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On October 13, 2015, your humble blogger received the AIS Inside Health Insurance Exchange quote of the day related to non-payment of the Risk Corridor payments, “…. there was a contract going into this that there would be certain protections… and plans would price as best as they could, knowing that there was no actuarial precedent for the risk. The news that CMS could pay carriers 12 cents for every dollar requested for the first year of the risk corridor program felt like Lucy moving the football at the last second.”
On Monday, January 23, U.S. District Judge John Bates issued his highly-anticipated decision regarding the Department of Justice’s anti-trust challenge that blocked the proposed $37 billion- merger between Aetna and Humana. The ruling in favor of the Department of Justice (DOJ) is significant because of the merger’s potential to cause Medicare Advantage disruptions and other […]
About five years ago our Chairman, Governor Mike Leavitt, approached a small group of us and expressed a desire for Leavitt Partners to architect a model that would predict the pace of America’s change away from a predominantly fee-for-service (FFS) payment system to some other form of loosely defined value reimbursement. Led by Dr. David […]
A week ago, one of our colleagues found himself ill. To him it felt to be a familiar case of the common cold or flu, for which he had been treated several times over the course of his life. With a desire to demonstrate the use of the telemedicine platform Leavitt Partners recently adopted, he […]
David Smith noted that “The challenge for health plans is to somehow communicate to plan members that the term ‘narrow network’ does not mean a lower quality of care or less access. “Plans will have to make sure that these are high performance networks that deliver a better experience to members due to better patient management.” for a Managed Healthcare Executive entitled “Number of Narrow Networks to increase in 2015”.
Two seismic shifts will transform the American health system: Health insurance exchanges, either public or private, and reimbursement models slowly migrating from fee-for-service.
The Fiscal Times quotes David Smith, director of Payer Services at Leavitt Partners, on his commentary on the complexities and challenges of the Affordable Care Act. The article focuses on how functional illiteracy could be a major barrier for effective implementation among the uninsured population.
In a July 11 HealthDay News article, David Smith and Dan Schuyler provided their insight into the implementation of health care reform for 2014. In regards to state health insurance exchanges, Dan said “self-reporting will streamline the enrollment process, but also opens the door to deliberate fraud, abuse and unintentional eligibility errors.” David downplayed the possibility that the White House would put the brakes on the state insurance exchanges or the individual mandate, noting that “Politically, the administration can’t afford a delay of the more critical pieces of the law and will move mountains to implement them on time while managing expectations.”
On July 10, HighRoads Announced Findings from a Leavitt Partners Report on Health Insurance Plans Operational Effectiveness. According to the report, all payers in all categories are struggling to meet ACA-driven requirements due to the necessity of gathering plan data from a myriad of different systems. David Smith said, “New ACA requirements are driving a range of health plan operational challenges that must be efficiently addressed with technology innovation for assured compliance. In our findings, it’s apparent that most of the plan data reside on older legacy systems industry-wide.”
David Smith, Analyst at Leavitt Partners, discusses the Congressional Budget Office’s (CBO) annual budget and economic outlook for 2013-2023.