Medicaid

Availity Responds to CMS Interoperability and Prior Authorization Final Rule with Advanced Solutions for Healthcare Interoperability

Retrieved on: 
Wednesday, March 27, 2024
Technology, Finance, Public Policy, Government, Healthcare Reform, Professional Services, Software, Health, General Health, Data Management, Principal, Fast Healthcare Interoperability Resources, Organization, Interoperability, FHIR, DTR, MIPS, Communication, Health Level 7, CHIP, CRD, Hospital, Prior authorization, Acquisition, The Final Rule, Medicaid, API, Documentation, PAS, Medicare, CMS, FFS, Health insurance

The Final Rule aims to enhance interoperability and streamline the prior authorization process by mandating certain health plans to implement specific Health Level Seven International® (HL7®) Fast Healthcare Interoperability Resources (FHIR®) APIs.

Key Points: 
  • The Final Rule aims to enhance interoperability and streamline the prior authorization process by mandating certain health plans to implement specific Health Level Seven International® (HL7®) Fast Healthcare Interoperability Resources (FHIR®) APIs.
  • The Final Rule requires health plans to support a FHIR API for prior authorization by Jan. 1, 2027.
  • The Final Rule requires provider organizations to attest to utilizing a Prior Authorization API to submit at least one authorization request in 2027.
  • Providers will be able to connect to Availity to access the Prior Authorization API for multiple payers.

Mark Farrah Associates Reviewed Enrollment Mix and Financial Metrics for Leading Health Plans

Retrieved on: 
Wednesday, March 27, 2024
Public Policy, Government, Insurance, Finance, Health, Healthcare Reform, Banking, Professional Services, Health Insurance, UnitedHealth Group, Medicare, CVS Health, Medicaid, MFA, CVS, HCSC, Health insurance

Mark Farrah Associates (MFA), www.markfarrah.com , reviewed final year-end 2022 enrollment mix and financial metrics for the top 5 health plans.

Key Points: 
  • Mark Farrah Associates (MFA), www.markfarrah.com , reviewed final year-end 2022 enrollment mix and financial metrics for the top 5 health plans.
  • UnitedHealth, Elevance Inc., CVS Health, Centene, and Health Care Service Corp. (HCSC) insured 43% Americans in the commercial, Medicare and Medicaid markets.
  • Key takeaways include:
    For 2022, leading health carriers comprised 38% for the commercial market and 22% for government lines.
  • Insights for this analysis were gleaned from MFA’s online database tool, Health Plans USA™ , an analytics tool for comparing market mix, market share and financial information about health plans, nationwide.

TruLite Health® Truity™ Platform Earns HITRUST® Certification

Retrieved on: 
Wednesday, March 27, 2024
Technology, Security, Health Technology, Professional Services, Software, Practice Management, DEI (Diversity, Equity and Inclusion), Managed Care, General Health, Health, Certification, Food and Drug Administration, Risk management, Joint Commission, Health equity, HITRUST, Patient, Health information management, Electronic health record, Workflow, Medicaid, Joint, Medicare, Privacy, Food, Medical device

TruLite Health , developer of the only health equity solution to remediate clinical bias, announced its Truity™ platform earned certified status by HITRUST for foundational cybersecurity.

Key Points: 
  • TruLite Health , developer of the only health equity solution to remediate clinical bias, announced its Truity™ platform earned certified status by HITRUST for foundational cybersecurity.
  • It addresses this challenge by driving patient-specific clinical, social and behavioral interventions, leading to improved healthcare outcomes and costs as part of an organization’s health equity strategy.
  • As the market’s first health equity platform, this certification is great validation of our commitment to securing sensitive health information with everything we do,” said Shaung Liu, TruLite Health chief technology officer and co-founder.
  • “We applaud TruLite Health for their commitment to cybersecurity and successful completion of their HITRUST e1 Certification.”

bluebird bio Reports Fourth Quarter and 2023 Annual Results and Highlights Operational Progress and 2024 Guidance

Retrieved on: 
Tuesday, March 26, 2024
Biotechnology, Health, Genetics, Pharmaceutical, Clinical Trials, PIN, Sickle cell disease, MSA, Bluebird bio, Telephone, Webcast, Patient, Gene, CMMI, QTC, Bank statement, Thalassemia, Annual report, Medicaid, Cell, Medicare, Bluebird, FDA, Pharmaceutical industry

bluebird bio, Inc. (NASDAQ: BLUE) (“bluebird bio” or the “Company”) today reported fourth quarter and annual financial results and business highlights for the year ended December 31, 2023, including recent commercial and operational progress.

Key Points: 
  • bluebird bio, Inc. (NASDAQ: BLUE) (“bluebird bio” or the “Company”) today reported fourth quarter and annual financial results and business highlights for the year ended December 31, 2023, including recent commercial and operational progress.
  • “In 2023, bluebird established a validated, commercial gene therapy strategy that brought ZYNTEGLO and SKYSONA to individuals living with beta-thalassemia and cerebral adrenoleukodystrophy.
  • Completed 2 patient starts for SKYSONA since the beginning of 2024, in addition to 6 patient starts completed for SKYSONA in 2023.
  • In the first quarter of 2024, bluebird signed its first Medicaid outcomes-based agreement for LYFGENIA with the state of Michigan.

Mark Farrah Associates Presents Annual Market Share for Health Plans Nationwide

Retrieved on: 
Thursday, March 21, 2024
Insurance, Data Analytics, Health, Data Management, Health Technology, Professional Services, Technology, Health Insurance, Intelligence, Medicare, Medicaid

Mark Farrah Associates, www.markfarrah.com , a leading provider of market data and intelligence solutions, provides a practical, low-cost tool for companies looking for a nationwide overview of the health insurance industry, including market share and general financial data for health plans nationwide in Health Plans USA™ .

Key Points: 
  • Mark Farrah Associates, www.markfarrah.com , a leading provider of market data and intelligence solutions, provides a practical, low-cost tool for companies looking for a nationwide overview of the health insurance industry, including market share and general financial data for health plans nationwide in Health Plans USA™ .
  • This online database gives you access to annual enrollment, revenue, and expenses for Commercial Risk, ASO, Medicare and Medicaid plans.
  • Annual 2023 data is now available!

UniCare Health Plan of West Virginia First in the State to Earn NCQA Health Equity Accreditation Plus

Retrieved on: 
Thursday, March 21, 2024
Professional Services, DEI (Diversity, Equity and Inclusion), Health, Health Insurance, Social Services, General Health, Andrew Kohut, Disease, NCQA, Transport, Health equity, Diabetes, Mortality, Gender identity, Overalls, Medicaid, UniCare, Quality assurance, Language, Hypertension, Accreditation, National Committee, Nursing

UniCare Health Plan of West Virginia recently earned the National Committee for Quality Assurance (NCQA) Health Equity Accreditation Plus, a recognition of UniCare’s leadership in developing solutions to enhance access equitable, high-quality healthcare.

Key Points: 
  • UniCare Health Plan of West Virginia recently earned the National Committee for Quality Assurance (NCQA) Health Equity Accreditation Plus, a recognition of UniCare’s leadership in developing solutions to enhance access equitable, high-quality healthcare.
  • “NCQA’s Health Equity Accreditation Plus recognizes our unwavering dedication to eliminating health disparities and ensuring access to high-quality care for everyone,” said Tadd Haynes, President, UniCare Health Plan of West Virginia.
  • “This milestone positions UniCare at the forefront of advancing health equity through our innovative and impactful programs and personalized care to improve the whole health of our members.”
    NCQA Health Equity Accreditation Plus builds upon the Health Equity Accreditation designation UniCare received last year, when it was recognized among the first Medicaid plans in the nation to create a strategic framework that prioritizes health equity based on race, ethnicity, language, sexual orientation, and gender identity.
  • “Organizations earning the Health Equity Accreditation Plus like UniCare Health Plan of West Virginia are leading the way in bridging this gap, and NCQA salutes their commitment.”

Scene Health and CareFirst Expand Partnership for Medicaid Members

Retrieved on: 
Thursday, March 21, 2024
Biotechnology, Professional Services, Managed Care, Other Health, Health, General Health, Pharmaceutical, Health Insurance, Infectious Diseases, Insurance, Clinical Trials, Culture, Johns Hopkins, Entrepreneurship, Partnership, CareFirst BlueCross BlueShield, Patient, Prescription, Asthma, Quality, Medicaid, Multimedia, Medicine, Hypertension, Pharmaceutical industry

Scene Health (Scene) and CareFirst BlueCross BlueShield (CareFirst), one of the country’s largest not-for-profit healthcare organizations, are proud to announce the expansion of their partnership.

