Revenue Cycle and Payer News 7-8-2020

Collaboration News:

Health Partners Plans and Children’s Hospital of Philadelphia Announce Agreement
Health Partners Plans (@hpplans) announced it has signed a contract with Children’s Hospital of Philadelphia (CHOP). The provider agreement is effective July 1, 2020 and grants all Pennsylvania-based CHOP facilities and physicians in-network privileges for HPP’s Pennsylvania member families.

Carrot Health and HealthMine Form Strategic Partnership to Improve Health Plan Performance and Member Satisfaction
Carrot Health (@Carrot_Health), a provider of healthcare solutions powered by consumer data, and HealthMine, the health action engagement company, announced a strategic product integration partnership for the health plan market. By combining Carrot Health’s MarketView™ platform and consumer data analytics with HealthMine’s engagement and rewards solution that empowers individuals to take the right actions to improve their health, this partnership creates a solution enabling health plans to improve performance and member satisfaction.

Cigna + Oscar Helps Small Business Owners who Recognize that a Healthy Workforce is the Key to a Vibrant Business in COVID-19 Environment
Cigna (@cigna) and Oscar are announcing that Cigna + Oscar, a new affordable and consumer-first health insurance for small businesses, will be available in Atlanta and in the San Francisco Bay Area and across Tennessee, including Nashville, Memphis, Knoxville, and Chattanooga effective Q4 2020, pending regulatory approvals.*

Financial News:

Oscar announces $225 million in new funding to drive growth and expand access to affordable health care.
Oscar* (@OscarHealth), the first direct-to-consumer health insurance company, recently announced that it has closed a $225 million funding round. The round positions Oscar to continue growth off of a $2 billion revenue base and puts the company on a path to further advance its mission of making health care simple.

Molina Healthcare Completes Acquisition of Certain Assets of YourCare Health Plan
Molina Healthcare, Inc. (@molinahealth) announced that it has completed its acquisition of certain assets of YourCare Health Plan, Inc., a not-for-profit subsidiary of Monroe Plan for Medical Care.

To Read:

How CareSource Leverages Partnerships to Address Social Determinants of Health
CareSource (@caresource) acknowledges that navigating the complexity of the social safety net can be just as overwhelming as understanding health insurance. As part of the CareSource Life Services program, JobConnectTM serves members statewide in Ohio, Georgia and Indiana with one-on-one coaching. Coaches serve as a connection point or hub for linking members with community resources.

COVID-19 News:

Insurer inaction on prior authorization reform requires federal response
According to the American Medical Association (@AmerMedicalAssn) more than two years after a landmark consensus statement signaled insurers were open to reforming the arduous prior authorization process, their subsequent inaction has translated into stalled progress and ongoing burdens for patients and physicians. According to new survey data released today by the American Medical Association (AMA), physicians say prior authorization continues to interfere with patient care and can lead to adverse clinical consequences, with 16% of physicians reporting that the process has led to a patient’s hospitalization. Moreover, surveyed physicians see little, if any, progress toward easing agreed-upon burdensome barriers to patient care, highlighting the need for legislative action to address a problem affecting patients across the country.

How COVID-19 Could Reduce MA Risk Scores and Payments in 2021
According to a new analysis by Avalere Health (@avalerehealth) deferral of care during the COVID-19 pandemic is resulting in fewer claims and diagnoses among Medicare Advantage (MA) enrollees, which could lead to a 3%–7% reduction in 2021 risk scores and lower plan payments in 2021.

InnovaCare Health Shows Value of Highly Coordinated Care During COVID-19 Pandemic
During the ongoing COVID-19 pandemic, InnovaCare Health subsidiary MMM Healthcare is demonstrating the value of a highly-coordinated care model through their MMM Te Cuida program, which was established to manage and coordinate uninterrupted care for patients who have been diagnosed with, or are suspected to have, COVID-19.

Humana to Offer LabCorp At-Home COVID-19 Test Collection and Collaborate with Walmart and Quest Diagnostics to Offer Drive-Thru Testing for Humana Members
Humana Inc. (@humana) announced a pilot home-testing program that will enable at-home COVID-19 test collection for members, making Humana the first insurer to offer LabCorp’s at-home test-collection kits. Humana also announced an innovative new collaboration with Walmart and Quest Diagnostics to help members more easily get tested – becoming the first health care company to offer its members drive-thru testing at hundreds of Walmart Neighborhood Market drive-thru pharmacy locations across the country. Humana will continue to waive member costs related to COVID-19 diagnostic tests.

Top Areas of Concern for High Risk Populations During Coronavirus Crisis Identified through Medica Outreach Program
Medica (@Medica4Me) recently reported that findings show that the biggest areas of need among people at highest risk for complications from the coronavirus include community and mental health resources to address increased anxiety, medication issues and food concerns. Those findings are based on information gleaned through Medica’s coronavirus outreach program designed to reach its highest-risk members. The program was launched within days of the declaration of a national public health emergency.

CVS Health and American Lung Association join forces to combat COVID-19 and protect against future respiratory viruses
CVS Health (@cvshealth) and the American Lung Association have launched a campaign at CVS Pharmacy locations to support the Lung Association’s COVID-19 Action Initiative, which will expand COVID-19 research and fund the development of new vaccines, detection tests and treatment to defend against future respiratory viruses.

Anthem, Inc. Leads Collaboration to Develop Tools to Help Public Officials and Businesses Make Informed Decisions Related to COVID-19
Anthem, Inc. (@AnthemInc) introduced a suite of digital tools that provide in-depth, trusted, and aggregated information for multiple stakeholders to use in making informed, data-driven decisions during the COVID-19 pandemic. Led by Anthem, Inc.’s new C19 Explorer and C19 Navigator, these decision support tools are also designed to assist public health officials and business leaders as they plan for re-opening and return-to-workplace. This work is part of Anthem’s best-in-class data scientists and clinicians collaborating with a global alliance of leaders, such as TM, CloudMedx,, and

Making the Cut:

UnitedHealth Group Named One of the 50 Most Community-Minded Companies in the United States
For the ninth consecutive year, Points of Light, the world’s largest organization dedicated to volunteer service, has included UnitedHealth Group (@UnitedHealthGrp) on The Civic 50 as one of the 50 most community-minded companies in the country for its civic engagement in 2019.