Recondo Technology, the market leader in cloud-based single-platform revenue cycle management (RCM) solutions, has released a suite of application programming interfaces (APIs) to significantly streamline payment, improve patient satisfaction, and simplify technology innovation. [Read more…]
Centene Corporation (NYSE: CNC) has appointed former Missouri Attorney General Chris Koster to Senior Vice President, Corporate Services effective today. Mr. Koster will report directly to Chairman, President and CEO Michael F. Neidorff, and will assist in business-related issues, outside of Government Relations, for Centene’s locally-based health plans across the country. [Read more…]
Talix, Inc., a premier provider of risk analytics solutions for value-based care, today announced that Shahyan Currimbhoy, senior vice president of product management and engineering at Talix, and Karena Weikel, ASA, FAHM, CSFS, vice president of risk and revenue management at Geisinger Health Plan (GHP), will be presenting at the 2017 RISE Nashville Summit. The summit takes place March 6-8, 2017 at the Omni Nashville Hotel in Nashville, Tenn. [Read more…]
Don’t repeal the Affordable Care Act (ACA) without specifying what will replace it. This is among the policy recommendations issued by the National Alliance of Healthcare Purchaser Coalitions (National Alliance), a nonprofit, membership association of employer led coalitions across the country serving 12,000 purchasers and 41 million Americans.
Additional recommendations include:
— Preserve employer-sponsored coverage by refraining from capping the individual tax exclusion for premiums and continue to allow businesses to fully deduct the costs.
— Avoid increasing the number of uninsured individuals, as the cost of their inevitable medical care will get shifted to those who do pay the bills.
— Continue to move away from fee-for-service (or “volume-based reimbursement”) toward alternative payment models that reward providers for good outcomes and high quality, not medical errors, unnecessary procedures and other low value care. Preserve the ability of the federal government to partner in these efforts (Center for Medicare & Medicaid Innovation and other value-promoting elements of the ACA, and the Medicare Access and CHIP Reauthorization Act of 2015).
— Expand assistance to states, regions, and local communities promoting transparency by pushing hospitals and medical groups to report on the quality of care they provide.
— Support comparative effectiveness research. Employer-purchasers need to know which new or higher cost therapies result in outcomes that are significantly better, somewhat better, about the same, or worse than current or less costly options.
— Allow employer-purchasers maximum flexibility in experimenting with benefit designs.
A Purchaser Viewpoint on Health Policy in Transit is the result of a collaboration of the National Alliance’s Government Affairs Affinity Group led by members including the Louisiana Business Group on Health, Midwest Business Group on Health, Minnesota Health Action Group, Pacific Business Group on Health, and Wyoming Business Coalition on Health.
In three new issue briefs, the American Academy of Actuaries examines a number of key public policy considerations that policymakers should weigh when evaluating specific proposals for reforming or replacing the Affordable Care Act. Developed by the Academy’s Individual and Small Group Markets Committee, the papers address high-risk pools, selling health insurance across state lines, and association health plans. [Read more…]
America’s leading nursing organizations and the over 3.5 million nurses they represent, today called on the Trump Administration and Congress to prioritize patient health and the patient-provider relationship in any health reform proposals. [Read more…]
Consumers are just beginning to discover that Anthem eliminated coverage for out-of-network doctors now that the Affordable Care Act “Open Enrollment Period” to secure health coverage for 2017 ended on January 31. [Read more…]
Aflac, the leader in voluntary insurance sales at the worksite in the United States, is making it even easier for customers to access much-needed financial support while they are in the hospital. [Read more…]
Employer-sponsored health insurance is greatly affected by geographic region, industry, and employer size. While some cost trends have been fairly consistent since the Patient Protection and Affordable Care Act (ACA) was put in place, United Benefit Advisors (UBA) finds several surprises in their 2016 Health Plan Survey. [Read more…]
Secretary of Health Dr. Karen Murphy is urging the commonwealth’s U.S. Congressional delegation to consider the effect that repealing the Affordable Care Act (ACA) could have on all Pennsylvanians, especially children and seniors in need. [Read more…]
Discern Health has announced their affiliation with Mai Pham, MD, MPH as a Senior Advisor. Mai most recently served as Chief Innovation Officer at the Centers for Medicare & Medicaid Innovation (CMMI). Among other achievements at CMMI, Mai spearheaded development and implementation of the alternative payment model (APM) portion of MACRA, which will fundamentally change the way that Medicare pays for physician services. [Read more…]
International Medical Group® (IMG®), a leader in global benefits and assistance services, has named Craig Peters as chief revenue officer (CRO). [Read more…]
Hospitals and health systems in New Jersey have already absorbed nearly $1.5 billion in funding cuts since the Affordable Care Act was enacted in 2010, with the promise of expanded healthcare coverage to mitigate these losses. As the 115th Congress advances legislation to repeal major provisions of the ACA, healthcare providers are concerned the cuts will remain despite the coverage of 796,291 state residents being jeopardized. [Read more…]
The President and CEO of the Senior Care Pharmacy Coalition (SCPC) today predicted the increasingly apparent role of Pharmacy Benefit Managers (PBMs) as unaccountable middlemen in the national drug pricing chain will result in a higher level of scrutiny from Congress, regulators and the media in 2017. [Read more…]
The Permanente Medical Groups serving Kaiser Permanente members and patients across California received 5-star ratings for overall performance — the highest recognition possible by the California Office of the Patient Advocate — in the second annual Medical Group Report Card for Medicare Advantage Members. [Read more…]
Insurance Commissioner Teresa Miller today reminded Pennsylvania consumers that the open enrollment period for 2017 health insurance coverage available through the federal marketplace at www.Healthcare.gov closes at 11:59 p.m. on January 31. More than 413,000 Pennsylvanians are currently enrolled in plans for 2017. [Read more…]
To help people affected by breast cancer understand and prepare for changes to healthcare insurance policies that might affect them, Living Beyond Breast Cancer (LBBC) has created a Healthcare Newsroom on LBBC.ORG. [Read more…]
Milliman, Inc., the premier global consulting and actuarial firm, has published six questions for consideration by healthcare stakeholders about the Trump Administration’s recent executive order, which gives a sweeping command to the leaders of the new administration to unwind certain aspects of the Patient Protection and Affordable Care Act (ACA)—especially those components deemed “burdensome.” It remains unclear how the Trump Administration will implement this authority, especially due to the interconnected nature of the ACA, but given Milliman’s comprehension of the law, several key questions arise. [Read more…]
