MedCity News

AUGUST 19, 2024

of prior authorization requests submitted to MA insurers were denied in 2022, according to a recent KFF report. The post Report: MA Insurers Denied 3.4M About 7.4% Of these denials, only 9.9% were appealed. Prior Authorization Requests in 2022 appeared first on MedCity News.

Insurance 288

Insurance 288

MedCity News

NOVEMBER 13, 2023

Just 37% of employees trust their insurer to suggest high-quality care regardless of cost, while 53% trust their employer with their health, according to a survey released by Included Health.

Insurance 322

Insurance 322

MedCity News

OCTOBER 6, 2024

With rising expectations from every stakeholder in the insurance ecosystem, the ability to quickly process data, automate key processes, and rapidly build and iterate on digitally supported health plans will be essential. The post The Digital Renaissance in Health Plan Ops: What Technologies Should Insurers Deploy?

Insurance 293

Insurance 293

MedCity News

NOVEMBER 4, 2022

The American Hospital Association specifically called out commercial insurers for their practices on prior authorization and claims denials and delays. Less than 1% of hospitals and health systems said their relationship is improving and the rest said it has stayed the same.

Insurance 313

Insurance 313

Fierce Pharma

DECEMBER 4, 2024

AstraZeneca’s Daiichi Sankyo-partnered antibody-drug conjugate Enhertu has made it onto China’s national insurance program despite the star med being a part of an ongoing investigation in the count | AstraZeneca’s Daiichi Sankyo-partnered antibody-drug conjugate Enhertu has made it onto China’s national insurance program despite the star med being (..)

Insurance 253

Insurance 253

MedCity News

JUNE 30, 2024

The post Why Insurers Beat CMS In the MA Star Ratings Battle appeared first on MedCity News. CMS recently announced that it is recalculating Medicare Advantage Star Ratings. It comes after two lawsuits on the issue.

Insurance 291

Insurance 291

MedCity News

APRIL 22, 2024

The post Why the Commonwealth Fund Created a Task Force for Employer-Sponsored Insurance appeared first on MedCity News. In 2025, the task force will release a blueprint of actionable recommendations on how employers can improve their coverage.

Insurance 292

Insurance 292

MedCity News

AUGUST 9, 2022

Commercial insurers’ practices, such as prior authorization and white bagging, are needed to reduce costs for patients, said Kristine Grow, senior vice president of communications at AHIP.

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Insurance Patients Pharma 313

MedCity News

OCTOBER 16, 2022

Most of the insurers, or 75%, blamed the overuse of care for the rise in medical costs. The 10% increase is the largest in almost 15 years, the Willis Towers Watson survey found.

Insurance 318

Insurance Healthcare Healthcare Medical 318

MedCity News

JULY 5, 2023

Insurtechs like Bright Health Group, Clover Health and Oscar Health set out to disrupt health insurance — but have they actually done so? Not in a positive way, several experts say.

Insurance 284

Insurance 284

MedCity News

NOVEMBER 5, 2023

Despite most insurer execs saying that digital transformation is a top priority, only 8% believe the majority of their staff embrace digital transformation, according to data from West Monroe.

Insurance 313

Insurance 313

MedCity News

JULY 29, 2022

Even with employer-sponsored insurance, many still have issues with chronic conditions, maternal health, behavioral health, substance use and healthcare access. When comparing by race, disparities become more apparent.

Insurance 301

Insurance Healthcare Healthcare 301

MedCity News

DECEMBER 4, 2023

Rising out-of-pocket costs and barriers preventing or delaying the utilization of healthcare coverage highlight the need for a comprehensive approach that goes beyond insurance coverage alone and addresses the underlying issues affecting healthcare accessibility and affordability.

Insurance 293

Insurance Healthcare Healthcare 293

MedCity News

MAY 21, 2023

Individual market insurers are estimated to owe about $500 million in rebates to enrollees this year, a Kaiser Family Foundation analysis found. Small group market insurers are anticipated to owe about $330 million, and large group market insurers are expected to owe about $250 million.

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Insurance Marketing Medical 273

MedCity News

NOVEMBER 20, 2023

That’s why Health Net created a request for information process to help the insurer determine which startups are the best fit for its Medicaid population, according to Dr. Pooja Mittal, vice president and chief health equity officer at Health Net. Many digital health startups aren’t built with Medicaid members in mind.

Insurance 307

Insurance 307

MedCity News

AUGUST 22, 2022

Notably, in the list, the so-called disruptors of the insurance industry are the ones whose CEOs appear to be winning financially even though their stock performance has left much to be desired.

Insurance 261

Insurance 261

Fierce Pharma

MAY 2, 2023

in cyberattack case after court rejects insurers' 'warlike action' claim aliu Tue, 05/02/2023 - 10:07 Merck entitled to $1.4B

Insurance 310

Insurance 310

MedCity News

DECEMBER 14, 2023

Sales performance management (SPM) solutions, also known as distribution management systems, continue to be a competitive differentiator and vital to insurers’ top and bottom lines.

Insurance 284

Insurance Competition Management Sales 284

MedCity News

JANUARY 31, 2025

Lindemer discusses a recent report she co-authored, which focuses on maternal health opportunities in employer-sponsored insurance. In this episode, were joined by Emily Lindemer, an executive director at Morgan Health.

Insurance 271

Insurance 271

MedCity News

OCTOBER 4, 2022

Of people who were found inadequately insured, 9% were uninsured, 11% had a period without coverage over the past year and 23% had coverage all year but were underinsured, the Commonwealth Fund report showed.

