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New Provider Network Mandate May Threaten Insurance Exchanges
The Centers for Medicare & Medicaid Services' proposal to mandate broader provider networks in public insurance exchanges could have the unintended consequence of discouraging insurer participation, according to analysts at Moody's.
The Centers for Medicare & Medicaid Services' proposal to mandate broader provider networks in public insurance exchanges could have the unintended consequence of discouraging insurer participation, according to analysts at Moody's.
After concerns in states like New Hampshire and Maine over some providers being left out of plans available in new insurance exchanges, CMS is proposing a new set of network adequacy standards for 2015. Depending on how broad the requirements end up, they could be counterproductive to the goal of using high-quality provider networks to control costs, argue Moody’s senior vice president Lisa Martin and public finance managing director Kendra Smith in a new briefing.
Under the proposal, first outlined in a summary of various proposed and final rules in early February, CMS would ask insurers selling qualified health plans for lists of all in-network and out-of-network hospitals, primary care, mental health and oncology providers to measure whether they offer patients “reasonable access” in their service areas. For essential community providers, CMS regulators are proposing extending the percentage required in a service area from 20 percent with to 30 percent, with limited exceptions.
Read the full story here: http://bit.ly/1jf7IA4
Source: Healthcare Payer News
Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
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Insufficient Data, Disparities Plague Lung Cancer Risk Factor Documentation
September 24th 2023On this episode of Managed Care Cast, we speak with the senior author of a study published in the September 2023 issue of The American Journal of Managed Care® on the importance of adequate and effective lung cancer risk factor documentation to determine a patient's eligibility for screening.
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Gene Therapy Success in UK Likely Depends on Overcoming Education, Psychological Support Challenges
November 27th 2023Education, psychological support, and implementation guidance are the top unmet needs identified by investigators from the United Kingdom concerning gene therapy use for hemophilia.
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