MailMyPrescriptions.com has entered into an agreement with Alliance HealthCard of Florida, Inc. Alliance HealthCard of Florida, Inc., a division of Aon Benefit Solutions, Inc., an Aon subsidiary (NYSE: AON), will make mailmyprescriptions.com available to America’s Health Care Plan/RX Plan Agency, Inc. (AHCP) owned by National General Insurance Company (NASDAQ: NGHC). [Read more…]
Alere Inc. (NYSE: ALR), a global leader in rapid diagnostic tests, has provided an update on the decision by the Centers for Medicare & Medicaid Services (CMS) to revoke Arriva Medical’s Medicare billing privileges. [Read more…]
ReWalk Robotics Ltd. (Nasdaq: RWLK) (“ReWalk”), the leading global exoskeleton developer and manufacturer, announced today the donation of a ReWalk Personal 6.0 System to Daniel Timms, who sustained a spinal cord injury (SCI) in 2012 in a parachuting accident. Thanks to a number of generous donors, Walkabout Foundation, a London-based not-for-profit organization that donates wheelchairs to disadvantaged individuals worldwide and supports critical research in paralysis, was able to provide the device for Mr. Timms. [Read more…]
WellCare Health Plans, Inc. (NYSE: WCG) has signed a definitive agreement to acquire certain assets, including Medicaid membership and certain provider contracts, from Phoenix Health Plan (PHP), a wholly owned managed care subsidiary of Tenet Healthcare. PHP provides health benefits primarily to more than 50,000 Medicaid beneficiaries as of Dec. 1, 2016 in Maricopa County, Arizona, the state’s largest geographic service area. [Read more…]
Harmony Health Plan, Inc., a subsidiary of WellCare Health Plans, Inc. (NYSE: WCG), gave $10,000 to Kidz Korna to help make the holidays special for thousands of children living in Chicago’s low-income communities, such as Englewood, Bronzeville, Roseland and the Westside. [Read more…]
Chubb today announced that Graham Lambourne, currently Global Clients Claims Manager, Europe has been promoted to the role of Head of Multinational Claims for Overseas General Insurance. [Read more…]
Finding a replacement for Obamacare that their colleagues will support may prove to be an impossible task for Republicans on Capitol Hill, says a health economist familiar with the obstacles involved. [Read more…]
Apollo Medical Holdings, Inc. (“ApolloMed” or “the Company”) (OTC: AMEH), an integrated population health management company, and Network Medical Management, Inc. (“NMM”), one of the largest healthcare Management Services Organizations (MSOs) in the United States, have announced that they have signed a definitive merger agreement pursuant to which the companies will combine in a stock-for-stock merger transaction. [Read more…]
Holiday stress can be a pain in the neck…and the teeth, warns Delta Dental. If too much family time or the mad dash for last minute gifts causes you to grind or clench your teeth, be aware that it can cause your teeth to ache, wear down, become loose or even crack. Headaches, pain or soreness of your neck and jaw muscles, and clicking, popping and pain in your jaw joints are also possible side effects. [Read more…]
Medicare’s star ratings of hospitals fail to provide the public with an easy comparison of the quality of inpatient care provided. An analysis by J. Graham Atkinson, D.Phil., Jayne Koskinas Ted Giovanis Foundation for Health and Policy (JKTG) executive vice president for research and policy reveals the biases inherent in the rating system along with conceptual problems in the design of the method used to combine individual quality scores. [Read more…]
NextHealth Technologies Inc., a prescriptive analytics and consumer engagement platform that measurably reduces medical costs for health plans, announced that David H. Klein has joined its board. As a CEO with over 30 years of experience managing health plans and delivery systems, Mr. Klein brings extensive experience in strategy, operations and policy. [Read more…]
WellCare Health Plans, Inc. (NYSE: WCG) announced that its employees are giving back to the Tampa Bay community this holiday season by volunteering with Tampa-based, social-service agency Metropolitan Ministries, which provides life-changing support to those who are homeless and at risk of becoming homeless by assisting them with food, clothing, shelter and other vital services. [Read more…]
Emerge, an online platform that reimagines how consumers purchase emergency insurance, has announced that its site is live and ready to educate individuals and help them avoid the risk of medical debt. [Read more…]
Veterans Deserve Care, a grassroots coalition committed to reducing wait times in VA facilities, applauded a decision by the U.S. Department of Veterans Affairs (VA) to finalize a rule allowing veterans to receive high-quality care by providing direct access to nurse practitioners. [Read more…]
The City of Fort Worth (the “City”) is pleased to announce the expansion of its member healthcare coverage offering starting January 2017 through Employer Direct Healthcare’s SurgeryPlus®, a supplemental benefit for non-emergent surgeries that provides higher quality care, a better experience and lower costs. [Read more…]
The Pennsylvania Medical Cannabis Industry Group (“PAMCIG”) has partnered with Next Wave Insurance Services, LLC (“Next Wave”), which is backed by top rated insurance and reinsurance carrier partners providing comprehensive insurance coverage nationwide. The partnership between the largest marijuana trade association in the state and the leading provider of property and casualty insurance will bring a valuable solution to the potential applicants for Pennsylvania’s medical marijuana industry. [Read more…]
GetInsured, a market leader in individual health insurance ecommerce, announced recently that it has acquired Array Health, a leading provider of group health insurance ecommerce technology. Together, the companies will make it possible for insurers, employers, state governments and benefits brokers to deliver a superior consumer experience through a single, scalable ecommerce solution that supports group, individual and Medicare health enrollment. [Read more…]
The U.S. business group of Sun Life Financial has released a study titled “Voluntary Benefits: An Unknown but Needed Option,” illustrating that due to health care costs continuing to rise, American workers need to adequately understand what voluntary benefits are. [Read more…]
AMSUS, The Society of Federal Health Professionals, announced the creation of a new board, the Executive Advisory Board (EAB), during its Annual Meeting in Maryland recently. [Read more…]
The Partnership for Quality Home Healthcare — a coalition of home health providers dedicated to improving the integrity, quality, and efficiency of home healthcare for our nation’s seniors – recently urged Congress to pass the Pre-Claim Undermines Seniors’ Health (PUSH) Act of 2016 to provide more time for implementing a Medicare home health pre-claim review policy to ensure Medicare and home health agencies are prepared to manage the process and maintain continuity of care for home health beneficiaries. [Read more…]
Research shows old age is seen as a problem, worries about healthcare and social services and people not prioritising or doing enough to prepare for their own retirement. Research conducted by Chase de Vere, the national firm of independent financial advisers, paints a depressing picture of increasing longevity in the UK. [Read more…]
FAIR Health’s consumer website marked another year as the preeminent site for consumers to access accurate, actionable healthcare cost estimates and health insurance information. In a time of flux in healthcare policy at the federal and state levels, the site continues to serve as a lighthouse to consumers at sea among high-deductible health plans, narrow networks and other potentially confusing aspects of the healthcare marketplace. To that end, FAIR Health offers five tips for consumers below. [Read more…]
International Medical Group® (IMG®), a leader in global benefits and assistance services, recently announced the company’s new corporate branding and logo. [Read more…]
The annual enrollment period for Medicare ends next week for most Medicare beneficiaries. For the first time, Magnolia Health, is offering a Medicare Advantage HMO, available to anyone eligible for Medicare and living in the following counties in Mississippi: George, Harrison, Hinds, Jackson, Madison, Rankin and Stone. [Read more…]
Former Walmart associate Jacqueline Cote and her lawyers filed a motion today asking the U.S. District Court for the District of Massachusetts to grant preliminary approval of a class action settlement in Cote’s action that challenged Walmart’s lack of health insurance benefits for same-sex spouses of Walmart associates prior to 2014. [Read more…]
Sovereign Health, a leading national provider of behavioral health treatment services, has announced the seventh installment of the “Beyond NIMBY” series, a second series that addresses the strong community opposition to recovery-oriented housing and addiction treatment services for persons with substance use disorders in residential neighborhoods — often referred to as “not in my backyard.” [Read more…]
UPMC Health Plan Service and Sales Associates are now available to answer individual’s health insurance questions and meet your health care coverage needs at a new Monroeville Mall store. The grand opening celebration was today, Saturday, Nov. 5, 2016 from 10 a.m. to 3 p.m. [Read more…]
Centene Corporation (NYSE: CNC) announced recently that its subsidiary, Kentucky Spirit Health Plan, Inc. (Kentucky Spirit), has settled all lawsuits and complaints associated with its contract with the Commonwealth of Kentucky (the Commonwealth). [Read more…]
Seven California news stations have not aired a single story about Proposition 61 to educate voters on the measure that would cap state prescription drug prices, despite receiving nearly $1.7 million in ad money from the pharmaceutical industry’s record-breaking $126 million No campaign. [Read more…]
Consumer Watchdog today called out the Kaiser Family Foundation for holding a one-sided debate on drug price controls tomorrow that allows the opponents of Prop 61, the drug makers who raised $90 million against the effort to rein in California’s drug bills, a seat but leaves proponents out. [Read more…]
Health insurance premiums will likely increase by an average of 76 percent for Oklahomans who buy individual coverage through the Affordable Care Act’s marketplace. The increases for individual market plans range from 58 percent to 96 percent. [Read more…]
Effective October 1, 2016, the Medi-Cal Fee-For-Service program provides unrestricted, $0 copay access to NARCAN® Nasal Spray for its beneficiaries. As a result of this decision, beneficiaries can now obtain NARCAN® Nasal Spray from pharmacists across the state within 24 hours, establishing an unprecedented level of access and coverage. [Read more…]
Alignment Healthcare has hired former Aetna executive Kevin P. Enterlein to head its Florida market, which the California-based population health management company entered January 1st. [Read more…]
Karen Brach has been named the new President of Meridian Health Plan of Illinois and is scheduled to step into that role on April 5. Brach is a managed care executive with more than 15 years of Medicaid and Medicare managed care senior leadership experience. [Read more…]
AmeriVeri (http://www.ameriveri.com/) helps protect the integrity of Medical Records and saves patients from unnecessary, costly and possibly dangerous treatments resulting from medical coding errors. What many don’t realize is how shockingly common these errors are. [Read more…]
While care transformation continues to lead the list of concerns for hospital and health system executives, this year two of the top four topics relate to patients’ non-clinical needs, according to The Advisory Board Company’s Annual Health Care CEO Survey. Specifically, meeting consumer expectations and patient engagement made notable moves up the list. [Read more…]
Centene Corporation (NYSE: CNC) has appointed Mark Brooks to Senior Vice President and Chief Information Officer, effective immediately. Mr. Brooks will oversee the development and implementation of all information technology and systems for Centene. [Read more…]
According to the latest survey conducted by leading personal finance website GOBankingRates.com, 43 percent of Americans expect to pay more for health insurance in 2016, with 23 percent expecting to pay “a little more than the last year” and 20 percent expecting to pay “a lot more than the last year.” [Read more…]
GeoBlue today announced the appointment of Guillaume Deybach as President and CEO for parent company Highway to Health, Inc (HTH). This concludes the global search conducted over a period of several months for an exceptional candidate able to effectively blend industry expertise with strategic vision. [Read more…]
Leading global startup accelerator Dreamit announced today that the Dreamit Health program developed in collaboration with Penn Medicine and Independence Blue Cross (Independence) has received a $325,000 grant from Blackstone Charitable Foundation to drive innovation in the health care sector. [Read more…]
Capital BlueCross today announced Chris Davis as the company’s new vice president of ancillary services. Davis was previously vice president of sales and service at Dominion Dental Services, a national dental and vision plan administrator headquartered in Alexandria, Va. [Read more…]
ProAssurance Corporation (NYSE: PRA) announced that Chief Financial Officer Edward L. Rand, Jr. will assume additional duties as the President of Medmarc, the Company’s life science and legal professional liability insurance subsidiary. Additionally, ProAssurance announced the promotion of Karen M. Murphy, J.D., to Executive Vice-President of Medmarc and Head of Life Sciences for ProAssurance. The changes will be effective March 1, 2016, following the retirement of Medmarc’s long-time president, Mary Todd Peterson. [Read more…]
Paradigm, a molecular information & Next Generation Sequencing corporation specializing in providing testing for cancer patients recently announced that it has entered into a contractual agreement with UnitedHealthcare for coverage of PCDx™.
PCDx™ is a Next-Generation Sequencing (NGS) based diagnostic test that is designed to provide physicians and patients with a more targeted, personalized approach to cancer treatment by identifying the underlying genomic and proteomic alterations of a patient’s tumor’s DNA, RNA & Protein.
