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So far kristian has created 143 blog entries.

This Company’s AI-Fueled Tech Is About to Bring Digital Health Care to Millions

FORTUNE- By SY MUKHERJEE 7:00 AM EST - JANUARY 17,2018 Digital health firm HealthTap and Bupa, a health care provider that offers both insurance and medical services to millions around the world, are teaming up in a massive strategic partnership that could make “digital end-to-end” medical services a widespread reality, HealthTap CEO Ron Gutman told Fortune in an early interview previewing the arrangement. Gutman describes it as the “biggest digital health deal” he knows of. That’s a bold claim; but the company’s new partnership with Bupa can’t be easily brushed off. Bupa does both the grunt work of medical care services (through hospitals and clinics) and the more heady business of insurance; it employs about 80,000 people around the world and has a far larger consumer base that stretches across the globe. By combining forces with Bupa, HealthTap’s artificial intelligence-powered services—which can allow patients to figure out whether they need to immediately go to a hospital if they’re feeling sick, access doctors through virtual visits, receive reminders about taking or refilling prescription medications, and generally keep one, unified record of their medical history—will be available to millions, according to the companies. Those are all goals (and technologies) that plenty of other digital health upstarts are seeking. So what makes HealthTap’s latest collaboration different? “Everything in one app,” says Gutman. He describes it as a true “end-to-end” digital service for medicine, where even the insurance part of the equation is taken care of within the app. “Over the past year we have worked together to implement a number of solutions for day-to-day customer needs, such as easily finding local doctors covered by Bupa insurance, scheduling physiotherapy, immunizations, and doctor visits with local clinics, and connecting residents in [...]

By |January 17th, 2018|Blog, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on This Company’s AI-Fueled Tech Is About to Bring Digital Health Care to Millions

CVS-Aetna deserves chance to disrupt health-care system

THE HILL : BY DR. ROGER KLEIN, OPINION CONTRIBUTOR — 01/10/18 07:00 PM EST -THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL On Dec. 3, drugstore chain CVS announced that it would purchase insurer Aetna for $69 billion, making this the largest health insurance merger in American history. The acquisition comes on the heels of a period of consolidation in the health-care industry that has been driven by rapidly increasing costs, declining reimbursement, technological change, increasing regulatory burdens and legislative changes, most prominently the Affordable Care Act. Its purpose is to allow these two entities to more effectively compete with other integrated providers like UnitedHealth Group, with its physician practices, surgery centers, urgent care clinics and pharmacy benefit manager, Kaiser Permanente, Geisinger Health System, more conventional providers like hospitals and physician groups and even disruptive retailers like Amazon. The CVS-Aetna merger is known as a “non-horizontal” merger. This means that the merging companies are neither actual nor potential competitors in the same markets. Instead, the CVS-Aetna combination brings together sellers whose relevant products are mostly complementary goods and services like prescription drugs, pharmacy benefit management, primary care and health insurance. The merger also has “vertical” elements. For example, health insurers are often purchasers of prescription drugs, pharmacy benefit management services, prescription drugs and other pharmacy products. Historically, federal enforcement activity has centered on “horizontal” mergers, that is, mergers of competitors. Typically, horizontal mergers present a greater risk of harming consumers than do non-horizontal mergers. However, the recent Justice Department lawsuit challenging AT&T’s $85 billion purchase of Time Warner and remarks Assistant Attorney General for the Antitrust Division Makan Delrahim made at an American Bar Association conference in November [...]