Insurance 261

Insurance Medical 261

MedCity News

MARCH 16, 2023

Physicians face a lot of barriers from insurers in completing studies on drugs in the accelerated approval pathway, declared Dr. Robert Califf, commissioner of food and drugs at the Food and Drug Administration. Insurers need to help, he said during the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum.

Insurance 261

Insurance Food and Drug Administration Food Physicians 261

MedCity News

DECEMBER 20, 2022

Quality, affordability and convenience are the key reasons for why Americans favor employer-sponsored insurance. Nearly 90% of Americans prefer to receive their health coverage through an employer versus other means, according to a new survey.

Insurance 284

Insurance 284

MedCity News

MARCH 31, 2024

Insurers should immediately end their overreach into medical decision-making and work with medical providers and their patients to ensure timely care for all.

Insurance 293

Insurance Patients Medical 293

MedCity News

AUGUST 30, 2023

While the recent rollbacks of authorization requirements by insurers are a positive step forward, there is still work to be done in streamlining processes and reducing administrative burdens in the healthcare industry.

Insurance 284

Insurance Healthcare Healthcare 284

World of DTC Marketing

JUNE 1, 2022

Five of America’s largest health insurers reported more than $11bn in profits in the second quarter – a decline from the same period last year when the Covid-19 pandemic helped drive sky-high profits yet they are having more of a say on patients’ treatments even when HCPs disagree. Then there is prior authorization.

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Insurance Patients Doctors Physicians 225

MedCity News

JUNE 13, 2024

The post AmeriHealth Caritas Exec: Worst Thing Insurers Can Do Is Be Paralyzed by AI Challenges appeared first on MedCity News.

Insurance 279

Insurance 279

MedCity News

MARCH 19, 2024

Do you advise self-insured employers? The 2023 Benefit Consultant Sentiment INDEX offered robust insights and cast a spotlight on the evolving roles of employers as they navigate the changing healthcare landscape. Your insights offer leading, innovative points of view that can guide employers and peers.

Insurance 257

Insurance Consulting Healthcare Healthcare 257

MedCity News

JUNE 5, 2024

More than 100 skilled consultants to self-insured employers shared their perspectives on the changing dynamics in healthcare benefits in MedCity News’ second annual 2024 Benefit Consultant Sentiment Index (The Index): Benefit Consultants’ Perspective on Shifting Employer Healthcare Landscape.

Consulting 274

Consulting Insurance Healthcare Healthcare 274

MedCity News

MAY 29, 2023

About 68% of Americans believe employer-sponsored insurance is important for employee recruitment and 77% believe it’s important for retention, according to a new AHIP survey.

Insurance 261

Insurance Recruitment 261

MedCity News

OCTOBER 20, 2023

FOLX Health is now in-network with insurers, including Blue Shield of California. The company serves the LGBTQIA+ community and offers virtual primary care, one-on-one therapy, mental health medication management, hormone replacement therapy, pre-exposure prophylaxis and care navigation.

Insurance 273

Insurance Networking Management Medical 273

MedCity News

FEBRUARY 21, 2025

Future Family launched a nationwide IVF insurance product on Wednesday. The post Future Family Guarantees ‘Baby or Your Money Back’ with New Nationwide IVF Insurance appeared first on MedCity News. If families don’t achieve a live birth after two cycles of IVF, they can get their money back.

Insurance 208

Insurance 208

World of DTC Marketing

JULY 27, 2022

Health insurers have started effectively stealing co-pay coupons, leaving patients on the hook for far higher expenses. Huge Insurance companies continue shifting costs onto patients, with disastrous consequences for individuals’ health and society. The problem is that PBMs are out for themselves and shareholders, not patients.

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Insurance Prescription Medicine Medical 226

MedCity News

FEBRUARY 28, 2023

Over the next 18 to 24 months, Humana will exit the Employer Group Commercial Medical Products business, which includes fully insured plans, self-funded plans and Federal Employee Health Benefit plans. The decision represents Humana’s move to double-down on its Medicare Advantage business, one expert said.

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Insurance Marketing Medical 246

MedCity News

AUGUST 16, 2022

Unlike hospitals, insurers will be less exposed to supply chain issues, higher interest rates and labor shortages. These issues will likely be modest, Moody’s said in its August report.

Insurance 241

Insurance 241

MedCity News

JUNE 20, 2023

There are a lot of administrative hurdles behavioral health providers have to go through to join an insurer’s network. That’s why the industry needs something similar to the “Common App” for applying to be in-network with insurers, said Cara McNulty, president of behavioral health and mental wellbeing at CVS Health.

Insurance 246

Insurance Networking 246

MedCity News

FEBRUARY 28, 2023

In 2021, Medicare Advantage gross margins averaged $1,730, more than double other insurance markets, the Kaiser Family Foundation report found. The individual market’s gross margins averaged $745 per enrollee, group market’s gross margins averaged $689 per enrollee and Medicaid managed care’s gross margins averaged $768 per enrollee.

Insurance 246

Insurance Marketing Management Medical 246

MedCity News

AUGUST 7, 2023

However, just 16% of adults are still interested in taking weight-loss drugs if they’re not covered by insurance. About half of adults, or 45%, said they are at least somewhat interested in taking a “safe, effective weight-loss drug,” according to a new survey by KFF.

Insurance 246

Insurance Prescription 246