Inland Empire Health Plan (IEHP), with the approval of its Governing Board, added $5 million additional dollars to its Network Enhancement Fund (NEF) to bring new providers to practice in the Inland Empire (IE) to help improve access to care for more than 1.12 million IEHP Members. The program, started in late 2014, continues to add new providers to the Inland Empire. [Read more…]
As the number of Minnesota soldiers returning home after serving overseas continues to increase, so do the challenges that come with transitioning into work and civilian life. Blue Cross and Blue Shield of Minnesota (Blue Cross), which has long supported military members and their families through employment and community outreach, has been recognized as the first and only health insurance provider in Minnesota to be designated as a Beyond the Yellow Ribbon company following a unanimous vote by the State of Minnesota Yellow Ribbon Action Plan Review Board.
Overseen by the Minnesota Department of Military Affairs, the Beyond the Yellow Ribbon program, established in 2008, supports service members, veterans and their families by connecting them with career counseling, professional development training and employment resources. In order to achieve a Beyond the Yellow Ribbon designation, companies must build relationships with local military leaders, identify which employees have military connections and commit to hiring and retaining veterans.
“In just ten days, January 31, 2016, most residents of Atlanta must have health insurance or face new tax penalties,” said Dr. Jane L. Delgado, President and CEO of the National Alliance for Hispanic Health, the nation’s leading Hispanic health advocacy group. She added, “making a decision on health insurance is not easy and many are looking for help they can trust. Our bilingual Navigators are ready to help!.” [Read more…]
Consumer Watchdog will challenge executives at a Department of Insurance hearing into the proposed Centene/Health Net merger to commit to strong consumer protections as conditions of a merger approval.
The Department of Insurance has broad authority to set conditions on the merger deal. [Read more…]
As monthly premiums for the most popular plans offered under the Affordable Care Act are seeing a 10.1 percent spike up from 2015*, GOBankingRates conducted a study to see which states’ residents are paying more (or less) for health insurance in 2016 – and what they’re getting for their money.
New York residents pay the most for basic health insurance, whereas residents of New Mexico pay the least, according to a new study released today by leading personal finance website GOBankingRates.com.
The study compared silver plans ? the most popular plan according to the Department of Health and Human Services ? offered through the national or state-level insurance exchanges administered through the Affordable Care Act.1
The lowest-cost silver plans for each state were ranked based on the favorability of the following cost factors:
The plan’s monthly premium
The emergency care copay
The copay for care from a primary physician
To see full details on the methodology, visit:
CentraState Medical Center is establishing a new benchmark for patient education best practices by integrating video medication education with a patient’s Electronic Medical Record (EMR) using in-room televisions. Partnering with TeleHealth Services, the 284-bed hospital is optimizing clinical workflows while proactively addressing readmissions, HCAHPS score improvement and Meaningful Use initiatives. [Read more…]
The deadline is drawing near for uninsured consumers to sign up for Affordable Health Care this month. Numerous legislators across the country continue to wrestle with whether to expand their state’s Medicaid provisions to accommodate ACA. However states and others can look at the efficiency of DC-based, Trusted Health Plan, a Medicaid Managed Care Organization that has made significant impacts in the marketplace with a business model that is providing cost savings and efficiency. “Our goal is simple… reduce healthcare cost, improve quality and expand access to care. We are positively impacting the lives of our members,” says Thomas Duncan, Trusted Health Plan; CEO. [Read more…]
DinnerTime has signed an agreement with Johns Hopkins HealthCare to provide Johns Hopkins Employer Health Programs (EHP) members with free access to DinnerTime’s personalized meal planning and sale-smart shopping service. As of January 1, 2016, Johns Hopkins EHP members can sign up for DinnerTime free-of-charge when using their EHP membership number and referral code as part of their EHP benefits package. [Read more…]
WellCare Health Plans, Inc. (NYSE: WCG) announced that it will release its financial results for the fourth quarter and full year of 2015 on Tuesday, February 9, 2016, at approximately 6:30 a.m. Eastern time. The company will also host a conference call at 9:30 a.m. Eastern time that morning to discuss its financial results. [Read more…]
The HealthWell Foundation®, an independent non-profit that provides a financial lifeline for inadequately insured Americans, has announced it has opened a new fund to provide financial assistance to Medicare patients suffering from renal cell carcinoma (RCC). Through the fund, HealthWell will provide grants up to $10,000 to assist RCC patients with copayments and premiums. Patients who are on Medicare and have annual household incomes up to 500% of the federal poverty level are eligible for the fund.
According to the National Kidney Foundation, RCC is the most common type of kidney cancer in adults. About 30 percent of people who are diagnosed with RCC develop advanced (metastatic) disease, in which the cancer spreads to other parts of the body— most often the bones or lungs. Kidney cancer is usually treated with a combination of nephrectomy (surgical removal of all or part of the kidney), radiation therapy, immunotherapy, chemotherapy and hormone therapy. Kidney cancer can often be cured if found and treated before it has spread.
Senior Health Insurance Company of Pennsylvania (SHIP) has announced that it has executed a reinsurance transaction with Teachers Protective Mutual, a mutual insurance company, for SHIP to reinsure all of Teacher’s long-term care business.
Founded in 1912, Teachers Protective Mutual offers a variety of insurance coverage including accident, health, life and disability. The company offered individual long-term care products from 1992-2005 to residents in Ohio, Pennsylvania and Virginia.
As part of the transaction, SHIP will initially provide 100 percent coinsurance of the block of long-term care policies Teachers Protective Mutual holds, and will seek to assume the Teachers policies into SHIP in 2016. The transaction has obtained all required regulatory approvals necessary to proceed.
WellStar Health System is deploying an innovative solution to improve the patient experience while providing better patient care. WellStar’s electronic medical record patient portal, WellStar MyChart, will provide patients with round-the-clock access to their providers’ notes in addition to instructions, next steps, medication lists and test results from outpatient medical visits. WellStar is the first Georgia-based health system to offer this service to its patients. [Read more…]
hCentive, the leader in health insurance exchange solutions, announced recently that the company has added new health and ancillary insurance carriers and benefits administrators to its WebInsure Benefits marketplace. WebInsure Benefits is a single cloud-based platform for brokers to efficiently manage their employer group and individual business and simplify administration. The platform provides employers control to shop, enroll and manage health insurance, ancillary benefits, and consumer-directed accounts while delivering an intuitive online experience for consumers.