Tax on medical devices to resume after 2-year suspension

CNBC via AP- JANUARY 1ST, 2018 While much of corporate America will enjoy a tax cut in the new year, one industry is getting a tax increase it has fought hard but so far unsuccessfully to avoid. A 2.3-percent excise tax on medical device manufacturers is set for reinstatement Monday after a two-year hiatus. It was originally imposed in 2013 as one of several taxes and fees in the Affordable Care Act that pay for expanded health insurance under the law The tax was strongly opposed by the $150 billion a year industry that produces everything from catheters to heart stents to artificial joints. In Congress, it was unpopular not only with Republicans but many Democrats from states like Massachusetts and Minnesota with large numbers of medical device companies. Congress voted to suspend the tax for 2016 and 2017 with the widespread expectation it would be permanently abolished before 2018. But various GOP efforts to repeal the Affordable Care Act and the taxes associated with it failed, and the sweeping federal tax overhaul recently signed by President Donald Trump didn't eliminate the medical device tax either. Industry groups Including the Advanced Medical Technology Association (AdvaMed) and the Medical Imaging & Technology Alliance warn the tax will take a $20 billion bite out of the industry over the next decade. "What we have seen from past experience is that it comes out of funding for product development, research and the jobs associated with those things," said J.C. Scott, AdvaMed's head of government affairs. "We fear we will see employment freezes or reductions and a slowdown in the pipeline for medical innovation." The slashing of the overall corporate tax from 35 percent to 21 percent may soften [...]

How the New U.S. Tax Plan Will Affect Health Care

Harvard Business Review: David Blumenthal- December 19, 2017 The new Republican tax bill, which the House passed this afternoon and the Senate is expected to approve tonight, is complex, but what it will mean for health in the United States is simple: less. It will mean less health insurance for individuals; less coverage for elderly and poor Americans; less revenue for doctors, hospitals, and myriad health care businesses; and, quite possibly, a less-healthy, less-productive workforce. The tax bill will be the most important health care legislation enacted since the Affordable Care Act (ACA) in 2010. The law’s two major health-related aspects are the elimination of the penalties paid by people who fail to have health insurance as required by the so-called individual mandate, and the bill’s overall impact on the federal deficit — which will increase by an estimated $1.45 trillion after allowing for predicted economic growth. According to the Congressional Budget Office (CBO), the repeal of the individual mandate penalties could result in as many as 13 million fewer Americans having health insurance. About 5 million are projected to be people who previously bought health insurance as individuals either within or outside the ACA’s marketplaces. Some will choose not to buy insurance because the penalty has disappeared. Others, especially higher-income individuals who don’t qualify for subsidies under the ACA, will drop insurance because of increases in average premiums predicted by the CBO. These premium increases will occur because, with the repeal of the mandate, many young, healthy people will exit markets, leaving a sicker, more costly insurance pool behind. Older individuals will be most affected. For example, a 60-year-old not receiving subsidies could face premium increases of $1,781, $1,469, $1,371, and $1,504, respectively, in Alaska, [...]

UnitedHealth Buys Large Doctors Group as Lines Blur in Health Care

NY Times - By REED ABELSON DEC. 6, 2017 In another example of the blurring boundaries in the health care industry, UnitedHealth Group, one of the nation’s largest insurers, said on Wednesday that it is buying a large physician group to add to its existing roster of 30,000 doctors. UnitedHealth’s Optum unit will acquire the physician group from DaVita, a large for-profit chain of dialysis centers, for about $4.9 billion in cash, subject to regulatory approval. DaVita operates nearly 300 clinics across a half-dozen states, including California and Florida. With the purchase, UnitedHealth is increasingly moving into the direct delivery of medical care. “Combining DaVita Medical Group and Optum advances our shared goal of supporting physicians in delivering exceptional patient care in innovative and efficient ways,” Larry C. Renfro, Optum’s chief executive, said in a statement. Analysts praised the move as keeping with UnitedHealth’s broader goal of building a large ambulatory care business. “The asset is strongly synergistic” with the company’s overall “mission and strategy,” Ana Gupte, an analyst for Leerink, told investors after the deal was announced. The proposed acquisition comes after the announcement that another big insurer, Aetna, planned to merge with CVS Health. That transaction, if approved, could transform CVS’s 10,000 drugstores into community-based health care “hubs,” where people could get blood tests or help managing a chronic disease like diabetes. Executives at Aetna and CVS said that this new model would result in better care and lower costs for patients. At a time of growing uncertainty in the health care marketplace, doctors, drugstores, hospitals and insurers are looking outside their traditional businesses to join forces. The tax overhaul proposed congressional Republicans could cut payments to federal programs like Medicare sharply and upend [...]

