Payer Roundup—Anthem BCBS Indiana offering free legal services to Medicaid enrollees

Anthem headquarters
Anthem BCBS is offering free legal help to Medicaid recipients in Indiana. (Anthem)

Anthem BCBS Indiana offering free legal services to Medicaid enrollees 

Anthem Blue Cross Blue Shield Indiana launched a medical and legal partnership with Indiana Legal Services to provide Medicaid consumers free legal assistance. This pilot program will offer legal counseling for issues such as housing, utilities, income support, education, employment and family law. 

Studies show that people living in lower income brackets have more unresolved legal problems, and the inability to access legal services can result in the loss of housing, employment and childcare disputes. 

“This program exemplifies Anthem’s commitment to not only providing healthcare services but also looking for innovative programs that help address other issues that impact health and quality of life,” Kimberly Roop, M.D., Medicaid plan president at Anthem Indiana, said in a release. (BusinessWire)


2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

PAHCF: Medicare for All would erase 9 years of progress

In honor of the nine-year anniversary of the signing of the Affordable Care Act (ACA), the Partnership for America’s Health Care Future (PAHCF) released a memorandum celebrating advances, such as the increase of health coverage to more than 180 million Americans, and denouncing a Medicare for All solution. 

Over the same period of time, 12 million citizens have gained access through Medicaid in 37 states and the District of Columbia. The memo calls for tools already in existence, such as reinsurance, to stabilize premiums rather than a starting over with a public-only system. 

“Rather than eliminating our entire healthcare system and starting over again with a costly, poorly conceived, one-size-fits-all system—as supporters of Medicare for All-style plans would have us do—we should be using the powerful tools within our existing system to move America towards universal coverage,” Lauren Crawford Shaver of PAHCF wrote in the memo.

The partnership's members include America's Health Insurance Plans, the Blue Cross Blue Shield Association, the American Hospital Association, the American Medical Association and the Pharmaceutical Research and Manufacturers of America. (Memorandum) (PDF)

Humana expands value-based specialty care

Humana announced an expansion of value-based orthopedic specialty care for its Medicare Advantage members, which includes a new bundled payment model for spinal fusion surgeries and a broadening of its Total Joint Replacement Episode-Based Model for total hip or knee joint replacement procedures.

The Spinal Fusion Episode-Based Model will improve payments for readmissions, cervical complications and lumbar complications for participants at Fort Wayne Orthopedics and Ortho NorthEast (Indiana), Mayfield Brain & Spine (Ohio), and OrthoVirginia (Virginia). 

And through the expansion of the Total Joint Replacement Episode-Based Model, eight specialty groups will join the already 60 medical practices in 19 states. These Humana programs are two of the three specialty-care bundled payment models, along with Maternity Episode-Based Model. (BusinessWire)

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