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SCAN Health Plan secured a significant court victory when a federal judge ruled that CMS inappropriately calculated its star ratings for the 2024 plan year. SCAN and other insurers like Elevance Health argued that the changes in methodology violated the Administrative Procedure Act. This ruling highlights the complexities insurers face with regulatory updates, which may influence future implementations of star rating methodologies. https://bit.ly/4eax2I9 Fierce Healthcare #healthcare #HealthPlans

💡 Dr. Rand Paul has introduced the Health Marketplace for All Act of 2024, aiming to give Americans greater access to affordable and flexible healthcare. The legislation focuses on expanding the availability of Health Savings Accounts (HSAs), increasing competition, and reducing regulatory barriers that drive up costs. This act could empower individuals and businesses to find the solutions that work best for them, shifting healthcare toward a more market-driven and patient-focused model. 👉 Do you think initiatives like the Health Marketplace for All Act will drive meaningful change? What impact do you see this having on the current system? 🔍 Learn more about the legislation below. #Healthcare #HealthMarketplace #HealthRosetta #HealthcareReform #Transparency #PatientFocusedCare

Commercial And Medicare Insurers See Dip In Prevention And Equity Performance Scores Modern Healthcare (9/16, Devereaux, Subscription Publication) reports the National Committee for Quality Assurance’s health plan ratings, released Monday, showed a slight decline in commercial and Medicare insurers’ scores on prevention and equity measures. Compared to last year’s report, “Medicare plans’ scores...decreased to an average of 3.08 stars, from 3.4 stars. Commercial health plans’ average score dipped to 3.0 stars, from 3.15 stars in 2023.” https://lnkd.in/eAD8yPPN

The Medical Loss Ratio (MLR) rebate ensures health insurers use most premiums for medical care, not overhead. If insurers don’t meet the required 80-85% threshold, they must issue a rebate. Employers offering health plans may need to share these rebates with employees, either through: 🔹 Cash refunds 🔹 Premium reductions 🔹 Enhanced benefits It’s crucial to handle these funds properly and in compliance with regulations like ERISA. Have you received an MLR rebate? How are you managing it? https://lnkd.in/eqU3fxC2

Health Data News Roundup: NCQA Annual Health Plan Ranking; Payer Health IT Spending Trends; and the State of Medicare Advantage in 2024 #HIT #HealthPayers #Payers #HealthData https://bit.ly/4gydWNh

How much and why ACA Marketplace premiums are going up in 2025 By Jared Ortaliza, Matthew McGough, Anna Cord, and Cynthia Cox KFF Health insurers submit rate filings annually to state regulators detailing expectations and rate changes for Affordable Care Act (ACA)-regulated health plans for the coming year. A relatively small, but growing, share of the population is enrolled in these plans (compared to the number in employer plans). However, these filings are generally more detailed and publicly available. These filings provide insight into what factors insurers expect will drive health costs for the coming year. For 2025, across 324 insurers participating in the 50 states and DC, this analysis shows a median proposed premium increase of 7%, which is similar to last year. Based on a more detailed analysis of publicly available documents from insurers in 10 states and DC, growth in health care prices stood out as a key factor driving costs in 2024. In addition to inflation, some insurers also mention increased utilization of weight loss and other specialty drugs as influencing premiums. Pandemic-related costs and the unwinding of Medicaid continuous coverage are having little, if any, impact on individual market premiums for 2025. https://lnkd.in/gS5Hz-k4

Attention healthcare industry professionals! 🚨 Pre-market turbulence hits U.S. health insurers as Medicare Advantage reimbursement rates remain unchanged. With margins potentially squeezed next year, it's crucial for us to stay informed and adaptable in navigating this landscape. #medicare #medicareadvantage #healthcare #actuary

“From a provider standpoint, engaging the real purchasers of care — whether they are employers or individuals — is a mission-critical priority, given the continuing financial pressures of the acute care business.” Very good article by the #HFMA that highlights payer trends as insurers are increasingly inserting themselves into the care delivery model. Overall, insurer profitability is down and someone needs to make up for that. Healthcare providers must know their contracts well and be ready to challenge every place it can fall apart; every prior auth, every reimbursement delay, every underpayment, every denial. The fact that insurers have spent the last ten years becoming competitors and monopolies to healthcare providers has no doubt created self inflicted profit challenges that they’ll have no problem spreading around. #revenuecyclemanagement #healthcare #healthcarefinance

Can you afford NOT to improve your companies cost position? According to Health Affairs, Healthcare costs will outstrip inflation again... Here is where you might free up some capital: Fully insured health plans can come with hidden costs that eat into your budget. By switching to a partially self-funded plan, you gain more control over healthcare spending and avoid paying the profit margins and risk charges included in fully insured premiums. Key Takeaway: Moving away from fully insured plans can significantly improve your company’s financial health by reducing overall healthcare costs. https://lnkd.in/e7FiQ5s7

Affordability and access are the main focuses in the #healthcare debate today. Current trends show that premiums are growing, provider access is being restricted, and the choice of plans are lower. It's important to stay on top of what's happening in the space, especially if you count yourself in healthcare #leadership. See this special report: