House Wants To Rein In Private Equity
A bipartisan House bill would require extensive reporting on private equity firms’ healthcare holdings and ownership structures. The reporting is aimed at identifying financial arrangements that may impact the financial health of the healthcare entity as well as impacts on healthcare delivery. The bill is similar to state laws on transparency in private equity. Other states have gone deeper and ruled out certain financial arrangements by private equity for acquired healthcare entities.
(Article may require a subscription.)
#healthcare #congress #privateequity
Providers Direct Contract With Employers
There is a growing trend in providers direct contracting with employers. Local networks are leveraged and providers avoid prior authorization and other administrative burdens. Both employers and providers are cutting out the insurance middleman.
(Article may require a subscription.)
#healthplans #employercoverage #providers
https://www.modernhealthcare.com/providers/mh-northwell-commonspirit-direct-contracting-employers
Providers May Get Changes For Quality Reporting
A new bipartisan House bill would allow Medicare Accountable Care Organizations (ACOs) to continue to meet quality standards by using electronic clinical quality measures (eCQMs), Merit-Based Incentive Payment System clinical quality measures, and Medicare clinical quality measures through performance year 2029. ACOs were supposed to file with eCQMs starting last year.
#medicare #acos #quality
https://www.medpagetoday.com/practicemanagement/reimbursement/121998
Major ACA Exits
More exits now occurring for Exchange market for 2027. Nine insurers have announced exits for 2027, either nationally or in specific states. We are approaching almost half of all states impacted with pullouts.
Additional articles: https://www.beckerspayer.com/payer/bcbs-massachusetts-to-drop-small-group-individual-ppo-plans/ and https://www.beckerspayer.com/payer/aca/centenes-ambetter-to-depart-new-hampshire-aca-market/ and https://www.beckerspayer.com/payer/aca/medica-to-exit-aca-market-in-3-states/
#exchanges #healthcare
https://www.beckerspayer.com/payer/aca/6-insurers-exiting-aca-markets
Cordani Partially Exits
David Cordani is exiting as CEO of The Cigna Group but will have the role of Executive Chairman. He had been with the company for 35 years.
#cigna #healthplans
CMS Wrong To Freeze Hospice
While fraud is rampant and should be addressed, the author of a Health Affairs Forefront blog is right that the 6-month enrollment freeze hurts seniors and there are better ways to address the issue.
(Article may require a subscription.)
#hospice #medicare
— Marc S. Ryan
