Approximately 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans—a segment projected to reach 46% by 2025. Due to rapid growth of the 65-and-older portion of the population, Medicare expenditures are forecast to reach $1,559.4 billion in 2028, with spending per enrollee reaching $20,751.
Key trends are influencing this growth, including:
- An aging population
- Continued increase in overall Medicare costs
- Government support and benefit flexibility (e.g.,
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Medicare Advantage | Payers | News, Analysis, Insights
CVS Health in Talks to Acquire Signify Health
What You Should Know:
- Signify Health is exploring strategic alternatives including a sale, according to a Wall Street Journal report. Initial bids are due this coming week. Additional companies are also in acquisition discussions with Signfiy Health, and CVS could face competition from other managed-care providers and private-equity firms.
- The potential Signify acquisition has a market value of around $4.7 B after its shares rose on the news of a potential sale.
Leveraging
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Telehealth Utilization Grew 10.2% Nationally in May 2022
What You Should Know:
- In May 2022, for the second straight month, telehealth utilization, as measured by telehealth's share of all medical claim lines, grew nationally and in every US census region (Midwest, Northeast, South, West), according to FAIR Health's Monthly Telehealth Regional Tracker.
- FAIR Health reports national telehealth utilization increased 10.2 percent, from 4.9 percent of medical claim lines in April to 5.4 percent in May. Regionally, the greatest increase
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Netsmart Acquires SNF Claims Data Analytics Solution CORE Analytics
What You Should Know:
- Netsmart announced that it has acquired CORE Analytics, the industry-leading skilled nursing facility (SNF) claims data analytics offering from Zimmet Healthcare.
- With the addition of Core Analytics, Netsmart Simple™is now the only solution suite in the market capable of calculating quality measures and Five-Star ratings leveraging Minimum Data Set (MDS), Payroll-Based Journaling (PBJ) and UB-04 claims data.
Software Solutions to Problems in
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Homeward Raises $50M, Inks Value-Based Contract with Priority Health
What You Should Know:
- Homeward raises $50M Series B funding round co-led by ARCH Venture Partners and Human Capital.
- The funding round also includes participation from General Catalyst, which led Homeward’s Series A funding, and Lee Shapiro and Glen Tullman, Co-Founders of 7wireVentures, one of the country’s most successful early-stage healthcare venture funds.
Value-Based and Comprehensive Care
Americans living in rural communities are experiencing increasing health disparities
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Caption Health, Heartbeat Health Partner to Provide Access to Cardiac Care
What You Should Know:
- Caption Health and Heartbeat Health today announced a partnership that will enable providers to offer their patients earlier access to cardiovascular care than ever before possible.
- Together, the partners are increasing access to early cardiac evaluations and care by providing these two innovations as a value-based bundle for health providers, payers, and value-based care organizations.
Improving Access To Cardiac Care
Limited access to cardiac diagnosis and
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Curana & Innovaccer Partner to Improve Outcomes for Senior Living Communities
What You Should Know:
- Today, Innovaccer Inc., the Health Cloud company, announced that Curana Health is partnering with Innovaccer to build a leading edge value-based care solution to support delivery of exceptional care quality at the lowest possible cost for one of healthcare’s highest risk populations: residents in senior living communities across the country.
- Together, Curana Health and Innovaccer will build an industry-leading value-based-care toolkit using the Innovaccer Health
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6 Success Strategies as CMS Drives More Accountable Care by 2030
For the better part of a decade, the shift toward value-based care in the U.S. has been driven by the establishment of the Center for Medicare and Medicaid Innovation (CMMI). Working to develop, test and evaluate new payment and delivery models in Medicare, Medicaid and the Children’s Health Insurance Program, CMMI has taken aim at improving the provider experience, generating better patient outcomes and reducing the overall cost of care.
Recently, CMMI stated that by 2030 every Medicare
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Geisinger Taps Cohere Health to Streamline Prior Authorizations
What You Should Know:
- Today Geisinger Health Plan (GHP) and Cohere Health, a provider of utilization management (UM) technology, announced they are joining forces to streamline the prior authorization process for providers.
- Cohere’s collaborative UM platform will help GHP support value-based care delivery, reduce administrative costs, and lead the nation in aligning quality improvement initiatives across all its lines of business, including
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The No Surprises Act: How Payers Can Stay Compliant
As the healthcare system continues to evolve to adopt a more patient-centric approach, surprise billing has become a topic discussed by consumers and policymakers. Surprise billing can occur when a patient unknowingly receives care from providers that are outside their network. This can result in balance billing, the practice of billing a patient the difference between what their health plan covers and what the provider charges. Unfortunately, these bills are often the result of care provided in
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