By |December 14th, 2017|Blog, Consulting, doctor, doctor Credentialing, Healthcare Professionals, ICD-10, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on UnitedHealth Buys Large Doctors Group as Lines Blur in Health Care

UnitedHealth’s Splish Beats CVS-Aetna’s Splash

Bloomberg Gadfly - By Brooke Sutherland Max Nisen - Dec 6, 2017 11:52 AM EST UnitedHealth Group Inc. is that kid in school who's always doing better than you.The $214 billion company announced on Wednesday that it's buying DaVita Inc.'s physician-network business for $4.9 billion. It's just the latest step in UnitedHealth's push to diversify its revenue. Thanks to deals over the past few years, the company isn't just the largest private U.S. health insurer, it's also a pharmacy-benefit manager, a health care analytics company and increasingly a provider of medical care through physician clinics, outpatient services and urgent care centers. *The company's two largest insurer purchases -- of units of Fiserv and Sierra Health Services -- were both announced in 2007 and included a number of non-insurance businesses that likely now fall under Optum This is the blueprint that CVS Health Corp. and Aetna Inc. are attempting to follow with their $77 billion merger. Antitrust authorities have made abundantly clear that they aren't fans of further consolidation among the top health insurers nor among the top drug-store operators, forcing companies to look elsewhere in the health-care world for growth opportunities. UnitedHealth has proven that diversification does more than just create new revenue streams -- it also offers cost, information, and convenience advantages that can in turn bolster the appeal and performance of the insurance unit. The problem for CVS-Aetna is that UnitedHealth had the idea first, and the DaVita deal is a reminder that it has no intention of slowing down. UnitedHealth is a much larger provider of medical services than many people realize, and deals like the DaVita acquisition and its $3.2 billion purchase of outpatient-services provider Surgical Care Affiliates Inc. earlier this year have [...]

On children’s health coverage, congressional inaction has brought us to the ‘nightmare scenario’

LA TIMES - Micahel Hiltzik- November 27, 2017 Child healthcare advocates have been warning, and warning, and warning that Congress’ delay on reauthorizing funds for the Children’s Health Insurance Program places health coverage for as many as 9 million children and pregnant women at risk. But since the funding expired Sept. 30, there has been no action by Congress. Now, advocates say, “the nightmare scenario is close” for states across the country, to quote former Medicare and Medicaid chief Andrew Slavitt, as the state-federal program runs out of federal money. State officials in Colorado started sending letters to families on CHIP as early as Monday, warning them that their kids’ health insurance could run out Jan. 30 and they should “start researching private health insurance options.” If Congress doesn’t vote within two weeks to resume the program’s $15 billion in annual funding, the state officials said, they would send out official notification of the program’s cancellation. A similar high-wire act is playing out in at least 11 states whose CHIP coffers will be exhausted by the end of December, according to the Kaiser Family Foundation; that roster includes California. In Colorado and 20 others, there’s just enough money left from earlier appropriations to last into the first month or so of 2018. We’ve sounded the alarm about the expiration of CHIP in four columns since May, when congressional dysfunction built to the point that a reauthorization of CHIP by Sept. 30 began to look doubtful. The fears of children’s advocates proved true when the deadline passed without a vote; but even then most assumed that the delay would be brief, and the issue would be resolved before too many states had to take stringent measures. [...]

By |December 1st, 2017|Blog, Commercial Insurance, Credentialing, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, medicare claims, Obamacare, Physician Credentialing|Comments Off on On children’s health coverage, congressional inaction has brought us to the ‘nightmare scenario’

