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May 25, 2017 Subscribe Our Team Contact Us
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Today’s Rundown

  1. CBO details AHCA impact on marketplace premiums; industry calls on Senate to preserve ACA coverage gains
  2. CBO releases score for Republican healthcare bill, estimates that 23M will lose insurance by 2026
  3. Blue Cross and Blue Shield of Kansas City exits exchanges, leaving some with no health plan options
  4. [Sponsored] Simplifying Contract Performance Monitoring Leads to Value-Based Care Success
  5. Iowa insurance agency agrees to pay local governments $1.3M in overcharged premiums
  6. Texas psychiatrist latest person convicted in $158M Riverside Medicare fraud scheme
  7. Department of Justice arrests 4 in insider trading scheme involving information from CMS

Featured Story


CBO details AHCA impact on marketplace premiums; industry calls on Senate to preserve ACA coverage gains

Thursday, May 25, 2017 Though the Congressional Budget Office projects that millions could lose their insurance coverage under the American Health Care Act, Republican leaders are focusing on the good news in the report: deficit reductions and lower premiums. Meanwhile, industry groups say those potential positives don’t change their concerns about the costs of so many Americans losing their insurance.

Top Stories


CBO releases score for Republican healthcare bill, estimates that 23M will lose insurance by 2026

Wednesday, May 24, 2017 The Congressional Budget Office has released its score of the latest version of the American Health Care Act, and it projects that 23 million people will lose insurance coverage by 2026 if the bill becomes law. This is lower than previous estimates, which suggested that 24 million would lose coverage over the next 10 years.


Blue Cross and Blue Shield of Kansas City exits exchanges, leaving some with no health plan options

Thursday, May 25, 2017 Blue Cross and Blue Shield of Kansas City announced it will not offer individual Affordable Care Act exchange plans in its 32-county service area in Kansas and Missouri in 2018. That leaves about 19,000 people with no exchange plan choices unless another insurer steps in.


[Sponsored] Simplifying Contract Performance Monitoring Leads to Value-Based Care Success

By: Geneia An advanced analytics platform offers payers a simpler, more effective way to manage value-based contracts and provider performance on quality and cost metrics.


Iowa insurance agency agrees to pay local governments $1.3M in overcharged premiums

Thursday, May 25, 2017 Two Rivers Insurance Co., which is based in Burlington, Iowa, denied allegations that it inflated the amount spent on premiums for plans purchased through Wellmark Blue Cross and Blue Shield, but the state’s Insurance Division determined that the group “engaged in unfair and deceptive acts and practices," according to court documents.


Texas psychiatrist latest person convicted in $158M Riverside Medicare fraud scheme

Thursday, May 25, 2017 A Houston-area psychiatrist is the latest person convicted for his role in a $158 million Medicare fraud scheme in which patients were admitted into intensive psychiatric programs. After a five-day trial, Riaz Mazcuri, 65, of Harris County, Texas, was convicted by a federal jury of one count of conspiracy to commit healthcare fraud and five counts of healthcare fraud, according to an announcement from the U.S. Department of Justice.


Department of Justice arrests 4 in insider trading scheme involving information from CMS

Thursday, May 25, 2017 The DOJ announced four arrests in an insider trading scheme based on confidential information obtained from the Centers for Medicare & Medicaid Services.

News of Note

Health Care Services Corp., which is the parent company of Blue Cross and Blue Shield in five states, earned $869 million in profit in the first quarter of 2017, reversing more than $442 million in losses on the Affordable Care Act’s exchanges. Axios article Native Americans could be significantly impacted by being denied expanded Medicaid through the Indian Health Service. STAT article As debate continues to swirl about healthcare reform, California’s public radio station took a dive into the coverage that the state’s congressional representatives have through the Federal Employees Health Benefits Program. KQED report

Resources


[Whitepaper] Confidence in the Cloud: Insurers Make the Leap for Business Agility

Presented By: Oracle In this white paper, we explore the insurance industry’s shift from rejecting the cloud to moving its most important business functions and sensitive data to the cloud along with the strategic benefits of cloud solutions in the insurance industry.


[Whitepaper] Digital Transformation Piece by Piece: A Game Plan for the Unshakable Healthcare Payer

Presented By: Oracle Companies capable of moving swiftly will manage to stay profitable. That’s why digital transformation must be the top priority for health insurers. In this white paper, we offer a practical strategy for healthcare payers to transform their organizations cost effectively with minimal risk: one component at a time.


[Whitepaper] Reduce Medical Loss Ratio by Straight-Through-Processing with Oracle Health Insurance Components

Presented By: Oracle With the steady increase of healthcare costs, health insurance payers are faced with a multitude of new challenges. Learn how Oracle Health Insurance Components can boost auto-adjudication and give you the flexibility you require to achieve operational excellence.


[Webinar] Best practices for using in-home assessments to improve health outcomes

Presented By: Quest Diagnostics

  1. In this 30-minute discussion, learn about three best practices your health plan can implement to ensure in-home assessments support improved health outcomes, as well as more accurate identification of member conditions for risk adjustment and HEDIS submissions.

[Marketplace] Blair’s Health Plan Raised Its Medicare Rating from 3 to 4 Stars

Presented By: Geneia Is your health plan still using expensive, one-off tactics like mobile mammograms and ‘chart chasing’ to improve your Medicare Star rating? Geneia’s advanced analytics offers a proven, better way to achieve a rating of 4 or more stars. Learn how.


[Whitepaper] Preventing Hospital Readmissions and Improving Transitions of Care

Presented By: MCG MCG, part of the Hearst Health network and a leading provider of informed care strategies, offers a complimentary white paper download: Preventing Hospital Readmissions and Improving Transitions of Care by Angela Askren, RN, MSN, CNC.


[Whitepaper] Six gray areas of HIPAA you can’t ignore

Sponsored by: Scrypt This guide exists to shed some light on some of the ‘gray areas’ of HIPAA. This guide will help anyone concerned with HIPAA compliance gain a better understanding of the areas which may be a cause for confusion or concern.


[Whitepaper] Mobile health & HIPAA: Playing it safe in 2017

Sponsored by: Scrypt Is texting putting your business at risk for a HIPAA violation? The following steps are intended to help organizations appropriately manage the use of mobile devices in the healthcare setting.


[Whitepaper] The Paperless Future of Healthcare and Life Sciences

Sponsored By: DocuSign DocuSign’s eSignature solutions modernize healthcare and life science organizations by eliminating paper and antiquated signature processes while meeting compliance requirements and reducing costs and errors.


[Whitepaper] DocuSign Life Sciences eBook: Reducing Cycle Time with Digital Transaction Management

Sponsored By: DocuSign The patients who rely on your scientific leadership are expecting more.


[Whitepaper] Streamline Regulatory Compliance in Life Sciences with Digital Transaction Management

Sponsored By: DocuSign The U.S. Department of Justice has collected upwards of $17 billion in settlements from the healthcare industry since 2009, including more than $2 billion from a single life sciences company.

Events

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