Practice Management
In advance of formal approval of its merger with Aetna, Humana plans to stop participating in some state insurance exchanges constructed under the Affordable Care Act (ACA, or “Obamacare”). The company says its member base dropped 21% compared with the first quarter of 2015. That includes those who bought policies under the ACA exchanges, which many insurers say are hard on their bottom lines to begin with. UnitedHealth Group was the first major insurer to …
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IMS Health Holdings Inc. and Quintiles Transnational Holdings are merging in an all-stock deal aimed at creating “a leading portfolio of anonymous patient records, technology-enabled data collection, and observational research experts to address critical healthcare issues of cost, value, and patient outcomes.” The new company, to be called Quintiles IMS Holdings, says its combined strength will be to support drug development from inception through demonstrating the value of new medicines. The 2015 combined revenue of …
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The Centers for Medicare and Medicaid Services (CMS) calls it a brand-new platform, while skeptics are saying it’s just the same-old structure with a fresh coat of paint. Either way, CMS is rolling out the Quality Payment Program, which it says will ease documentation requirements for physicians while also providing new opportunities to earn bonuses by providing quality care. Under the program, physicians can receive Medicare reimbursement by participating in either the Merit-Based Incentive Payment …
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We’ve seen lots of data indicating that patients worry about being able to afford good healthcare for themselves and their families. Those concerns go beyond the household budget, though: A new study shows that citizens are more concerned about domestic healthcare costs than any other financial issue. In fact, “healthcare costs” were named by nearly twice as many people as Social Security benefits, which was the second most mentioned concern (31% vs 16%), followed by …
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Patient advocates and regulators at every level decry that a lack of price transparency often leads to patients getting bigger bills than they expected after leaving a doctor’s office. However, a new study published in Health Affairs calls the actual value of price transparency tools into question—if for no other reason than it’s unclear how often patients would actually use such a tool. Researchers looked at how a population of Aetna members fared using that …
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Most patients who gave their healthcare providers low scores after an encounter did so because of perceived bad service, not poor medical care, according to a new study published in the Journal of Medical Practice Management. In fact, 96% of complaints in an analysis of 35,000 online reviews were related mainly to communication and wait times. Just 1 in 25 patients who gave their provider one or two stars (on a five-star scale) said they …
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With a storm of protest from state workers still ringing in their ears, North Carolina legislators have backed off a plan to eliminate traditional “80/20” insurance (in which plan members pay 20% of healthcare costs until their deductible is met). Instead, they’ll incentivize preventive care by lowering copays for routine medical visits and some prescription drugs in 2017. That could mean higher traffic in primary care practices—and even longer waits to see PCPs in a …
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No longer satisfied with revealing states in which it plans to stop offering insurance under the Affordable Care Act (ACA, or “Obamacare”) a few at a time, UnitedHealth Group has acknowledged it will drop out of all but a “handful” of states by the end of this year. Right now, it participates in exchanges in 34 states; the dawn of 2017 will see it offering health coverage in just 12, as now planned. The market …
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Wall Street analysts have predicted that Optum would add 25 to 30 urgent care centers per year through acquisition and startups, but on a recent call with analysts the company predicted it would grow at a quicker pace on its way to operating clinics in 75 markets. A key step in that strategy, as we reported, was buying MedExpress for the urgent care centers it operates in 14 states. Optum still says those locations will …
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Patients who don’t need to be visiting the emergency room at all are too often not only evaluated, but admitted into the hospital through the ED. Some even wind up in critical care units, according to a new study published in JAMA Internal Medicine. While some patients may be heading to the ED because they’re unsure of the most appropriate setting for their symptoms, others claim lack of access to primary care as the main …
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