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HHS Releases Plans - Deregulation With Focus on Financial Risk … Non-ACA Plans

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Providers, insurers and pharmacies can expect a major regulatory overhaul later this year.  The administration's spring 2018 unified agenda , released on Wednesday, offered a preview into various agencies' regulatory and deregulatory plans for the near future. Policy changes outlined by the Department of Health and Human Services (HHS) include reduced paperwork burdens for hospitals, greater flexibility for non-ACA-compliant plans, and additional tactics to fight the opioid epidemic, all of whic...
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Reimbursement, Quality Scores & Risk Adjustment Improve HCC Practices

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Hierarchical condition categories (HCCs) reveal the severity, complexity and interaction of member conditions. They are used by the Centers for Medicare and Medicaid Services (CMS) to adjust risk scores that determine payment for Medicare Advantage (MA) beneficiaries. With CMS leading the way, additional government and commercial payers leverage HCCs to drive quality ratings, shared savings, risk scores and payment adjustments for a broad range of value-based contracts and activities. As HCCs ri...
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Administration Unveils ‘American Patients First’ Plan on Drug Costs

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The administration unveiled it’s policy plan to tackle the rising cost of drugs. The " American Patients First " blueprint builds on the administration’s 2019 budget proposal and calls for changes in Medicare Part D alongside a focus on price transparency.  This "American Patients First" policy plan tackles the rising cost of drugs. The President called the proposal "the most sweeping action in history to lower the price of prescription drugs for the American people" at an event to mark the rele...
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Advanced Bill Allowing Veterans to See More Private Health Providers

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A US House of Representatives panel has advanced legislation to allows more veterans to see doctors outside the Veterans Affairs system.  The bill, the VA MISSION Act , passed the House Veterans Affairs Committee 20-2. This bill would allow more veterans to go outside the VA healthcare system and use private-sector doctors when VA medical centers can't provide appointments within a month, when veterans have to drive more than 40 minutes to access care, or when care is determined inadequate by VA...
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The ACA Health Plan Draft Labor Rule Needs Rewrite

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The administration has been looking for lifeboats for Americans trapped in old ACA exchanges. One project is to expand “association health plans,” on Association Health Plan (AHPs), that let employers team up to offer coverage. But the fine print in the proposed Labor Department rule is causing concern and needs to be cleaned up. The Issue: Whether the new rule will let association health plans set prices based on risk, which is how insurance is supposed to work. The point of the rule is to let ...
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Why Healthcare Needs to Invest in Consumer Journeys

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For healthcare organizations to improve their consumer experience, they need to emphatically understand their experience from start to finish. A proven way to do that is by mapping the consumer journey. As healthcare requires sensitivity, it’s critical to know how and when consumers need to engage with you, to anticipate what they need, and guide them along the most relevant path. With the growth of expanded care delivery options, such as urgent care facilities, patients are increasingly unaffil...
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Affordable Health Care Gallup Poll Results

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Higher than in past surveys, fifty-five percent of Americans worry a “great deal” about affordable health care , according to a recent Gallup poll.  With numerous problems facing the country, health care is most noted and scoring at the very top. Higher than crime and violence, federal spending, budget deficits and gun ownership, the availability and affordability of health care is noted as a big fear factor. According to Gallup, for the last five years, health care has been first or tied for fi...
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Simplified Health Policies Cheaper but Riskier Than ACA Plans

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Insurance agents say individuals are buying indemnity plans instead of ACA coverage, which has become far more costly Sales are growing for a type of limited health policy offering a cheaper alternative to traditional insurance but leaves buyers risking big bills if they have major medical needs.  Known as fixed indemnity plans, the products offer limited help, typically paying set amounts toward the cost of doctor visits, hospital days or other services. These plans carry restrictions on people...
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Healthcare Deals – Reshaping the Landscape

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The health-care industry is in the throes of a major shake-up and is creating a situation in which companies face a greater risk by standing pat than possibly overpaying for an acquisition. Amazon.com Inc., Berkshire Hathaway and JPMorgan Chase have all announced in January that they would start their own nonprofit company aimed at lowering medical costs for their employees. Separately, The Wall Street Journal reported that Amazon has designs on expanding its hospital-supplier business. Historic...
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Health Care Price Controls Focus of New Bill

California's government would set prices for hospital stays, doctor visits and other health care services under legislation introduced Monday (4-9-18), vastly remaking the industry in a bid to lower health care costs. The proposal, which drew swift opposition from the health care industry, comes amid a fierce debate in California as activists push aggressively for a system that would provide government-funded insurance for everyone in the state. Across the country, rising health care costs have ...
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