Revenue Cycle and Payer News – October 25, 2023

Collaboration News

Humana and USAA Expand Relationship to Offer High-Quality, Affordable Medicare Advantage Plans Designed with Veterans in Mind
Humana (@Humana) and USAA Life Insurance Company announced the expansion of their co-branded Medicare Advantage plans designed with veterans in mind to provide coverage options that complement health care benefits received through Veterans Affairs (VA).

New Coalition Addresses Health Equity Challenges through Inclusive Data Collection
The National Minority Quality Forum (NMQF), the Blue Cross Blue Shield Association (@BCBSAssociation), and 17 partner organizations announced the formation of the Data Equity Coalition, a new partnership to improve health outcomes through better, more accurate and more representative data on race, ethnicity and language (REL) and sexual orientation and gender identification (SOGI).

Company News

Oscar Health, Inc. Announces 2024 Market Expansion Plans, Offering Affordable, Accessible, and Technology-Enabled Care for the Eleventh Consecutive Year
Oscar Health, Inc. (@OscarHealth), a healthcare technology company, announced its 2024 market expansion efforts for its Individual and Family Plans, marking Oscar’s eleventh consecutive year as a prominent carrier in the ACA marketplace. Oscar will offer its innovative, member-centric plans in 165 new counties, making high-quality and affordable healthcare a reality for more consumers.

Sendero Health Plans Names Sharon Alvis as Next Chief Executive
Sendero Health Plans Inc. (@senderohealth) announced it has named Sharon J. Alvis as the new chief executive officer to lead the nonprofit health maintenance organization (HMO), which was created and is funded and owned by Central Health. Sendero offers health insurance plans through the Affordable Care Act’s (ACA) federal Health Insurance Marketplace.

CVS Health Ventures Makes Strategic Investment in Amalgam Rx
Amalgam Rx, Inc., a company in enabling data-driven health care decision making, announced the participation of CVS Health Ventures (@CVSHealth) in its Series B investment round.

Aetna Better Health of Illinois injects over $235,000 to support urban farming in the Chicagoland area
Aetna Better Health® of Illinois, a CVS Health® company, has provided over $235,000 to support urban farming in the greater Chicago area.

Independence Blue Cross one of first health plans in Philadelphia region to earn NCQA Health Equity Accreditation
Independence Blue Cross (@ibx) has earned Health Equity Accreditation from the National Committee for Quality Assurance (NCQA) for all its insurance plans. Only approximately five percent of accredited plans nationally have been awarded this recognition for their health equity work.

Product News

RxBenefits Announces 340B Solution Designed to Support In-House Pharmacy Needs of Hospitals and Other Covered Entities
RxBenefits (@rxbenefits), the employee benefits industry’s first technology-enabled pharmacy benefits optimizer (PBO), announced the launch of Optimize 340B, a solution designed to maximize the value of 340B on the prescription plans of hospitals and 340B grantees. pitals and other covered entities.

UnitedHealthcare’s Surest Leads to More Preventive Care, Improves Member Satisfaction and Lowers Costs, Data Shows
The UnitedHealthcare (@uhc) Surest™ health plan, which eliminates deductibles and offers clear upfront pricing information to people in advance of treatment, helps members more frequently access preventive care services and lower out-of-pocket costs, according to recent data. At the same time, the data shows employers can reduce health care costs by up to 15%, with an average savings of 11%.2

UnitedHealthcare’s 2024 Medicare Advantage Plans Offer Enhancements to Benefits that Matter Most to Members
UnitedHealthcare® introduced its 2024 Medicare Advantage plans, delivering a simpler member experience with enhanced benefits, broad network access and cost-savings through valuable specialty and prescription drug coverage.

UnitedHealthcare to Offer Individual and Family Plans on the Health Insurance Marketplace in 26 States for 2024
UnitedHealthcare (@UnitedHealthGrp) announced its 2024 Individual and Family ACA Marketplace Plans, which feature affordable coverage, convenient access to care and a wide range of benefits in 26 states.

5 Star Ratings

Lumeris Drives Third Consecutive 5-Star Rating for Essence Medicare Advantage Plan
Essence Healthcare, Lumeris’  (@Lumeris) wholly-owned, 5-Star Medicare Advantage (MAPD) plan, has received an overall plan rating of 5 stars from the Centers for Medicare & Medicaid Services (CMS). This is the fourth time and third consecutive year that Essence Healthcare has received a 5-Star rating — a testament to the organization’s consistent high performance and operational excellence, enabled by Lumeris’ strong strategic guidance and technology solutions.

Eighty-seven (87) percent of Aetna Medicare Advantage members in 4-star plans or higher for 2024
Aetna®, a CVS Health® company (@CVSHealth), announced that 87 percent of its Medicare Advantage (MA) members are in 2024 Medicare Advantage Prescription Drug (MAPD) plans that are rated 4 stars or higher (out of 5 stars) by the Centers for Medicare & Medicaid Services (CMS). This represents a significant achievement, given the considerably more stringent CMS measurement criteria this year.

Humana Tennessee Medicare Advantage HMO Plan Achieves Highest Quality Rating for 2024
Humana announced that, for the third consecutive year and the fourth time overall, its statewide Humana HMO Medicare Advantage plan in Tennessee has achieved the highest possible 5-star rating from the Centers for Medicare & Medicaid Services (CMS). The 5-star Cariten Health Plan Inc. HMO plan is offered in all of Tennessee’s 95 counties.

Humana Kentucky Medicare Advantage HMO Plan Scores Top 5-Star Rating Third Year in a Row
For the third consecutive year, the Centers for Medicare and Medicaid Services (CMS) has awarded the highest possible quality rating to Humana for its northern Kentucky HMO plan offered in Boone, Campbell, Grant, Kenton and Pendleton counties. The Humana Health Plan of Ohio, Inc. HMO plan is one of four Humana contracts that received a 5-star rating for 2024 on CMS’s 5-star rating system.

Making the Cut, Milestones, Accolades, Awards and More

Ohio Behavioral Healthcare Provider Network recognizes CareSource with Innovation Award
The Ohio Behavioral Healthcare Provider Network announced they have awarded their first-ever Innovation Award to CareSource (@caresource). The presentation was made to CareSource at the OBHPN annual all staff meeting in Columbus. The Innovation Award is provided to a single outstanding partner that innovates to better serve people with severe mental illness.

To Read

Proposed Mental Health Parity Rule Could Limit Access to Quality Mental Health CareRobust access to quality mental health and substance use disorder services could be jeopardized due to a proposed rule from the Departments of Labor, Health and Human Services, and the Treasury, according to comments submitted by the Blue Cross Blue Shield Association (BCBSA).

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