- Hypertrophic Cardiomyopathy (HCM)
- Eyecare
- Urothelial Carcinoma
- Hemophilia
- Heart Failure
- Vaccines
- Neonatal Care
- NSCLC
- Type II Inflammation
- Substance Use Disorder
- Gene Therapy
- Lung Cancer
- Spinal Muscular Atrophy
- HIV
- Post-Acute Care
- Liver Disease
- Asthma
- Atrial Fibrillation
- COVID-19
- Cardiovascular Diseases
- Prescription Digital Therapeutics
- Reproductive Health
- The Improving Patient Access Podcast
- Blood Cancer
- Ulcerative Colitis
- Respiratory Conditions
- Multiple Sclerosis
- Digital Health
- Population Health
- Sleep Disorders
- Biosimilars
- Plaque Psoriasis
- Leukemia and Lymphoma
- Oncology
- Pediatrics
- Urology
- Obstetrics-Gynecology & Women's Health
- Opioids
- Solid Tumors
- Autoimmune Diseases
- Dermatology
- Diabetes
- Mental Health
MA plans taking a hit
Network selection is one tool plans are using to overcome cost pressures
Selective provider networks is nothing new. It is evidence of the continuing tradeoffs in the delivery of-and payment for-health services.
It could be weeks or months before the situation between UnitedHealthcare and its recently terminated physicians is sorted out in the appeals process, but the larger issue is how revenue pressure on insurers is playing out in the market.
"The moves that United is making in Rhode Island, as well as in many other states across the country, to remove selected physician groups from its Medicare Advantage network seems to indicate a material change in their contracting strategy,” says Jim Donohue, a leader in ECG's Contracting and Reimbursement practice.
Medicare Advantage plans are taking a hit as the federal government waters down payment and cuts back on star-program bonuses.
“United, like other health plans, likely anticipates further downward pressure on their revenues from the federal government,” Donohue says. “In response, they seem to be transitioning to a smaller provider network, through which they believe they can more effectively manage medical costs and quality measures on which the health plan is evaluated and which impact their financial performance."
Additional profit pressures include medical loss ratio limitations, uncertain risk pools and provider merger activity.
Bridging the Diversity Gap in Rare Disease Clinical Trials with Harsha Rajasimha of IndoUSrare
November 8th 2023Briana Contreras, an editor with Managed Healthcare Executive, spoke with Harsha Rajasimha, MD, founder and executive chairman of IndoUSrare, in this month's episode of Tuning in to the C-Suite podcast. The conversation was about how the disparity in diversity and ethnicity in rare disease clinical trials in the U.S. has led to gaps in understanding diseases and conditions, jeopardizing universal health, and increasing the economic burden of healthcare.
Listen
Managing Editor of Managed Healthcare Executive, Peter Wehrwein, had a discussion with William Shrank, M.D., a venture partner with Andreessen Horowitz, a venture capital firm in Menlo Park, California, about how artificial intelligence's role is improving healthcare, where we are today with value-based care and the ongoing efforts of reducing waste in the healthcare space for this episode of the "What's on Your Mind" podcast series.
Listen
35th World AIDS Day Marks 20 Years of PEPFAR: Challenges and Strategies to Combat HIV/AIDS
November 29th 2023PEPFAR, having invested $100 billion and saved 25 million lives in the global fight against HIV/AIDS, faces Congressional hurdles in its reauthorization due to abortion debates. Despite widespread support and no evidence of abortion-related activities, the legislative process is at a standstill. Members of PEPFAR and authors of a recent editorial stress the significance of PEPFAR and advocate for integrating behavioral and social science into healthcare programs to achieve UNAIDS targets and address barriers in HIV/AIDS testing and treatment.
Read More
