Insurance

Insurers Negotiate Lower Hospital Prices for HIX Than for Commercial Groups

September 15th 2022, 1:00pm

Article

Hospital price transparency data suggest that health insurance exchange (HIX) plans get lower negotiated rates than commercial group plans and higher negotiated rates than Medicare Advantage plans.

Sex Differences in Medicare Beneficiaries’ Experiences by Low-Income Status

September 14th 2022, 1:00pm

Article

Only low-income male Medicare beneficiaries had worse patient experience than their female counterparts. The authors discuss opportunities to improve experiences for all patients.

Implementing Multistate Behavioral Health Pay-for-Performance Initiatives in Medicaid Managed Care

September 8th 2022, 4:00pm

Article

The authors describe a pay-for-performance initiative targeting behavioral health providers, which was introduced by a large Medicaid managed care organization across multiple states.

Comparing Spending Across Medicare Programs

August 22nd 2022, 1:00pm

Article

As Medicare Advantage increasingly becomes the dominant form of Medicare coverage, Congress must improve transparency of programmatic costs and benefits to promote beneficiary choice.

Advocate Speaks on Prior Authorization, Insurance-Related Barriers for HS Treatment

August 13th 2022, 7:10pm

Video

Brindley Brooks, who founded HS Connect (HSconnect.org), a patient advocacy group for those affected with hidradenitis suppurativa (HS), discussed step edits and other barriers to treatment caused by insurance requirements in the management of HS.

Race, Insurance Type Among Predictors of Depressive Symptoms in Atopic Dermatitis

August 10th 2022, 6:40pm

Article

Most patients with atopic dermatitis had flunctuating levels of depressive symptoms, with having public or no insurance, more severe itch, and skin pain cited as additional predictors of adverse mental health outcomes.

Premium Tax Credits in the American Rescue Plan and Off-Marketplace Enrollees

August 10th 2022, 1:00pm

Article

We estimate that the median 2021 premium tax credit for off-marketplace enrollees in California would be $311 if they switched to marketplace plans, with wide variation by age and plan size.

Medicaid Expansion, Managed Care Plan Composition, and Enrollee Experience

August 8th 2022, 4:00pm

Article

Medicaid expansion was associated with substantial changes in Medicaid managed care plan composition, which may influence a plan’s performance on enrollee experience metrics.

Formulary Restrictions and Stroke Risk in Patients With Atrial Fibrillation

August 4th 2022, 4:00pm

Article

Limiting access to non–vitamin K antagonist oral anticoagulants through step therapy and prior authorization may exacerbate current underuse of anticoagulants and increase the risk of stroke in patients with newly diagnosed atrial fibrillation.

Incidence, Mortality, Costs Increased Among Medicaid Patients With NVHAP

August 3rd 2022, 12:17pm

Article

A recent study calculated the incidence and mortality rates for patients with Medicaid coverage who had nonventilator hospital-acquired pneumonia (NVHAP) and found possible associations between greater health care costs and NVHAP diagnosis.