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What We're Reading: Health Insurance Coverage and Unecessary Procedures
What we're reading on October 12, 2015: health insurance marketplaces may have challenges keeping customers they already have, but in California, consumers leaving the state insurance exchange are gaining coverage elsewhere, and the government is increasingly pursuing cases of potentially unnecessary procedures.
Insurance Dropouts Present a Challenge for Health Law
Health insurance marketplaces getting ready for the next open enrollment period, which starts November 1, will have the added challenge of keeping customers they already have, reports New York Times. The last open enrollment period ended in February and by the end of June there had been a drop of about 15% in the total number of people enrolled in the federal and state marketplaces.
Read more: http://nyti.ms/1PpQvob
Cincinnati Hospital to Pay $4.1 Million to Settle Claims for Unnecessary Surgeries
The government is increasingly pursuing cases of potentially unnecessary procedures, reports Modern Healthcare. A hospital in Cincinnati will pay $4.1 million to settle government allegations that the hospital was billing Medicare and Medicaid for unnecessary spine surgeries.
Read more: http://bit.ly/1Ms6Fwd
Consumers Dropping Covered California Plans Gain Insurance Elsewhere
The vast majority (85%) of individuals who have dropped their health insurance coverage through Covered California, the state’s health insurance exchange, gain insurance elsewhere. Nearly half of those who do are opting for employer-based coverage, while others are turning to Medi-Cal and private coverage, FierceHealthPayer reports.
Read more: http://bit.ly/1Lm8FFz
NCCN Data Find Racial, Socioeconomic Disparities in Quality of Care for Metastatic Pancreatic Cancer
April 9th 2025New data from the National Comprehensive Cancer Network (NCCN) reveal that socially vulnerable and minority patients with metastatic pancreatic cancer are less likely to receive recommended treatments and achieve longer survival.
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Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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Lp(a) and Getting a Head Start Against Heart Disease: Jeremy Wigginton, MD
April 8th 2025Lipoprotein a (Lp[a]) is a valuable tool for assessing a patient's risk of cardiovascular disease, which can facilitate earlier intervention efforts and reduce health care costs, argued Jeremy Wigginton, MD.
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Organizational Factors Associated With Variation in Primary Care Providers in ACOs
April 8th 2025A higher percentage of accountable care organization (ACO) primary care providers was associated with physician leadership, upside financial risk, and financial compensation of physicians tied to performance measures.
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