Kaiser blasts 30% price hike sought by Oregon system

https://www.beckershospitalreview.com/finance/kaiser-blasts-30-price-hike-sought-by-oregon-system.html?utm_medium=email

Kaiser Permanente Blasts 30% Price Hikes Sought By Salem Health | The Lund  Report

Oakland, Calif.-based Kaiser Permanente says the 30 percent price hike Salem (Ore.) Health is seeking for Kaiser insurance members in the Salem market is too steep. Salem Health argues the increase is justified, according to The Lund Report

Kaiser and Salem Health last negotiated their agreement seven years ago. Salem Health says it’s seeking a steep increase because prices under the current agreement lag the market by 30 percent. 

“Over the past year, Salem Health has consistently communicated with Kaiser the need for a new, market-based contract,” Salem Health said in a statement to The Lund Report

The old contract expired two weeks ago, and talks between Kaiser and Salem Health are at a stalemate. Kaiser says the price hike is unreasonable and excessive. 

“These overinflated prices are unnecessary, and they are not the direction we want to be going regionally and nationally,” Caroline King, MD, a physician leader at Kaiser in Salem, told The Lund Report. “And so if we feel there is a player in the market that is doing this, it is for us to speak up.” 

Any agreement entered into between the organizations will affect the healthcare costs of about 40,000 Kaiser insurance members in the Salem market, according to the report. 

Walmart Health COO outlines health insurance business: 5 things to know

https://www.beckershospitalreview.com/payer-issues/walmart-health-coo-outlines-health-insurance-business-5-things-to-know.html?utm_medium=email

NCDHHS on Twitter: "A few years ago, Durham's David Tedrow couldn't drive a  car. He'd forgotten how to answer a telephone. Now, he's started Senior  Health Insurance Brokers, LLC, and was honored

Lori Flees, senior vice president and COO of Walmart Health, officially launched Walmart Insurance Services Oct. 6. The insurance agency will “assist people with enrolling in insurance plans and simplify what’s historically been a cumbersome, confusing process,” Ms. Flees said.

Five things to know:

1. Ms. Flees outlined the operations of Walmart Insurance Services in a Oct. 6 blog post. Walmart will begin selling Medicare insurance plans during this year’s open enrollment period, from Oct. 15 through Dec. 7. 

2. Walmart Insurance Services will provide Medicare products, including Part D, Medicare Advantage and Medicare Supplement plans. The products will be offered by Humana, UnitedHealthcare, Anthem Blue Cross Blue Shield, Amerigroup, Simply Health, WellCare, Clover Health and Arkansas Blue Cross and Blue Shield. More insurers will be added, Ms. Flees said.

3. In July, the Arkansas Democrat Gazette broke news that Walmart had started seeking Medicare sales managers and insurance agents for a new entity called Walmart Insurance Services.

4. In early October, Walmart announced its partnership with Medicare Advantage insurer Clover Health on its first health insurance plans, which will be open to half a million people in eight counties in Georgia.

5. Walmart’s insurance business is licensed in all 50 states and Washington, D.C. Ms. Flees said the company has hired insurance agents to help people find insurance plans.

10 states where private insurers pay the most, least relative to Medicare

https://www.beckershospitalreview.com/finance/10-states-where-private-insurers-pay-the-most-least-relative-to-medicare.html?utm_medium=email

Market Muscle: Study Uncovers Differences Between Medicare And Private  Insurers | Kaiser Health News

Nationwide, private insurers pay an average of 247 percent more than what Medicare pays for similar services, according to a RAND Corp. study published Sept. 18. 

The study examined 750,000 claims for inpatient hospital stays and 40.2 million claims for outpatient services between 2016 and 2018. The sample included data from 3,112 hospitals across 49 states.

The Advisory Board mapped where private insurers pay hospitals the most and least relative to Medicare. Data for Hawaii, North Dakota, Maryland and South Dakota were unavailable. 

Here are the 10 states where private insurers pay the most relative to Medicare:

1. West Virginia: 349.2 percent
2. South Carolina: 349.1 percent
3. Florida: 340 percent
4. Tennessee: 329.5 percent
5. Alaska: 327.5 percent
6. Indiana: 304.1 percent
7. Georgia: 299 percent
8. Minnesota: 295.7 percent
9. Wisconsin: 290.3 percent
10. Virginia: 288.3 percent

Here are the 10 states where private insurers pay the least relative to Medicare:

1. Arkansas: 186.1 percent
2. Michigan: 193.6 percent
3. Rhode Island: 195.9 percent
4. Nevada: 207.9 percent
5. Pennsylvania: 208.8 percent
6. Kentucky: 214.2 percent
7. Connecticut: 214.6 percent
8. Utah: 216.1 percent
9. Kansas: 225.9 percent
10. Massachusetts: 227.7 percent

 

 

Cartoon – Modern Health Policy

MSSNYeNews: October 18, 2019 - Foul Turns FairMSSNYeNews Surprise Medical  Bills -

Cartoon – Modern Healthcare

Out Of Pocket Cartoons and Comics - funny pictures from CartoonStock

 

Cartoon – Employees’s Carrying the Load

The Cost of Employer Insurance Is a Growing Burden for Middle-Income Families ← Health Over Profit

Cartoon – Out of Pocket Experience

Out Of Pocket Cartoons and Comics - funny pictures from CartoonStock

HAP and Henry Ford collaboration creates new health plan for Michigan businesses

https://www.healthcarefinancenews.com/news/hap-and-henry-ford-collaboration-creates-new-health-plan-michigan-businesses

HAP introduces innovative health plan for Michigan businesses in  collaboration with Henry Ford Health System

Health Alliance Plan (HAP) and Henry Ford Health System have furthered their partnership through the release of Pivotal, a new health plan for Michigan-based businesses.

The plan was created for businesses with more than 100 employees and offers customized benefit options for each company.

WHAT’S THE IMPACT

Pivotal’s network includes seven hospitals, more than 6,000 physicians and 3,500 ancillary providers including urgent care, labs, radiology, imaging, rehab services, long-term care and nursing facilities, and physical, occupational and speech therapy.

Its members will have access to providers within the Henry Ford Health System, Henry Ford Physician and Jackson Health networks, Henry Ford Allegiance Health, as well as HAP’s ancillary provider and pharmacy network, and its contracted pediatric providers.

The plan recognizes the current need for telehealth services by offering virtual care for zero cost-share for in-network visits.

Members can use Pivotal’s telehealth offerings in three different ways: through at-home video visits, clinic-to-clinic video visits where providers can connect with specialists at other facilities, and with e-visits where non-emergency visits are conducted through email.

Pivotal plans also come with concierge services that include personalized onboarding for every employer group, phone support, as well as guaranteed same-day appointments with a primary care physician for sick visits and specialist appointments within 10 business days.

THE LARGER TREND

HAP has been working with Henry Ford since it became a subsidiary of the health system in 1986.

Henry Ford leveraged another partnership with CarePort during the COVID-19 public health emergency to communicate directly with post-acute care providers to share the COVID-19 testing status of patients. This allows providers to take the necessary safety precautions, including deciding if the facility can admit the patient at all, triaging care and managing the use of personal protective equipment.

ON THE RECORD

“HAP and Henry Ford have a long history of working together and sharing the same focus,” Genord said Dr. Michael Genord, president and CEO of HAP. “Working together, we’ve made sure that as many Michigan businesses as possible have access to high-quality affordable care, whether they’re in Detroit or Jackson or anywhere in between.”