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Byline: Nona Tepper And Tim Broderick UnitedHealth Group and Humana continue to dominate Medicare Advantage, but their memberships grew more slowly than the industry at large during 2024 open enrollment, [...]

Objective: To examine the effect of enrollee switching from a broad-network accountable care organization (ACO) health maintenance organization (HMO) to a 'high performance' ACO-HMO with a selective narrow network and comprehensive patient navigation system on access, utilization, expenditures, and enrollee experiences. Data Sources: Secondary administrative data were obtained for 2016-2020, and primary interview and survey data in 2021. Study Design: Fixed-effects instrumental variable analyses of administrative data and regression analyses of survey data. Outcomes included access, utilization, expenditures, and enrollee experience. Background information was gathered via interviews. Data Collection/Extraction Methods: We obtained medical expenditure/enrollment and access data on continuously enrolled members in a broad-network ACO-HMO (n = 24,555), a subset of those who switched to a high-performance ACO-HMO in 2018 (n = 7664); interviews of organizational leaders (n = 13); and an enrollee survey (n = 512). Principal Findings: Health care effectiveness data and information Set (HEDIS) access measures were not different across plans. However, annual utilization dropped by 15.5 percentage points (95% CI: 18.1, 12.9) more in the high-performance ACO-HMO, with relative annual expenditures declining by $1251 (95% CI: $1461, $1042) per person per year. High-performance ACO-HMO enrollees were 10.1 percentage points (95% CI 0.001, 0.201) more likely to access primary care usually or always as soon as needed and 11.2 percentage points (95% CI 0.007, 0.217) more likely to access specialty care usually or always as soon as needed. Plan satisfaction was 7.1 percentage points (95% CI: -0.001, 0.138) higher in the high-performance ACO-HMO. Interviewees noted the comprehensive patient navigation system was designed to ensure patients remained in the narrow network to receive care. Conclusions: ACO and HMO contracts with selective narrow networks supported by comprehensive patient navigation can reduce expenditures and improve specialty access and patient satisfaction compared to broad-network plans that lack these features. Payers should consider implementing narrow networks with comprehensive support systems. KEYWORDS health care costs, health care organizations and systems, instrumental variables, observational data/quasi-experiments, 1 | INTRODUCTION Accountable care organizations (ACOs) are 'groups of health care providers who give coordinated care [and] chronic disease management [where]... the organization's payment is tied to achieving healthcare [...]

2022 DEC 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Obesity, Fitness and Wellness have been published. According [...]

Objective. To test for differences in patient outcomes when hospital and post-acute care (PAC) providers participate in accountable care organizations (ACOs).Data/Setting. Using Medicare claims, we examined changes in readmission, Medicare spending, and length of stay among patients admitted to ACO-participating hospitals and PAC providers.Design. We compared changes in outcomes among patients discharged from ACO-participating hospitals/PACs before and after participation to changes among patients discharged from non-participating hospitals/PACs over the same time period.Results. Patients discharged from an ACO-participating hospitals and skilled nursing facilities (SNF) had lower readmission rates (--1.7 percentage points, p-value = .03) than before ACO participation and non-participants; and lower per-discharge Medicare spending (--$940, p-value = .001), and length of stay (--3.1 days, p-value Conclusions. Hospital and SNF participation in an ACO was associated with lower readmission rates, Medicare spending on SNF, and SNF length of stay. These results lend support to the ACO payment model.Key Words. Post-acute care, hospitals, accountable care organizations, Medicare, By creating incentives to manage the health of their members across health care settings, accountable care organizations (ACOs) have the potential to induce providers to work together to improve coordination [...]

Research and Markets has announced the addition of the 'Payer Services Global Market Report 2021: COVID-19 Growth and Change to 2030' report to its offerings. In a release, Research and [...]

Community Health Plan of Washington (CHPW) reported that it will cover acupuncture for Medicaid members statewide age 18 and up who experience chronic pain. 'We're committed to improving the health [...]

UnitedHealthcare and Optum reported they are taking action to help people affected by the recent earthquakes and ensuing aftershocks across parts of California. According to a release, support includes assisting [...]

Humana reported it is engaging with physician groups across the country to launch a national, value-based care oncology program designed to provide more integrated cancer care for Humana Medicare Advantage [...]

Two health organizations are calling for a tax on 'sugary drinks.' The goal of the AMERICAN HEART ASSOCIATION and the AMERICAN ACADEMY OF PEDIATRICS (AAP) is to limit children's intake [...]

Anthem Blue Cross reported that they are joining the AI for Health Affiliation program as the initial Founding Member. According to a media release, Artificial Intelligence for Health (AIHealth) is [...]

UnitedHealthcare and Optum are taking action to help people affected by recent flooding across parts of Nebraska. According to a media release, support includes assisting health plan participants who may [...]

Two health management organizations have partnered on a guide that walks plan sponsors through seven steps in evaluating their wellness efforts. Companies want to be sure they're getting the best [...]

Merging the business operations of hospitals and physician practices is neither a quick nor an easy process, and often involves considerable financial and staff resources. Despite the complexity, such initiatives [...]

In this article ... Study why physician leaders should consider making the move to include genomics in their health care organizations., HOPING TO CAPITALIZE ON THE PROMISE AND power of personalized medicine, leading health systems are switching their focus from genetics to genomics. A genomics program switches attention from individual mutations, [...]

United Healthcare recently became the latest major insurer to offer a 'virtual primary care service.' Initially, the service will be part of some employer-sponsored insurance plans in 11 states. United [...]

A young Soldier returns home from deployment to Afghanistan severely impaired. His traumatic brain injury and post-traumatic stress disorder are invisible, yet they render him incapable of thinking clearly and [...]

Health New England, in partnership with its Community Benefits Advisory Council, recently reported recipients of its inaugural Where Health Matters Grant Program.According to a release, four area non-profit organizations were [...]

Chronic disease and other serious illnesses, along with mental illness, exact a huge toll on the workplace. Together, they affect the health of your employees and your company's productivity. That's [...]

Thanks to the support of the San Antonio community, the 'March Out Hunger' food drive collected close to 94,000 pounds of food, or more than 73,000 meals, to help combat [...]

Kaiser Permanente reported it is again among the nation's elite when it comes to providing care and service to its Medicare members. According to the Centers for Medicare & Medicaid [...]