WellCare Health Plans, Inc. (NYSE: WCG), a leading provider of managed care services for government-sponsored health care programs, announced recently that it honored its high-performing network physicians in New York by making them the first inductees into WellCare of New York’s new All-Star Quality Team.
WellCare of New York launched the All-Star Quality Team to recognize the instrumental role that physician providers play in helping its members live better, healthier lives. The 25 physicians selected demonstrated excellence in caring for members per federal metrics called Health Care Effectiveness Data and Information Set® (HEDIS) and were recognized for their HEDIS 2015 results. These measures gauge how effectively WellCare manages its members’ chronic diseases, such as asthma and rheumatoid arthritis, and ensures that members receive preventive care, such as immunizations and health screenings.
WellCare now ranks fourth highest out of 16 plans in providing quality care for Medicaid recipients in New York. The ranking is based on health care quality metrics, member and provider satisfaction, and regulatory compliance measurements as determined by New York’s Office of Health Insurance Programs.
The National Association of Professional Insurance Agents (PIA) has hailed passage of the Policyholder Protection Act. The measure was included in the omnibus appropriations agreement that was passed 316-113 in the House and 65-33 in the Senate on December 18.
The Policyholder Protection Act prohibits federal regulators from using assets designated to pay out insurance claims to “prop up” an affiliated bank. [Read more…]
Thirty-two hospitals in 15 states agreed to pay more than $28 million to settle a whistleblower lawsuit brought by Phillips & Cohen LLP alleging that the hospitals overcharged Medicare for a type of back surgery known as kyphoplasty. [Read more…]
WellCare of Iowa, a subsidiary of WellCare Health Plans, Inc. (NYSE: WCG), announced today that the company will aggressively contest the order issued by Janet Phipps, director of Iowa’s Department of Administrative Services, which overturned the state’s original decision to award a Medicaid contract to WellCare of Iowa.
“This decision does not accurately reflect the facts, the integrity of Iowa’s procurement process or Iowa law,” said Lauralie Rubel, state president, WellCare of Iowa. “WellCare intends to use every avenue available within the legal system to correct this erroneous outcome. We will immediately seek an injunction that maintains the status quo to allow WellCare of Iowa to continue its participation in the program while this matter is appealed in a court of law.”
PROCEPT BioRobotics, a privately held medical device company based in Silicon Valley, announced today the closing of $42 million in a venture round of equity financing led by Novo A/S. New investor CPMG, Inc. and existing investors also participated in the round.
PROCEPT’s AquaBeam System combines image guidance and robotics to deliver Aquablation, a novel minimally invasive waterjet ablation therapy that enables targeted, controlled, and heat-free removal of tissue for the treatment of lower urinary tract symptoms.
PROCEPT will use the proceeds from the financing for a limited commercial launch of AquaBeam in targeted international markets and to conduct the WATER study (Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue), a randomized blinded controlled clinical trial. PROCEPT has received conditional approval from the FDA for an investigational device exemption trial in the United States to evaluate the safety and effectiveness of Aquablation.
Hemp Health Inc., maker of cannabidiol (CBD) products, today introduced THC Buzzkill, a patent-pending CBD supplement that counteracts the ‘high’ of marijuana. Sold as an oral spray, THC Buzzkill absorbs into the bloodstream rapidly and lessens the psychoactive effects of THC using all-natural ingredients. THC Buzzkill is the first supplement designed for marijuana users who need to sober up quickly.
THC Buzzkill’s primary ingredients come from high-CBD, low-THC cannabis. Kosher, vegan and non-GMO, the cannabis is sourced from sustainable farms in Germany, Denmark and other European countries. THC Buzzkill is legal all 50 states and 42 countries.
THC Buzzkill pilot users report that the tincture lessens the effects of marijuana within 15 minutes. The supplement does not remove chemical traces of THC from the human body, and it does not make it safe for the marijuana user to drive an automobile or operate machinery. Taking THC Buzzkill prior to consuming marijuana will not block the effects.
THC Buzzkill is sold in a 1 ounce or 2 ounce bottle. Users can expect roughly 40 applications per ounce. The supplement will be sold online at www.hemphealthinc.com and at marijuana dispensaries, smoke shops and health stores nationwide. In states that permit recreational marijuana use, residents can expect to find THC Buzzkill at convenience stores and gas stations.
To learn more about THC Buzzkill, visit https://hemphealthinc.com
The twenty-first annual BIO-Europe® international life science partnering conference will be held in Munich, Germany, November 2–4, 2015. Organized by EBD Group, the event is co-hosted by BioM Biotech Cluster Development, the Bavarian Ministry of Economic Affairs and Media, Energy and Technology, and Cluster Biotechnology Bavaria.
Bavaria is an ideal location because it is home to a broad spectrum of high-capacity industries including life sciences and is a leading business region in Europe. There are 270 life science companies in the Munich biotech cluster, characterized by innovative small and medium-sized biotech companies and a focus on new therapeutics and diagnostics, “omics”-technologies, personalized medicine and biomarker research.
BIO-Europe is Europe’s largest partnering conference serving the global biotechnology industry and is facilitated by EBD Group’s partneringONE®, the gold standard one-to-one networking solution for the life sciences.
Moleculera Labs today announced the receipt of a two-year, $300,000 matching grant from the Oklahoma Center for the Advancement of Science and Technology (OCAST). This grant supports the development and clinical validation of new diagnostic testing panels to identify autoantibodies directed against neuronal antigens in patients experiencing neuropsychiatric disorders such as depression, bipolar disorder and schizophrenia. Such panels are intended to assist physicians in identifying the subset of patients whose symptoms may actually be caused by underlying treatable infection-triggered autoimmune and inflammatory responses.
Research by Madeleine Cunningham, Ph.D., Moleculera’s co-founder and Chief Scientific Officer, and her collaborators has led to development of the Cunningham Panel™, which measures relevant anti-neuronal antibodies and neuronal cell-activating antibodies circulating in the patient’s blood, as well as the activity of a key enzyme in the brain involved in the up-regulation of many neurotransmitters including dopamine. This test panel aids physicians in identifying individuals with PANDAS or PANS, thus enabling those children to receive appropriate anti-infective and/or immunological treatment that often results in a dramatic reduction or resolution of symptoms, without resorting to symptomatic control with neuropsychiatric drugs alone.