Key Points: 
  • Scene Health (Scene) and CareFirst BlueCross BlueShield (CareFirst), one of the country’s largest not-for-profit healthcare organizations, are proud to announce the expansion of their partnership.
  • “Our partnership with Scene has helped deepen our understanding of the real-life experiences and challenges members were facing,” said Mike Rapach, President and CEO of CareFirst Community Health Plan Maryland (CHPMD).
  • “We are grateful for five years of outstanding partnership with CareFirst BlueCross BlueShield of Maryland’s Medicaid team.
  • “Innovations such as Scene Health's services seamlessly coordinated with other CareFirst health services, benefits, and rich network coverage are critical for us to improve the overall health and quality of care for our members."

TriValley Medical Group and Golden Valley Health Centers Expand Value-based Care in Central California

Retrieved on: 
Tuesday, March 19, 2024
Managed Care, Hospitals, Health Insurance, Health, FQHC, Federally Qualified Health Center, Data analysis, Health equity, Partnership, Patient, Acquisition, Commercial, MD, MBA, Medicaid, Medicare, CMS, Medi-Cal

TriValley Medical Group (TVMG), a leader in value-based care, is pleased to announce its new partnership with Golden Valley Health Centers (GVHC) through the acquisition of a majority stake in Sequoia Health IPA.

Key Points: 
  • TriValley Medical Group (TVMG), a leader in value-based care, is pleased to announce its new partnership with Golden Valley Health Centers (GVHC) through the acquisition of a majority stake in Sequoia Health IPA.
  • Sequoia Health IPA is a collaborative venture with GVHC, California’s leading Federally Qualified Health Center (FQHC) in the Central Valley region that provides care to more than 145,000 patients.
  • Jonathan Dinh, MD, MBA, CEO of TriValley Medical Group, stated, "This partnership is a step forward in offering quality care to communities in need.
  • Tony Weber, MBA, CEO of Golden Valley Health Center, commented, "Joining forces with TriValley Medical Group marks a significant moment in community healthcare.

Arches Medical Partners Acquires 11 Primary Care Practices in Rhode Island

Retrieved on: 
Wednesday, March 20, 2024
Managed Care, Health, Practice Management, NEMO, AMP, Physician, Patient, Commercial, Medicaid, Independent, Practitioner, Nursing

Arches Medical Partners (AMP), a Boston-based medical group management company, has successfully acquired the primary care practices in Rhode Island previously owned by VillageMD.

Key Points: 
  • Arches Medical Partners (AMP), a Boston-based medical group management company, has successfully acquired the primary care practices in Rhode Island previously owned by VillageMD.
  • Practice Locations: AMP now employs fifty PCPs, and operates eight office locations and three urgent care centers in Rhode Island.
  • Physician-Driven Approach: AMP is owned and advised by physicians with decades of experience serving patients and managing primary care businesses.
  • “We are excited about establishing new solution for our patients and creating this nucleus of primary care in Rhode Island.

GlobalData Report Highlights Staggering Economic Costs for Pennsylvania of $19.9 Billion Due to Obesity

Retrieved on: 
Tuesday, March 19, 2024
Public Policy, Government, Healthcare Reform, General Health, Health, Death, Overweight, Culture, Comment, Disease, Federation, Education, Conditional sentence, Head, Weight loss, GlobalData, News, Insurance, Woman, Parity, Medicaid, Workforce, DSM-IV codes, Eli Lilly and Company, Welfare, Medicare, Pharmaceutical industry

GlobalData’s report, ‘ Obesity’s Impact on Pennsylvania's Economy and Labor Force ,’ analyzes the economic and workforce implications of obesity in the State of Pennsylvania, as well as the impact on state tax revenue collections and costs.

Key Points: 
  • GlobalData’s report, ‘ Obesity’s Impact on Pennsylvania's Economy and Labor Force ,’ analyzes the economic and workforce implications of obesity in the State of Pennsylvania, as well as the impact on state tax revenue collections and costs.
  • In Pennsylvania, approximately one-third of adults are classified as having obesity (33.4%), and another third have overweight (34.3%) in 2022.
  • Employers in Pennsylvania paid an extra $2.3 billion in higher medical expenditures for health complications attributed to obesity and overweight.
  • The Obesity Action Coalition’s Stop Obesity Weight Bias Campaign includes media guidelines and bias-free image gallery .