Payer Roundup—North Carolina to begin Medicaid managed care; Anthem taps Google whiz for AI

data visualization
Data analytics is becoming increasingly important to health insurance companies. (ra2studio/iStock)

CMS approves North Carolina §1115 waiver

The Centers for Medicare & Medicaid Services (CMS) approved an §1115 waiver on Wednesday allowing North Carolina to implement Medicaid managed care. In addition to integrating medical, behavioral healthcare and pharmacy benefits, the state will create tailored plans for groups with certain needs, such as individuals with intellectual or developmental disabilities or people with substance use disorder.

The waiver allows the North Carolina Department of Health and Human Services (NCDHHS) to “build an innovative and whole-person centered system that addresses both medical and non-medical drivers of health,” said Mandy Cohen, M.D., secretary of NCDHHS.

The waiver will go into effect on Jan. 1, 2019. (Release | CMS approval letter)

Conference

13th Partnering with ACOS & IDNS Summit

This two-day summit taking place on June 10–11, 2019, offers a unique opportunity to have invaluable face-to-face time with key executives from various ACOs and IDNs from the entire nation – totaling over 3.5 million patients served in 2018. Exclusively at this summit, attendees are provided with inside information and data from case studies on how to structure an ACO/IDN pitch, allowing them to gain the tools to position their organization as a “strategic partner” to ACOs and IDNs, rather than a merely a “vendor.”

Anthem hires top Google engineer as AI lead

Anthem’s new head of artificial intelligence will be Udi Manber, a prominent computer scientist who formerly led Google’s search products division and launched a research center for the National Institutes of Health (NIH) in the Bay Area. Manber will oversee Anthem’s AI operations, and one of his first duties will be to put together a team. He is the first person with this role.

Health insurance companiesfrom startups like Oscar Health to giants like UnitedHealthare increasingly making use of data analytics. Some experts say insurers want to use enrollee data to improve health outcomes, but as an NPR-ProPublica investigation revealed in July, their motives aren’t always quite so benevolent. (CNBC article)

WellCare, Care1st plants regional office in Phoenix

WellCare and its subsidiary, Care1st Health Plan Arizona, announced on Tuesday it plans to launch a regional hub in Phoenix. Through this new office, the companies hope to better serve Medicaid members within Arizona, though the office will also augment the work done at WellCare’s Tampa headquarters.  

In addition to the new Phoenix office and its headquarters, WellCare has regional offices in seven other cities nationwide.

Care1st Arizona provides behavioral health services in eight of the state’s fifteen counties. The Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid program, awarded it a new Medicaid contract in March. (Release)

Congressional Democrats push back against changes to §1332 waivers

Ranking members of the three House committees with jurisdiction over healthcare released a joint statement on Tuesday criticizing recent changes to requirements for §1332 waivers.

“Allowing states to permit residents to buy these plans further destabilizes the health care market and drives up prices for people with pre-existing conditions,” wrote Representatives Frank Pallone, D-N.J., of Energy and Commerce, Richard Neal, D-Mass., of Ways and Means, and Bobby Scott, D-Va., of Education and the Workforce. “Loosening coverage requirements undermines protections that have helped millions of people gain access to affordable care,” they added.

Under the new guidance, waivers do not need to demonstrate that the same number of people (or more) will have comprehensive coverage, only that it will remain available as an option. (Release)

New report illuminates Medicaid trends, nationally and locally

A new report from Ari Gottlieb and Augustin Ruta, consultants at A2 Strategy Group, shed light on numerous Medicaid enrollment trends at the local level and nationwide.

In 2018, 74.2 million Americans received physical health benefits through the programa 1.1 million person decrease from 2017, but still more than a fifth (22.8%) of the population. The authors attributed this to economic growth as well as a “pause” in expansion decisions and some states trying to “aggressively prune” enrollment.

Of the 20 counties with the highest percentage of residents enrolled in Medicaid, nine are in Kentucky and four are in Alaska, the authors found. Topping that list are Kusilvak Borough in Alaska, with 81.3% of residents enrolled, and Kentucky’s Owsley County, with 65.5%.

The counties with the lowest percentages of people in Medicaid are concentrated in South Dakota, Virginia and Utah; most are small. Only 12 counties have less than 5% of residents in the program.

The report also found most of the Medicaid managed care population seems resides in populous countiesthink Los Angeles County; Kings County, New York; Maricopa County, Arizona; and Cook County, Illinois. The ten counties with the highest Medicaid managed care populations comprise just 0.3% of counties nationwide, but they are home to nearly a fifth of all managed care beneficiaries. (Report)

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