Clover Health Unveils Clover Assistant As SaaS Offering
Congratulations to Clover Health by unveiling its Clover Assistant as a SaaS technology offering. Clover Assistant, now marketed as Counterpart Assistant, is available to Medicare Advantage (MA) payers and providers to improve outcomes and close care gaps.
Additional article: https://www.modernhealthcare.com/insurance/clover-health-assistant-medicare-advantage
(Some articles may require a subscription.)
#medicareadvantage #clover #healthplans #providers
https://www.fiercehealthcare.com/payers/clover-assistant-ai-tool-now-available-payers-providers
New 340B Reform Bill Would Attempt To Return Program To Original Intent
A new House Republican Bill would create major reforms to the 340B program. Hospitals of course are panning the proposal. But more and more studies show that hospitals are abusing the program by claiming discounts and then massively marking up drugs anyway. It is driving costs for inpatient care dramatically for individuals, especially those with cancer. The program was intended to ensure access to those with low incomes.
#340b #hospitals
AI Promotion and Regulation On Capitol Hill Docket
Capitol Hill is looking at creating legislation that will both promote and regulate artificial intelligence, but there is hardly yet a consensus. In the meantime, executive agencies are meeting to craft a regulatory paradigm.
#ai #healthcare
Dollar General Pulls Mobile Health Clinic Initiative
More bad news on retail meets healthcare front. Dollar General is pulling the plug on its primary care mobile clinic initiative.
(Article may require a subscription.)
#retailmeetshealthcare #primarycare
https://www.modernhealthcare.com/providers/dollar-general-mobile-health-clinics-docgo
Warning Signs On Medicaid Front
Both United and Centene have said there are warning signs on the financial front for Medicaid. While states seemed to pony up additional funds during COVID as enrollment began to drop and risk in the program increased, the insurers are seeing bad warning signs regarding payments vs. risk. Other Medicaid plans are less worried.
See my recent blog and podcast where I raised issues about Medicaid economics turning south: https://www.healthcarelabyrinth.com/health-plan-economics-part-3-how-falling-medicaid-enrollment-is-impacting-health-plans-and-providers-alike/ and https://www.healthcarelabyrinth.com/23-how-falling-medicaid-enrollment-is-impacting-health-plans-and-providers-alike/
Additional article: https://www.beckerspayer.com/payer/unitedhealth-points-to-possible-medicaid-headaches.html and https://insidehealthpolicy.com/daily-news/mcos-say-members-largely-through-redeterminations-aca-enrollment-growing
(Some articles may require a subscription.)
#medicaid #redeterminations #healthplans
https://www.modernhealthcare.com/insurance/unitedhealth-medicaid-andrew-witty-bernstein-conference
Senate Democrats Scrutinizing MultiPlan
Senators Bernie Sanders and Ron Wyden are beginning their close scrutiny over the practices of MultiPlan and major payers who appear to be shifting costs from health plans to insureds.
Additional article: https://www.modernhealthcare.com/politics-policy/legal/bernie-sanders-ron-wyden-multiplan-travis-dalton-briefing
(Some articles may require a subscription.)
#multiplan #healthplans #surprisebilling
https://thehill.com/homenews/4691625-sanders-wyden-scrutinize-data-firm-over-sky-high-medical-bills/
Provider-Payer Contract Disputes Are Heating Up
Increasing costs and inflation along with Medicare Advantage prior authorization and claims denials are leading to contentious payer-provider contract negotiations.
In other news, providers want better MA prior authorization data: https://www.beckershospitalreview.com/legal-regulatory-issues/providers-want-better-medicare-advantage-prior-auth-data.html
#healthplans #providers
https://www.modernhealthcare.com/providers/health-plan-negotiations-inflation-claims-denials
— Marc S. Ryan
