a research note, Bernstein analyst Lance Wilkes noted that the acquisition fits in Elevance’s strategy by “1) expanding services businesses which can replace existing outside vendors to ELV’s MCO [managed care organization) business and also be cross-sold to ELV self-insured employer customers; and 2) providing these services to other MCOs, in particular for other smaller Blue Cross companies which represent an additional 65[M] members.”
The Latest
Meet Our Reporters
Meet Our Reporters