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A Story of Promise and Peril: OIG’s Review of the new CO-OPs

…for federal loans proposed initiatives such as: “Contractually requiring physicians to communicate with one another.” Managing “care transitions across health care settings.” “Provider data sharing from claims, clinical notes, and peer data to develop best practices for care coordination.” “Intensive primary care management for patients with multiple chronic conditions.” “Exclusive provider or medical home models that require patients to adhere…

New Report on State Approaches to Nondiscrimination under the Affordable Care Act

…changed their approach to nondiscrimination but are using new tools, such as attestations, outlier analysis, and internal tracking databases, to monitor for compliance. States raised questions about how nondiscrimination requirements relate to the essential health benefits benchmark plan and identified challenges in enforcement because of a lack of clinical expertise and the inability to fully see benefits in the filing…

Why Should Health Insurance Exchanges Drive Higher-Quality Health Care?

…that early elective deliveries increase a baby’s risk of neonatal complications and even death – and decades-old clinical guidelines from the American College of Obstetricians and Gynecologists recommending against this practice – such elective deliveries still occur in 10 to 15 percent of births. Elective deliveries scheduled for convenience or comfort instead of medical reasons have become so common that…

Shining a Light on Health Insurance: Senate Commerce Committee Examines Progress, Challenges

Health insurance is a product that everybody needs – yet, while we are glad to have it, most of us dread shopping for it. And it’s no wonder: health insurance is a complicated product that consumers have difficulty understanding, a common theme throughout Wednesday’s Senate Commerce Committee hearing on “The Power of Transparency: Giving Consumers the Information They Need to…

What Do You Know About Health Care Sharing Ministries?

…While an insurance company can’t get licensed to do business in a state without significant reserves for cases of insolvency, HCSMs have no such requirement. If the HCSM does not receive enough monthly share contributions to cover eligible medical expenses and the HCSM goes under, then the members just don’t get their medical bills paid. Third, if a member doesn’t…

Rate Review 2.0: The Next Generation

…elements: It requires that insurers submit data and documentation (called a Rate Filing Justification) regarding all rate increases, not just those above the 10% threshold established under HHS’ 2010 rate review regulation. Insurers must submit the Rate Filing Justification to HHS (via the Centers for Medicare and Medicaid Services (CMS)) and, if the state accepts it, to the state department…

Diane Rehm Show Takes a Look at Workplace Wellness Programs

…as simple as offering smoking cessation in the workplace or providing a gym membership to using financial incentives to encourage people to change their behavior. According to some estimates, only 7% of employers have comprehensive, well-designed programs. To have an effective program, there must be multiple elements, including an organizational structure that supports wellness and resources for workers to improve…

Welcoming New Arrivals to CHIR

…experience from his stints as in-house counsel for Coventry Health Care, Inc., and as a health insurance specialist at the U.S. Department of Health and Human Services’ Center on Consumer Information and Insurance Oversight (CCIIO). While working at Coventry, David advised the company in its efforts to comply with the ACA’s new requirements for health insurers and on day-to-day health…

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