Equifax Workforce Solutions, a leader in human resource, analytics and verification services, and a business unit of Equifax Inc. (NYSE: EFX), has achieved a major milestone in Affordable Care Act (ACA) management for employers. The company’s ACA Management Platform, a software application that automates ACA administrative tasks and helps employers reduce their potential for penalties, is now used to manage compliance for over 10 million employees.
The Equifax ACA Management Platform, which has been recognized as a leading technology by Human Resource Executive® Magazine, Ventana Research, and the Brandon Hall Group, has seen the adoption rate for ACA-related services grow exponentially since the final versions of Internal Revenue Service (IRS) reporting forms 1094 and 1095 were released. These forms, which require detailed monthly information regarding the coverage offered and provided to employees and their dependents, will be used by the IRS to assess fines under both the individual and the employer mandate.
In addition to releasing the IRS Reporting module to automate the preparation and fulfillment of forms 1095 and 1094, the company recently released additional features, including the Appeals Management module that streamlines the process of storing and responding to subsidy notifications from the exchanges.
Following the Supreme Court’s ruling on King v. Burwell, in favor of Burwell, the government has taken another step in the longevity of the ACA and its impact on employers. The much anticipated decision upheld the legality of Premium Tax Credits, or subsidies, for health insurance provided under the federal Marketplace. Because subsidies trigger penalties for employers, this decision had the potential to significantly impact the Pay or Play mandate. To help employers understand the impact of the Court’s ruling and the next steps they should take in the ACA compliance journey, Equifax is hosting a webinar on July 7, 2015.
The Medical Tourism Association® and Beijing Great-Idea Business Resources Company Ltd. have partnered to hold the World Medical Tourism and Global Healthcare Congress Asia-Pacific 2015, Nov. 14-16, 2015, in Guilin, China.
Renée-Marie Stephano, President of the Medical Tourism Association®, said the multi-year event will also include a five-day, three-city B2B and B2G trade mission with top Chinese executives. To register, go to www.asiamedicaltourismcongress.com/
Asia-Pacific will also be a major focus — including several sessions dedicated to health and wellness in the region — at the World Medical Tourism and Global Healthcare Congress, Sept. 27-30, 2015, in Orlando, Fla.
The World Medical Tourism & Global Healthcare Congress attracts some 3,000 key stakeholders – hospital administrators, doctors and clinicians, employers, government policy makers, insurance executives, facilitators, and hospitality and tourism interests – from across the globe to share their experiences and identify and solve issues that bear significantly on the industry. Participants, sponsors and invited speakers can keep abreast of Congress updates or register at www.MedicalTourismCongress.com
PDI, Inc. (NASDAQ: PDII) subsidiary Interpace Diagnostics announced that effective June 2015, ThyGenX™,i the company’s genetic mutation panel, has been approved by Aetna for assessing fine needle aspiration (FNA) samples from indeterminate thyroid nodules. Aetna’s coverage decision now means that ThyGenX is considered medically necessary. Aetna covers 46 million lives and its positive coverage decision brings the total number of lives covered for ThyGenX to more than 100 million.
Approximately 15-30% of the 525,000 thyroid FNA’s performed on an annual basis are indeterminate based on standard cytological evaluation, and thus are candidates for ThyGenX. ThyGenX has been validated in a prospective, clinical study involving over 600 patients and has a specificity rate of 89%.ii
Guidelines from the National Comprehensive Cancer Network (NCCN) indicate that molecular diagnostic approaches may be useful in the evaluation of thyroid FNA samples that are indeterminate to assist in patient management, including identifying patients who are appropriate candidates for surgery and those for whom surveillance is appropriate.
GuideWell Mutual Holding Corporation (GuideWell) has entered into a strategic partnership with Alignment Healthcare, LLC (Alignment Healthcare), a population health management company with technology-enabled clinical integration at its core. The new relationship is intended to improve clinical outcomes for Medicare Advantage members in Florida and positively impact overall health care costs.
Together, GuideWell and Alignment Healthcare will create senior-focused clinics in regions of Florida and feature an innovative, technology-enabled, patient-centered model of care, designed to reduce hospitalizations and improve clinical outcomes for medically needy elderly patients.
Utilizing proprietary technology, teams of physicians trained to manage the unique care needs of the most vulnerable patients in the community, will work in partnership with nurse practitioners, physician assistants, and nurse care managers. They will act as advocates and care navigators for their patients, and manage the delivery of health care across multiple disciplines and treatment settings in coordination with primary care physicians.
To further serve the aging population in Florida, GuideWell has acquired BeHealthy America, Inc., a Florida-based Medicare Advantage Health Maintenance Organization (HMO). This acquisition further complements the Medicare Advantage offerings currently available through GuideWell’s health insurance businesses. The new HMO product will combine an attractive benefits design with Alignment Healthcare’s unique care delivery model, providing a more comprehensive level of care for a growing segment of Florida’s Medicare Advantage customer base.
The prevalence of chronic conditions presents one of the greatest risks to the U.S in terms of population health and well-being. However, many serious conditions such as hypertension or hyperlipidemia can be successfully managed if the patient follows a clearly documented treatment plan. To that end, changes to the chronic care management model by the Centers for Medicare and Medicaid Services (CMS) offers an out-of-the-box approach to improve the outcomes for patients with two or more chronic conditions. Medical practitioners can bill non-face-to-face communications with Medicare beneficiaries, reducing the need for costly direct evaluations when a simple instruction may be all that is needed.
Recent analysis from Frost & Sullivan, CMS Changes in Chronic Care Management: Is it Really a Bridge to Value-based Care?(http://www.frost.com/q294859662), finds that despite a list of cons, the potential merits of this program demonstrate value. Even though it falls short of the new payment taxonomy and true telehealth, this approach to chronic care management is a transitional phase, beginning in the old world of Medicare while possessing the potential to evolve with changing demands.
EHE International, the recognized leader in preventive medicine and annual physical exams, today announced that the Prime Healthcare, Avon, CT office has been named an EHE-certified preventive care center. Through Prime Healthcare, Avon, EHE members in the Avon region now have greater access to its preventive care program to help them proactively maintain their health.
“EHE is proud to add Prime Healthcare in Avon to its growing private provider network. Prime Healthcare is eager to contribute to the wellness of its local community,” said Deborah McKeever, president of EHE International. “EHE members will benefit from the expertise and experience of Prime Healthcare’s doctors who have met our high professional and practice standards earning them the ‘EHE Certified’ status.”
