Medicare Advantage plans are frequently lauded for providing high-quality insurance coverage. And they're widely popular among Medicare-eligible consumers. But there's a dark side to these plans as well.
In fact, dozens of federal audit reports indicate that Medicare Advantage plans are making the same kind of deficiencies year after year, especially when it comes to inappropriately rejecting claims. The Centers for Medicare & Medicaid Services found that in 61 percent of the audits, insurers turned down claims for prescription drugs when they shouldn't have.
This is not something to take lightly. Many seniors take prescription medications, and many of those drugs are vital to their health and medical conditions. To potentially block their access to those drugs could prove extremely detrimental.
I'm rarely one to advocate for fighting instead of finding peace, but every now and then, you just have to stand up for what you think is right. And that's how I view the recent decision from Blue Cross Blue Shield of Illinois to not negotiate with hospitals that affiliate with each other. I recognize the right of providers to work together and address the problem of ever-rising healthcare costs. And I certainly don't think that provider consolidation is the only driver to those increasing costs. Insurers have their share of blame, as well.
The recent announcement that Anthem Blue Cross is partnering with seven major hospitals in the Southern California area to launch an integrated care program has been met with lots of publicity, including our own coverage of the venture. The collaboration, which is called Anthem Blue Cross Vivity and includes UCLA Health and Cedars-Sinai, will offer large employers less-costly coverage for members who use in-network hospitals and doctors. That in and of itself isn't particularly innovative or unique, since insurers and providers have shared savings and risks for years across different markets. But what is so special about Vivity, as a California Healthline article points out, is the way it's structuring the financial model.
When Aetna announced it was shuttering its CarePass mobile platform by the end of the year, industry experts have been left wondering what caused the demise of CarePass and whether other insurers' mobile engagement initiatives could suffer a similar fate. To gain exclusive insight into Aetna's decision to close its CarePass mobile platform and learn where the company plans to take its mobile health strategy in the future, FierceHealthPayer spoke with Michael Palmer, Aetna's chief innovation & digital officer.
As health insurers continue their quest of achieving consumer engagement, many believe that offering price transparency tools is a key factor in achieving that goal. And UnitedHealth is taking those tools one step further by providing very specific cost estimates to their members. That means UnitedHealth members can get an extremely accurate price for total service cost, out-of-pocket expenses, co-payments and any outstanding deductibles.
To learn more about how UnitedHealth is leading the charge on price transparency, FierceHealthPayer spoke with Victoria "Tory" Bogatyrenko, UnitedHealth's national vice president for product, innovation and marketing.