About 1 in 5 claims sent to fully insured commercial health insurers in Massachusetts were denied in 2024, according to February findings from the Massachusetts Health Policy Commission. These insurers submit claim denial data to the commission’s Office of Patient…
Research & Analysis
The acquisition of ASCs by UnitedHealth Group’s Optum, parent company of ASC chain SCA Health, was associated with double-digit price increases for competing insurers, according to a February study published in Health Affairs. The study examined Optum’s acquisitions of physician…
Four studies involving Oakland, Calif.-based Kaiser Permanente, Arkansas BCBS and Independence Blue Cross identified total cost savings through psychiatric collaborative care models, according to reports from the Mental Health Treatment and Research Institute, and the Bowman Family Foundation. Health plan…
Humana saw a 24.3% decrease in inpatient admissions, or a 229,000-stay dip, for Medicare Advantage members in value-based care arrangements versus those in traditional Medicare in 2024, according to Humana’s “12th Annual Value-based Care Report,” published Feb. 4. Humana reviewed…
Accountable alternative payment models held steady in 2024, according to a Feb. 2 survey by America’s Health Insurance Plans. In 2024, 44.9% of healthcare payments stemmed from alternative payment models that ensure provider accountability for quality and cost of care.…
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Cancer survivors enrolled in high-deductible health plans had significantly worse overall and cancer-specific survival than those in standard health plans, according to a study published Jan. 29 in JAMA Network Open. The researchers analyzed data from 147,254 adults ages 18…
Prior authorization ranks as the single biggest burden insured Americans face when navigating the healthcare system, according to a KFF Health Tracking Poll published Feb. 2. The poll was conducted Jan. 13-20 among 1,426 U.S. adults. Five things to know:
Medicare Advantage insurers will likely continue to scale back supplemental benefits and exit certain markets if CMS finalizes its proposed 0.09% payment increase for 2027, according to a Jan. 30 analysis from Fitch Ratings. “Depending on finalized payment rate and…
Participating Medicare Part D plans can officially begin covering weight-loss treatment in 2027. The initiative falls under CMS’ voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” — or BALANCE — model. The December news followed President Trump’s negotiations…
Medicare Advantage insurers made almost 53 million prior authorization decisions in 2024, according to a Jan. 28 KFF analysis. KFF relied on insurer data reported to CMS, focusing on service determinations, not claims determinations for services already provided. Withdrawn and…