“EHE’s continued expansion in the Avon area and across the United States is a sign that more and more employers are realizing the benefits of standardized clinical protocols in preventive health and annual exams,” added McKeever. “It is well-recognized that a focus on prevention helps control future healthcare costs, improves productivity and allows employees to proactively manage their own health. EHE has a century of experience in caring for employers’ greatest asset, its employees.”
If you would like to learn more about EHE International’s physician network, please contact:
Director, Provider Markets
Office: (212) 332-3025
Mobile: (203) 507-5609
Fax: (212) 332-1170
Email: [email protected]
To expedite payment reform across the U.S., the non-profit Health Care Incentives Improvement Institute (HCI3) has partnered with key stakeholders to support the transformation to a health care system based on quality and affordability. HCI3 partners include health plans, providers and purchasers who are actively working toward payment reform implementations, and technology and consulting firms offering services to support these efforts.
Organizations working with HCI3 to implement evidence-based incentive and payment reform programs include:
Blue Cross and Blue Shield of North Carolina
Community Health Choice
Horizon Healthcare Services, Inc.
McKinsey & Co
xG Health Solutions™
MTBC (NASDAQ: MTBC), a leading provider of fully-integrated, web-based healthcare IT and revenue cycle management solutions has commenced beta testing of MTBC SameDay Funding™ (MTBC SDF™), which will ensure that healthcare providers receive advanced insurance reimbursement as patient encounters are completed and claims submitted.
MTBC SDF, which is now in beta testing, leverages MTBC’s proprietary data sets and algorithms to estimate its participating clients’ claim level insurance reimbursements. Once these pre-adjudication estimations are made, MTBC will advance funds to its clients, in the amount of the anticipated reimbursement, and then recoup the advanced funds as the respective payer completes the adjudication and payment process.
Governor Tom Wolf has announced that Highmark will continue to cover pregnancy and related care at Magee-Womens Hospital of UPMC in 2015, despite it no longer being in their network of providers. Coverage for these services will be at in-network rates.
“Any woman who became pregnant and sought treatment in 2014 and has Highmark insurance will have in-network access to Magee-Womens Hospital in 2015,” said Governor Tom Wolf. “The needs of patients must always come first and I am pleased that we have reached a swift and necessary resolution in this matter.”
Under Governor Tom Wolf’s administration, the Pennsylvania Department of Insurance and the Pennsylvania Department of Health will work diligently to continue to enforce the consent decree between Highmark and UPMC.
“We are pleased that expectant mothers will continue to receive the access to the care they need,” said Acting Insurance Commissioner Teresa Miller. “Ensuring greater access to care and transparency for Western Pennsylvania patients is a top priority for this administration.”
The resolution on maternity care:
Considers pregnant women in continuity of care if treatment began prior to Dec. 31, 2014.
Covers patients who have retained Highmark insurance coverage, either individually or though group plans.
Information for health-care consumers with questions on Highmark and UPMC is available at www.StayInformed.pa.gov.
The Academy of Managed Care Pharmacy (AMCP) applauds two crucial provisions in draft legislation issued this week by the House Energy and Commerce Committee that combat the abuse of controlled substances and payment fraud in the Medicare Part D prescription drug benefit program.
AMCP Chief Executive Officer Edith A. Rosato, RPh, IOM issued the following statement:
The Academy is pleased the Committee’s bill includes Sec. 4281, which calls for creating safe pharmacy networks in Part D to prevent the abuse and diversion of controlled substances, and Sec. 4282, which authorizes Part D plans to suspend payment of claims to pharmacies suspected of a credible allegation of fraud.
While we are still analyzing these provisions in detail, we are gratified to see they are part of the larger discussion on improving patient health and ensuring the integrity of our health care system. These are issues that AMCP has taken the lead on for years. In the coming weeks, we will be offering lawmakers on the Committee in-depth recommendations on how these proposals might be modified to have the biggest positive impact.
The nearly 400-page draft bill, which stems from the Committee’s bipartisan 21st Century Cures initiative last year, aims to accelerate discovery, development and delivery of new drugs and therapies. It also includes reforms of various health care programs such as Medicare Part D. The Committee said it hopes to present legislation to President Obama by the end of the year.
The Academy has developed detailed positions on both Part D topics.
On controlled substances, AMCP’s position includes amending current law to allow Part D prescription drug plans and Medicare Advantage prescription drug plans to limit patients with a history of abuse to a single prescriber and/or pharmacy (or chain of pharmacies), similar to what already occurs in the private market and the Medicaid program..
On anti-fraud, AMCP’s position includes amending current law to allow health plans to withhold payments to pharmacies that are suspected of fraud in the program. This solution would allow plans to combat suspected fraud before payments are made, instead of attempting to recover the payments after the fact, which is often a difficult, if not impossible, task.
Centene Corporation (NYSE: CNC) today announced that its wholly-owned Florida subsidiary, Sunshine Health, was elevated to Commendable Accreditation by the National Committee for Quality Assurance (NCQA) for its Medical Managed Assistance and Child Welfare programs. NCQA evaluates how well a health plan manages all parts of its delivery system – physicians, hospitals, other providers, and administrative services in order to continuously improve the quality of care and services provided to its members.
Sunshine Health serves 400,000 Medicaid members under its Managed Medical Assistance and Child Welfare programs statewide.
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.
Aon Hewitt, the global talent, retirement and health solutions business of Aon plc (NYSE: AON), has announced that employers and individuals participating in the Aon Active Health Exchange are seeing notable reductions in health care spend for the third straight year.
More than 600,000 employees and their dependents enrolled in health benefits through the Aon Active Health Exchange for the 2014 calendar year. All of the 18 companies that participated in 2014 are returning to the Aon Active Health Exchange in 2015. Across those companies, rates for medical coverage increased an average of 5.3 percent. This is lower than the industry average and includes costs associated with the Affordable Care Act. According to Aon Hewitt’s estimates and several other organizations,1 average health care cost increases in 2015 for large U.S. employers with self-insured arrangements are projected to be between 6.52 percent to 8.0 percent3 before employers make changes in deductibles and copays. Based on employer and employee feedback, plan designs in the Aon Active Health Exchange for 2015 will once again remain unchanged.
