Revenue Cycle and Payer News 7-26-2017

In the News…

Hybrid Healthcare Pioneer Compliments Expansion With New Brand
The landscape of healthcare is changing. Better access, better service and honest billing have become patient directives, because it makes sense — it’s intuitive. The team who developed the hybrid care model and built the chain of successful, North Texas based, Legacy ER & Urgent Care facilities, is now launching INtuitive Health. INtuitive Health will serve as an expansion brand to partner with health systems around the country.

HHS announces ‘largest fraud takedown in history’, charging 400 defendants in schemes involving $1.3 billion in false billings
The Office of the Inspector General recently announced that the Department of Health and Human Services Office of Inspector General, state and federal law enforcement executed a massive fraud takedown this month that charged more than 400 defendants in connection with healthcare fraud schemes that involved roughly $1.3 billion in fraudulent billings to government payers including Medicare and Medicaid.

No health plans available to rural Nevada on exchange in 2018 as Anthem backs out
In what officials are calling a “health care crisis for rural Nevada,” roughly 8,000 Nevadans across 14 counties may not be able to purchase insurance from the Silver State Health Insurance Exchange next year as an insurer scales back coverage amid uncertainty over the future of the Affordable Care Act. For more about the disappearing insurers phenomenon check out David Harlow’s Healthblawg post, Counting noses at the county level: Marketplace participation.

Valley Health Plan Implements New Condition Management Solution from AxisPoint Health
AxisPoint Health (@AxisPointHealth), a provider of care management services to payers and other risk-bearing entities, announced that Valley Health Plan (@VHPhealth) is the first client to implement its new CarePoint condition management solution. CarePoint leverages advanced analytics to precision-target members who will benefit the most from focused interventions that transcend conditions. Valley Health Plan, the only locally based commercial health plan in California’s Santa Clara County, was looking for a care management solution to better engage its 160,000 members, many of whom are transient and hard to reach.

Biosimilars Gain Widespread Adoption by Health Plans
Based on a national survey of health insurers, 81 percent of plans report they are covering a biosimilar product. Nearly all payers indicate that a biosimilar’s cost relative to the originator is a key decision-making factor for determining coverage. In addition to costs compared to the originator, health insurers cite efficacy and safety of the biosimilar as important factors for coverage decisions.

New Medicare Incentives Encourage Accountable Care Organizations To Assume Greater Risk
New research from Avalere (@avalerehealthfinds that accountable care organizations participating in the Medicare Shared Savings Program would have earned an additional net payments of $886 million in 2015 if they had assumed greater financial risk under the program and had qualified for the 5 percent bonus payment now available under the Quality Payment Program.

Healthcare Revenue Cycle Management Software Market – Forecast and Industry Analysis by Technavio
According to Technavio’s (@Technaviomarket research report, the global healthcare revenue cycle management software market will grow at a CAGR of close to 5% during the forecast period. One of the key drivers witnessed in the market during the projected period is the increasing rate of recovery audits. Healthcare service providers are experiencing a rise in the cost of operations and a reduction in revenues due to the changing government regulations in the healthcare sector.