The U.S. healthcare system has been undergoing its own stress test. Stakeholders are currently experiencing a variety of pressures with a primary focus on finances, including administrative costs. The COVID-19 pandemic is often used as a convenient delimiter for the emergence of these problems, but in reality, tensions were brewing long before now and were caused by a variety of factors. Medicare Advantage (MA) is facing the headwinds of these issues – and as a result, MA
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Medicare Advantage | Payers | News, Analysis, Insights
Revitalizing Medicare Advantage: How The Push to Streamline Prior Authorization Will Impact Senior Care
As a physician, the odds that you’ve had a negative experience related to the prior authorization process are (unfortunately) highly likely. According to the American Medical Association’s (AMA) 2023 Prior Authorization Physician Survey, 1 in 4 physicians report that prior auths “have led to a serious adverse event for a patient in their care.” Think about the toll that this takes on professionals whose primary job is providing lifesaving care, and the thing preventing this care is outside their
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HLTH: Essence Healthcare to Offer Free Oura Ring to Medicare Advantage Members
What You Should Know:
- Essence Healthcare, a provider of Medicare Advantage (MA) plans forms a new partnership with ŌURA, the maker of the Oura Ring.
- Starting in 2025, eligible Essence MA members will receive a complimentary Oura Ring and a subscription to the Oura App, giving them access to advanced biometric tracking and personalized health insights.
Empowering Members with Data-Driven Insights
This unique benefit, a first for any MA plan, reflects Essence's
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Zing Health Raises $140M to Expand Medicare Advantage Plans for Underserved Seniors
What You Should Know:
- Zing Health, a trailblazing Medicare Advantage insurer, has announced a successful $140M funding round. The round includes participation from Health 2047 Capital Partners, CRG, and First Trust Capital Partners, alongside existing investors Newlight Partners, Town Hall Ventures, Health 2047, and Leavitt Equity Partners.
- The investment will fuel the expansion of Zing Health's integrated, chronic special needs-focused plans to reach more
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JAMA: Traditional Medicare Is, In Fact, The Failure
What You Should Know:
- A new article published in JAMA Internal Medicine reignites the debate about Medicare Advantage and traditional Medicare.
- Dr. Sachin H. Jain, CEO of SCAN Group and SCAN Health Plan, argues in favor of Medicare Advantage, while Drs. Adam Gaffney, David Himmelstein, and Steffie Woolhandler advocate for traditional Medicare.
Traditional Medicare: Lower Costs, Fewer Benefits
Traditional Medicare offers beneficiaries lower premiums, but it comes with
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M&A: Aledade Acquires Michigan’s Medical Advantage
What You Should Know:
- Aledade, the nation's leading network of independent primary care practices, announced today the acquisition of Michigan-based Medical Advantage.
- This strategic acquisition further solidifies Aledade's position as the preeminent Accountable Care Organization (ACO) network and a driving force in value-based care.
Expanding Physician Partnerships in Michigan
The acquisition significantly expands Aledade's network in Michigan, bringing the number of
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Wolters Kluwer Health Unveils AI-Powered Tool to Help Medicare Advantage Plans Ace Risk Adjustment Audits
What You Should Know:
Wolters Kluwer Health, a leading provider of healthcare information and analytics, has introduced a new weapon in the fight against potential financial penalties for Medicare Advantage Organizations (MAOs) – the Regulatory Audit Module.
- The AI-enabled tool leverages artificial intelligence (AI) to streamline the risk adjustment audit process, potentially saving MAOs millions of dollars.
The Challenge: A Complex and Costly Regulatory
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Humana & Strive Health Offers Value-Based Kidney Care to More Medicare Advantage Members
What You Should Know:
- Humana Inc. (NYSE: HUM) and kidney care provider Strive Health announced today a new multi-state, value-based care agreement for kidney care to more Medicare Advantage members.
- This expanded value-based kidney care partnership extends access to Strive's innovative kidney care model to Humana Medicare Advantage HMO and PPO plan members living with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) across five states.
Transforming Kidney Care
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UnitedHealthcare, RUSH Health Form Medicare Advantage Relationship
What You Should Know:
- UnitedHealthcare and RUSH Health announced a new relationship that will give UnitedHealthcare Medicare Advantage plan members network access to all RUSH Health locations in Illinois for the first time, effective immediately.
- The multi-year agreement, effective Oct. 1, provides UnitedHealthcare Medicare Advantage plan members with enhanced access to quality care and provides a new option as they choose which health plan best meets their healthcare needs
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M&A: MultiPlan Acquires Benefits Science LLC for $160M
What You Should Know:
MultiPlan, a provider of data-enabled cost management, payment, and revenue integrity solutions for 700+ healthcare payors announced the acquisition of Benefits Science LLC (BST) for $160M in cash and stock.BST was founded in 2012 by a group of MIT-trained experts in data science, including Dimitris Bertsimas, Ph.D., who is recognized as an early pioneer in healthcare analytics and who serves as the company’s chief data scientist. Dr. Bertsimas will continue with BST
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