Most Medicare ACOs to Leave if Excluded from MACRA: Survey

Medicare could be heading toward the collapse of a large portion of its accountable care organization (ACO) program, according to a new industry survey.

Fifty-six percent of Medicare ACOs said in a recent survey that they likely would leave the Medicare Shared Savings Program (MSSP)—which hosts the vast majority of Medicare ACOs—if proposed rules making them ineligible for a key alternative payment model (APM) designation are finalized.

The rules implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) excluded as qualifying APMs many existing programs, including the Comprehensive Care for Joint Replacement (CJR) model, the Bundled Payments for Care Improvement (BPCI) initiative, and Track 1 Medicare Shared Savings Program (MSSP) ACOs, which comprise 95 percent of the 434 MSSP ACOs.

The rule estimated that as few as 30,000 physicians could qualify initially for APM payments, which are seen as more lucrative and requiring less-burdensome quality reporting under MACRA compared with the Merit-based Incentive Payment System (MIPS) track.

The National Association of ACOs (NAACOS) survey findings were not surprising to some.

“It reflects the frustration a lot of organizations feel right now,” said Chad Mulvany, director of healthcare finance policy, strategy and development, for HFMA. “They are fundamentally redesigning their care delivery and […]

By |May 27th, 2016|Medicare/Medicaid|Comments Off on Most Medicare ACOs to Leave if Excluded from MACRA: Survey

Ohio ObamaCare co-op shutting down due to finances

A nonprofit health insurer in Ohio set up under ObamaCare is going out of business, regulators announced Thursday. It is the latest in a string of failures for “co-op” health plans.
The Ohio Department of Insurance announced that the co-op, known as InHealth Mutual, will be shut down, forcing its nearly 22,000 enrollees to find other plans within the next 60 days.
“Our examination of the company’s financials made it clear that the company’s losses would prevent it from paying future claims should its operations continue,” Lt. Gov. Mary Taylor, who is also the Ohio director of insurance, said in a statement.
The closure represents a significant disruption for the enrollees. The Obama administration and state regulators had worked to shut down any financially shaky co-ops before 2016 enrollment began on Nov. 1, in an attempt to avoid such failure in the middle of the coverage year.
But that is now happening in Ohio. The Department of Insurance said ObamaCare enrollees in the co-op plan should log onto the health law’s marketplace in the next 60 days to select a new health insurance plan.
“Thanks to the failure of Obamacare’s co-op health plans about 22,000 Ohioans will be forced to seek new coverage,” Rep. […]

By |May 27th, 2016|Health Reform|Comments Off on Ohio ObamaCare co-op shutting down due to finances

Highmark proposes 48% hike on ACA exchange plans

Pittsburgh-based Highmark, Pennsylvania’s largest insurer, is joining the ranks of other payers looking to raise their premium prices on Affordable Care Act exchange plans, according to the Tribune Review.

According to the proposals, ACA plans sold under the name Highmark Health Insurance Co. would increase by an average of 48 percent, while ACA plans sold under the name Highmark Inc. would rise an average of 38 percent. Highmark Health Insurance Co. plans cover 20,000 individuals and Highmark Inc. plans cover 39,000.

The proposed increases follow Highmark’s $773 million losses in 2014 and 2015 due to sicker-than-anticipated consumers and low premiums during those years. In addition, Highmark is proposing increases due to the expiration of the risk corridor and reinsurance programs in 2017.

“Our requested rate increases reflect what we believe need to make this market sustainable,” said Alexis Miller, Highmark’s senior vice president of individual and small group markets, according to the report.

However, the rate increases have yet to be approved by the Pennsylvania Insurance Department. When Highmark proposed increases of up to 37 percent last year, the department restricted it to an average increase of 20 percent.

Highmark isn’t the only insurer amping up rates. UPMC Health Plan asked for premium increases […]

By |May 27th, 2016|Health Reform|Comments Off on Highmark proposes 48% hike on ACA exchange plans


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