Amazon’s cloud is about to announce a huge health-care deal with Cerner

CNBC- Christina Farr | Jordan Novet Published 11:21 AM ET Wed, 22 Nov 2017 Updated 1:22 PM ET Wed, 22 Nov 2017 Amazon's cloud unit to partner with Cerner: Sources Amazon's cloud unit to partner with Cerner: Sources say Amazon's cloud business, in its march toward $20 billion in annual revenue, has nabbed top clients in areas ranging from energy and technology to financial services and government. Heading into its annual re:Invent conference in Las Vegas next week, Amazon Web Services has found a partner to help the company crack a massive industry that's been slower to adopt the cloud: health care. As part of his keynote at re:Invent, AWS CEO Andy Jassy is planning to announce that Amazon is teaming up with Cerner, one of the world's largest health technology companies, to help health-care providers better use their data to make health predictions about patient populations, according to sources familiar with the matter. The sources, who asked not to be named because the discussions are still in the final stages, said the partnership is initially focused on Cerner's so-called population health product — HealtheIntent — which enables hospitals to gather and analyze huge volumes of clinical data to improve patients' health outcomes and lower treatment costs. Cerner did not provide a comment for this story, and AWS representatives didn't respond to requests for comment. In addition to its health investments, AWS has sought to expand its push into the public sector. Earlier this week it announced plans for a group of cloud data centers for the CIA and other U.S. intelligence community members. Relative to most industries, hospitals and other health providers have resisted the shift from traditional data centers to the cloud because of [...]

I.R.S. Starts to Enforce Health Law’s Rule That Employers Offer Insurance

NY TIMES- By STACY COWLEY NOV. 16, 2017 As Republicans and the Trump administration continue trying to chip away at the Affordable Care Act, the Internal Revenue Service has begun, for the first time, to enforce one of the law’s most polarizing provisions: the employer mandate. Thousands of businesses — many of them small or midsize — will soon receive a letter saying that they owe the government money because they failed to offer their workers qualifying health insurance. The first round of notices, which the I.R.S. began sending late last month, are being mailed to companies that have at least 100 full-time employees and ran afoul of the law in 2015, the year that the mandate took effect. Large companies, defined in the law as those with 50 or more workers, are required to offer their employees affordable insurance or pay stiff tax penalties. The I.R.S. held off for years on assessing those fines, saying that it needed more time, and money, to build its compliance systems. Now, the agency says it is finally ready to go after scofflaws. “As the I.R.S. has publicly stated, the agency is obligated to enforce the Affordable Care Act’s employer shared responsibility provision,” said Bruce Friedland, an agency spokesman. Ten months ago, in his first executive order, President Trump directed government agencies to waive, defer or delay carrying out as much of the law as possible. This week, the Treasury Department said that it objected to the employer mandate but was legally compelled to enforce it. “Treasury lawyers see no ground for the secretary to direct the I.R.S. to not collect the tax,” the agency said in a written statement. “The A.C.A.’s employer mandate unfortunately remains the law of [...]

By |November 16th, 2017|Blog, Credentialing, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medical Billing, Medical Coding, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Physician Credentialing|Comments Off on I.R.S. Starts to Enforce Health Law’s Rule That Employers Offer Insurance

Insurers make billions off Medicaid in California during Obamacare expansion

Los Angeles Times - Chad Terhune and Anna Gorman- NOVEMBER 6, 2017 Medicaid is rarely associated with getting rich. The patients are poor, the budgets tight and payments to doctors often paltry. But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds that patient care is subpar. Health Net, a unit of Centene Corp., the largest Medicaid insurer nationwide, raked in $1.1 billion in profit from 2014 to 2016, according to state data obtained by Kaiser Health News. Anthem, another industry giant, turned a profit of $549 million from California’s Medicaid program in the same period. Overall, Medicaid insurers in the Golden State made $5.4 billion in profits from 2014 to 2016, in part because the state paid higher rates during the inaugural years of the nation’s Medicaid expansion under the Affordable Care Act, or Obamacare. Last year, they made more money than all Medicaid insurers combined in 34 other states with managed care plans. “Those profits are gigantic — wow,” said Glenn Melnick, a health economist and professor at USC. Alan Sager, a health-policy professor at Boston University, was surprised — and dismayed. “California is being wildly open handed and excessively generous with insurers,” he said. Jennifer Kent, California’s Medicaid director, said that health plan profits were higher than anticipated during the ACA expansion. But she said the state expects to recoup a significant amount of money within the next year once audits are complete and other retroactive rate adjustments are made. “We’re going to be taking a lot of money back. We’re talking billions of dollars,” Kent said in an interview Friday. No one should think “these plans just made off like bandits and [...]

By |November 9th, 2017|Blog, Commercial Insurance, Credentialing, doctor, doctor Credentialing, Healthcare Professionals, Medicaid, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on Insurers make billions off Medicaid in California during Obamacare expansion