Peter Hayes

Today's Health Insurance News: 🔍 Massachusetts' ConnectorCare Pilot Program Expands Access to Affordable Health Insurance 🏥 Massachusetts has successfully expanded its #ConnectorCare program, allowing more residents to access lower-cost health insurance plans. The pilot program, launched in 2024, has already enrolled over 51,000 people, surpassing expectations. This expansion was aimed at individuals who previously did not qualify due to higher income levels, offering them significant savings on premiums and co-pays. Key Points: Program Success: More than 51,000 new members have enrolled in ConnectorCare under the pilot, with 88% already utilizing their new coverage. Eligibility Expansion: For the first time, residents earning up to $72,900 and families of four with incomes up to $150,000 can access ConnectorCare plans, offering substantial savings and no-deductible policies. Cost Savings: Participants in the program can save an average of $150 per month on premiums, with low co-pays and no-cost prescriptions for chronic illnesses like #diabetes and hypertension. MassHealth Transition: About 30% of the new ConnectorCare enrollees were previously covered by #MassHealth, which recently removed 363,000 ineligible people as part of a redetermination effort. State and Federal Support: The expansion leverages state and federal subsidies, significantly reducing the cost of commercial health plans for eligible members. The program will cost Massachusetts $130 million in 2024. Conclusion: The ConnectorCare pilot program is proving to be a vital initiative in making healthcare more affordable and accessible for Massachusetts residents. With the expansion set to continue into 2025, more individuals and families will benefit from reduced healthcare costs, underscoring the state's commitment to ensuring comprehensive health coverage for all. #HealthInsurance #ConnectorCare #Massachusetts #AffordableCare #HealthcareAccess #MassHealth #ACA #MCG #SBM101 #SBMU https://lnkd.in/eSaJUHJw

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The new KFF analysis shows that nearly seven in 10 Medicare beneficiaries did not compare their #Medicare coverage with other Medicare options during the program’s annual open enrollment period for coverage in 2022. Enrollees in traditional Medicare were slightly more likely to skip shopping around than those in #MedicareAdvantage plans.

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Age-Friendly Insights Poll from The John A. Hartford Foundation: ➡️The vast majority of adults favor policies that assist older adults with dementia and their family caregivers with 92% supporting training to improve caregiving Read more and download the insights guide here --> https://hubs.li/Q02HY2CL0 #dementiacaregiving #dementiasupport #dementiatraining #caregiversupport #dementiaawareness

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𝐒𝐞𝐧𝐢𝐨𝐫 𝐇𝐞𝐚𝐥𝐭𝐡 𝐈𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 𝐌𝐚𝐫𝐤𝐞𝐭 𝐭𝐨 𝐒𝐞𝐞 𝐌𝐚𝐬𝐬𝐢𝐯𝐞 𝐆𝐫𝐨𝐰𝐭𝐡 𝐛𝐲 𝟐𝟎𝟑𝟎 𝗥𝗲𝗾𝘂𝗲𝘀𝘁 𝗙𝗼𝗿 𝗦𝗮𝗺𝗽𝗹𝗲 𝗟𝗶𝗻𝗸 𝗥𝗲𝗽𝗼𝗿𝘁:https://lnkd.in/g6Phtu_U Market Intellix (MI) published a new report, titled, "Senior Health Insurance Market." The report offers an extensive analysis of key growth strategies, drivers, opportunities, key segments, Porter's Five Forces analysis, and competitive landscape. This study is a helpful source of information for market players, investors, VPs, stakeholders, and new entrants to gain a thorough understanding of the industry and determine steps to be taken to gain a competitive advantage. #𝗢𝗽𝗽𝗼𝗿𝘁𝘂𝗻𝗶𝘁𝗶𝗲𝘀 • 𝗚𝗿𝗼𝘄𝗶𝗻𝗴 𝗦𝗲𝗻𝗶𝗼𝗿 𝗣𝗼𝗽𝘂𝗹𝗮𝘁𝗶𝗼𝗻: The global population of seniors is rapidly increasing, particularly in developed countries, presenting a significant opportunity for growth in the senior health insurance market. • 𝗜𝗻𝗻𝗼𝘃𝗮𝘁𝗶𝘃𝗲 𝗣𝗹𝗮𝗻 𝗢𝗳𝗳𝗲𝗿𝗶𝗻𝗴𝘀: There is an opportunity to develop innovative insurance plans that cater to the specific needs of seniors, such as long-term care insurance, critical illness coverage, and plans with wellness programs. • 𝗘𝘅𝗽𝗮𝗻𝘀𝗶𝗼𝗻 𝗶𝗻 𝗘𝗺𝗲𝗿𝗴𝗶𝗻𝗴 𝗠𝗮𝗿𝗸𝗲𝘁𝘀: Emerging markets, particularly in Asia and Latin America, are experiencing a rise in the senior population, creating opportunities for insurers to expand their offerings in these regions. • 𝗘𝗻𝗵𝗮𝗻𝗰𝗲𝗱 𝗖𝘂𝘀𝘁𝗼𝗺𝗲𝗿 𝗘𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻: There is an opportunity to improve customer education and awareness about the benefits of different senior health insurance plans, helping seniors make informed choices. 𝗧𝗵𝗶𝘀 𝗿𝗲𝗽𝗼𝗿𝘁 𝗶𝗻𝗰𝗹𝘂𝗱𝗲𝘀 𝘁𝗵𝗲 𝗳𝗼𝗹𝗹𝗼𝘄𝗶𝗻𝗴 𝗺𝗮𝗻𝘂𝗳𝗮𝗰𝘁𝘂𝗿𝗲𝗿𝘀 • Berkshire Hathaway • Prudential plc • Zurich Insurance • China Life Insurance Co.Ltd • Allstate • AIG • Manulife Financial Advisers Pte Ltd • AXA • Allianz • Aviva • Japan Post Holdings Co., Ltd. • Generali • Chubb • Reliance Nippon Life Insurance • CPIC • Munich Re • MetLife 𝗞𝗲𝘆 𝗕𝗲𝗻𝗲𝗳𝗶𝘁𝘀: • The report provides a qualitative and quantitative analysis of the current Senior Health Insurance market trends, forecasts, and market size from 2019 to 2026 to determine new opportunities. • Porter's Five Forces analysis highlights the potency of buyers and suppliers to enable stakeholders to make strategic business decisions and determine the level of competition in the industry. • Top impacting factors & major investment pockets are highlighted in the research. • The major countries in each region are analyzed and their revenue contribution is mentioned. #SeniorHealth #HealthInsurance #Medicare #SeniorCare #ElderCare #MedicareAdvantage #MedicareSupplement #LongTermCare #SeniorLiving #RetirementPlanning #SeniorBenefits #AgingPopulation #HealthcareForSeniors #SeniorWellness #AffordableCare Market intelliX Global Trends & Analysis

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State Insurance Law A new Massachusetts insurance law requiring no-cost coverage for screening and diagnostic imaging (exemptions apply) will go into effect on 1/1/2026. For more details, see DBI’s State Law Insurance Map and Table, available here: https://lnkd.in/gmM3dGBH   RANZCR Position Statement  The Royal Australian and New Zealand College of Radiologists have issued an updated Breast Density Position Statement – Why Reporting Matters. According to the statement, “RANZCR supports the inclusion of breast density reporting in all mammographic assessments. This move aligns with the growing global recognition of the importance of breast density in breast cancer screening. In countries like the USA, it is already mandatory to report breast density in mammograms, and similar practices are being considered in Europe.” Read here: https://lnkd.in/g-CgcgWu   New Study A study by Gjesvik and colleagues examined whether a commercially available AI algorithm for breast cancer detection could also estimate risk for future breast cancer development. This retrospective cohort study included 116,495 women aged 50-69 years who underwent at least 3 consecutive biennial mammography screening rounds in Norway. The study found that the AI algorithm for cancer detection was able to estimate future breast cancer risk 4-6 years before diagnosis. Specifically, compared to women who did not develop breast cancer[1], the study found: • The mean absolute difference in AI scores between breasts of women who developed screen-detected cancer or interval cancer was greater at each round and increased over the three rounds [2,3]. These results suggest that AI scores for cancer detection may be used to identify women at high risk of developing cancer who may benefit from supplemental screening.   1. A cancer detection score of 0-100 was given to each breast. The mean (SD) absolute differences in AI scores between breasts of women who did not develop breast cancer were  9.9 (17.5),  9.6 (17.4), and 9.3 (17.3) at the first, second, and third screening rounds, respectively. 2. Scores were higher in breasts that developed cancer, and this was compared to the noncancerous breast. The mean (SD) absolute differences in AI scores between breasts of women who developed screen-detected cancer in one breast and not the other were 21.3 (28.1), 30.7 (32.5), and 79 (28.9) at the first, second, and third screening rounds, respectively. 3. The mean (SD) absolute differences in AI scores between breasts of women who developed interval cancer in one breast and not the other were 19.7 (27.0), 21.0 (27.7), and 34.0 (33.6) at the first, second, and third screening rounds, respectively. Full study available here: https://lnkd.in/griZwA69