Companies participating in the Aon Active Health Exchange also reduced their overall health care cost for medical coverage by more than $750 per employee compared to their expected 2014 spending. These numbers factored in the savings delivered through the exchange model, the impact of employee choices to buy less rich coverage and the impact of employees who chose to purchase richer—and often more expensive—medical plans. Average health care costs were $8,342 per employee, down from $9,098 per employee. These savings were shared with employees through reduced payroll contributions, as well as through offering a range of more affordable health care coverage options.
Thousands of Pennsylvanians receive medical services every day from local health care systems. Each of these facilities has its own physicians and practitioners with their own specialized knowledge gained from their own experience providing care. But what if they came together to compare notes? What if they shared what they know about what works best for patients? What if, cooperatively, they focused on improving specific categories of care?
That is exactly the purpose of a new collaborative brought together by Capital BlueCross and the Health Care Improvement Foundation (HCIF). A first-of-its-kind for the central Pennsylvania and Lehigh Valley regions, the collaborative is focusing on improving health care safety, outcomes, and the overall patient experience by zeroing in on one important health initiative at a time.
The first area of focus that the collaborative’s health care system participants have agreed to work on with Capital BlueCross and HCIF is palliative care.
The aim of the collaborative is to advance the care and support of patients with advanced illness and their families across the region. Over the course of the collaborative, organizations will work together to improve the awareness and use of POLST (Pennsylvania Orders for Life Sustaining Treatment) by promoting advanced care planning conversations between health care providers and patients with advanced illness and their families, fostering shared decision-making about individualized goals of care, and ensuring the implementation of individualized health care goals across care settings.
A Regional Palliative Care Steering Committee is being formed to provide input into collaborative goals, metrics, and the curriculum for an in-person conference this fall. The committee will continue to work together to ensure that program activities best support participating organizations and that patient outcomes are met and sustained.
Success of the initiative will be monitored and measured by the Pennsylvania Health Care Quality Alliance. The Pennsylvania Health Care Quality Alliance is a non-profit that seeks to improve the quality of patient health through alliances between hospitals, physicians, health plans and other stakeholders who are dedicated to promoting responsible public reporting of health care information. More information can be found at www.pahealthcarequality.org.
Managed Health Care Associates, Inc. (MHA), a leading health care services and technology company focused on the alternate site health care provider marketplace, today announced the release of a new white paper titled, “The Right Care for the Right Cost: Post-Acute and the Triple Aim”. This paper is a collaborative effort between the MHA ACO Network and Leavitt Partners, a leading health care intelligence business, and focuses on the important role of the Post-Acute Care (PAC) Provider within an Accountable Care Organization (ACO).
Through detailed financial analyses and case study presentation, the work highlights the following:
— Type of services that ACOs should include within the post-acute spectrum
— How healthcare reform is impacting post-acute care payments and providers
— In what manner PAC partnerships support the ACO mission of better care, lower cost and overall increased health outcomes.
The paper also offers insight from specific case studies into the ACO-PAC Engagement Spectrum, which varies from minimal commitment to a fully integrated care continuum and how positive outcomes can help ACOs report on required CMS Quality Measures and reduce all cause and diagnosis specific Hospital Readmission Rates.
SpendWell Health, an online marketplace for health care services, has partnered with PaySpan®, Inc., a leading provider of health care reimbursement and payment automation services. Through the partnership, the SpendWell consumer retail experience of shopping for routine health care services now reaches PaySpan’s network of more than 700,000 health care providers. Together the partnership transforms how people shop for health care, provides financial benefits to providers and promotes a patient experience that is more affordable, administratively efficient and economically sustainable.
SpendWell is leveraging PaySpan’s financial network to reach providers, payers and consumers to create a nationwide online marketplace to give consumers with high-deductible plans a way to shop for quality routine health care services at competitive and fair prices. PaySpan creates new opportunities for providers to expand their business by treating more cash-pay patients with no financial risk.
Through a competitive market search and solution evaluation process, SpendWell selected PaySpan to power its financial reimbursement infrastructure for consumers, health plan members, patients, providers and payers using PaySpan’s Patient Centered Financial Home® commerce framework.
The Centers for Medicare & Medicaid Services (CMS) has issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have improved patient care and produced hundreds of millions of dollars in savings for the program.
In addition to providing more Americans with access to quality, affordable healthcare, the Affordable Care Act encourages doctors, hospitals and other healthcare providers to work together to better coordinate care and keep people healthy rather than treat them when they are sick, which also helps to reduce healthcare costs. ACOs are one example of the innovative ways to improve care and reduce costs. In an ACO, providers who join these groups become eligible to share savings with Medicare when they deliver that care more efficiently.
The National Committee for Quality Assurance (NCQA) ranked Kaiser Permanente of the Mid-Atlantic States the #1 health plan in Maryland, Virginia and the District of Columbia. The NCQA Health Insurance Plan Rankings initiative is a comprehensive and independent comparison that assesses 507 health plans nationally.
The data from NCQA’s Private Health Insurance Plan Rankings 2014–2015 shows Kaiser Permanente of the Mid-Atlantic States is among the most successful health plans in the nation, scoring the maximum of 5 out of 5 in Consumer Experience, Prevention, and Treatment; the only plan to achieve 5 out of 5 in all three components in Maryland, Virginia, and the District of Columbia.
The rankings, which look at 240 measures, are based 60% on clinical quality measures, 25% on consumer satisfaction measures, and 15% on Health Plan Accreditation Standards. Overall, Kaiser Permanente, published under the name Kaiser Foundation Health Plan of the Mid-Atlantic States, was ranked #13 out of 507 plans in NCQA’s Private Health Insurance Plan Rankings 2014–2015.
Meridian Health Plan of Iowa is the number one Medicaid HMO in Iowa and is the number 38 Medicaid HMO in the US according to NCQA’s Medicaid Health Insurance Plan Rankings 2014–2015.
Meridian Health Plan of Iowa’s performance in NCQA’s Medicaid Health Insurance Plan Rankings 2014-2015 immediately follows its recent NCQA accreditation status elevation from Accredited to Commendable for achievement in the areas of consumer protection and quality improvement. NCQA Accreditation evaluates how well health plans manage all parts of its delivery system – physicians, hospitals, other providers and administrative services – in order to continuously improve the quality of care and services provided to its members.
Health Plan Accreditation and the Medicaid Health Insurance Plan Rankings 2014–2015 are separate and distinct review processes and recognition. The complete list of NCQA’s Medicaid Health Insurance Plan Rankings 2014–2015 is available online at http://www.ncqa.org.