| 05.23.17 | Insurers get 90-day stay on CSRs, but 2018 planning is mired in uncertainty

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May 23, 2017 Subscribe Our Team Contact Us
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Today’s Rundown

  1. Health insurers get 90-day stay in House lawsuit over cost-sharing reduction payments
  2. Payers weigh participation in ACA exchanges while mired in partisan politics and legal uncertainty
  3. Senate rifts over pre-existing conditions stray from party lines
  4. [Sponsored] Simplifying Contract Performance Monitoring Leads to Value-Based Care Success
  5. Insurance plans should strive for equity, not equality

Featured Story


Health insurers get 90-day stay in House lawsuit over cost-sharing reduction payments

Monday, May 22, 2017 A federal appeals court has granted the Trump administration a 90-day delay in a lawsuit over cost-sharing reduction payments. House v. Price, brought originally by House Republicans against the Obama administration, argues that Congress never appropriated funding for CSRs, so the payments are unconstitutional. Payer organizations expressed relief at the short-term stay, but still worry about what will happen three months from now—and beyond.

Top Stories


Payers weigh participation in ACA exchanges while mired in partisan politics and legal uncertainty

Tuesday, May 23, 2017 With just about a month to go before health insurers must set rates and signal whether they’ll offer plans on Affordable Care Act insurance exchanges, the 90-day delay of a lawsuit over cost-sharing reduction payments and partisan politics has put them in a difficult spot.  


Senate rifts over pre-existing conditions stray from party lines

Tuesday, May 23, 2017 As the Senate discussions on healthcare reform ramp up, senators are divided over how to handle provisions for people with pre-existing conditions. Some conservatives favor simply repealing regulations that require insurers to cover people who have pre-existing conditions, while others are taking a stand in favor of keeping those protections.


[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.


Insurance plans should strive for equity, not equality

Monday, May 22, 2017 As legislators debate the next steps of health reform, expanding or paring back coverage options and adjusting plans is a hot-button issue. But as the conversation continues to unfold, the focus should be on achieving equity, not necessarily equality, experts say.

News of Note

Community Health Options, a Maine-based insurance co-op, posted a $3.7 million surplus in the first quarter of 2017. The co-op recovered from nearly $90 million in operating losses over the past two years. Bangor Daily News article The price tag for a proposed single-payer healthcare system in California could hit $400 billion, according to a report from the state Senate Appropriations Committee. About half of the program’s costs would be funded by a new payroll tax on workers and employers. Report (PDF) More than three-quarters (77%) of Americans believe insurance plans should also include mental health coverage, according to a new survey from the American Psychiatric Association. Release

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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