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American Hospital Association shares 6 ways administrative costs and insurer policies are causing hospital systems to lose money: 1.    Care denials increased by an average of 20.2% for commercial claims and 55.7% for Medicare Advantage claims in 2022-23. 2.    More than 40% of total expenses hospitals incur in patient care come from administrative costs due to prior authorization appeals. 3.    Machine learning and AI tools are driving the growth of denials without considering patients’ clinical circumstances or reviewing claims. The remaining 3 can be seen here: https://lnkd.in/gWcbdCg3 Our expert consultants help healthcare organizations improve their RCM through strategic guidance and recommendations to enhance revenue integrity, reduce denials, accelerate payment and improve the billing experience. #HospitalRCM #HealthcareFinances #HospitalFinances

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Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. But the insurance companies don’t always make these decisions. Instead, they often outsource medical reviews to a largely hidden industry that makes money by turning down doctors’ requests for payments, known as prior authorizations. EviCore uses an algorithm backed by artificial intelligence, which some insiders call ‘the dial,’ that it can adjust to lead to higher denials. Some contracts ensure the company makes more money the more it cuts health spending. And it issues medical guidelines that doctors have said delay and deny care for patients. Learn more here: https://loom.ly/QmElcqE

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1/4 of people dropped from #Medicaid in the past year remain #uninsured, according to #KFF. While it's possible many of them may still be eligible for the program if they re-enroll, there's also a lot of opportunity for #healthinsurance agents to help their communities find #Marketplace or other coverage that works for them. Need help figuring out which places could use you the most? Check out our webinar on prospecting the unwinding:👇

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🏛️💼 Anticipating 2025: Medicare is poised for significant transformations, especially concerning Part D prescription plans. With proposed changes aimed at reducing consumer spending on medications, insurance companies are bracing for increased financial responsibilities. This shift comes as the industry grapples with cost containment in the wake of pandemic-driven expenditure rebounds. How will these changes affect the healthcare landscape? Professionals, share your insights on navigating these upcoming challenges. . . . #Medicare2025 #Medicare #Employeebenefits #Medicarecoverage #HRInnovation #HRChallenges #HR #DoctorsChoiceusa #Healthcare

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A provider compensation approach requires balancing numerous objectives that seem to compete with each other, such as provider and market requirements vs. the financial viability of a health system. HSG Advisors offers proven best practices to align multiple goals into one integrated and effective strategy. Read more in this article: "Provider Compensation: Five Key Challenges Health Systems Face, and Strategies to Overcome Them." #providercompensation #healthcareconsulting #physician #hospital #healthsystem #compensationstrategy

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How do you move beyond just the “what” in claims data? With Amplity Health's qualitative, HIPAA-compliant database, you can get to the “why” treatments are started, switched, or stopped for a richer patient view. Hear Brian O'Donnell explain how accessing unfiltered, candid patient-provider interactions can help manufacturers make faster, smarter decisions for more effective patient care. Learn how Amplity Health can help your commercial teams use intel to drive deeper engagement and better outcomes. https://lnkd.in/gWfK-RkV #datadrivendecisions #gettothewhy #qualitativedatabase #betterpatientoutcomes

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How can health plans address rising costs? Eric Miller, FSA, CERA, MAAA, VP & Consulting Actuary, says that pairing weight loss medications with lifestyle changes like exercise is just one strategy. During the interview he also shares data from the Segal 2025 Health Plan Cost Trend Survey. Morning Brew Courtney Vinopal https://lnkd.in/g9EmEATV #Healthcare #HealthInsurance #EmployeeBenefits

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Brad Paulis, ASA, MAAA, and Partner at Continuing Care Actuaries will be participating in the LeadingAge / Ziegler CCRC CFO Conference Brad’s session will be on Thursday, April 25 at 11:00 AM CT HCBS Pivot – A Closer Look into Continuing Care at Home This year’s HCBS discussion will pivot to the topic of Continuing Care at Home (CCaH). As organizations look to diversify revenues and service lines, expanding the continuum into people’s homes will take a fresh look in this year’s session. Objectives: 1. Overview of services that are provided for Continuing Care at Home and payor arrangements for CCaH 2. Overview of trends related to this emerging area of care 3. Deep dive into case studies exploring the “Look of CCaH”

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New CMS report: The Medicare Shared Savings Program (MSSP) continues to demonstrate its effectiveness in delivering high-quality care while generating significant cost savings. Key highlights from the report: - MSSP generated $1.8B in savings for Medicare in 2022 - 483 ACOs participated, serving 11 million Medicare beneficiaries - 99% of ACOs successfully reported quality measures - 54% of ACOs earned shared savings payments These outcomes reinforce that VBC can drive care quality while improving financial outcomes for the ACOs who participate. Check it out here: https://lnkd.in/dJDNU6-c #Valuebasedcare #healthcareinnovation #ACOs #Medicare

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