The Medicare Payment Advisory Commission (MedPAC) paints a rosy portrait of home health margins. But an analysis of cost reporting data – that considers both traditional Medicare and Medicare Advantage (MA) payments – shows that providers are generally not sitting atop a hill of money. Instead, they are struggling to stay above water. Kalon Mitchell […]
The Centers for Medicare & Medicaid Services (CMS) dealt a blow to UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM) – the two largest Medicare Advantage (MA) administrators – by lowering their star ratings for 2025. Broadly, MA plans are rated on a scale from one to five, and CMS has lowered those ratings […]
Despite multiple large insurers pulling back on Medicare Advantage (MA), about 51% of Medicare beneficiaries are expected to be enrolled in an MA plan come 2025. The Centers for Medicare & Medicaid Services (CMS) has created a less rosy payment environment for MA plans over recent years, and that has forced some plans to exit […]
Essentia Health – a regional, nonprofit health system with a substantial home health arm – announced this week that it will no longer serve as an in-network provider for UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM) Medicare Advantage (MA) plans. It is the latest example of home-focused health care providers drawing a line […]
Yet another significant cut to home health payments has been proposed by the Centers for Medicare & Medicaid Services (CMS) for 2025. For providers, that means more pushback against cuts is in order, locally and in Washington, D.C. But it also means preparing for a world where Medicare fee-for-service is no longer a reliable backbone. […]
While getting a fair rate is top of mind for home health providers, the ones that are seeing the most success in their negotiations with Medicare Advantage (MA) payers are selling their ability to be a solution. Even before entering negotiations with MA plans, providers should have a clear understanding of the challenging reimbursement environment […]
Humana Inc. (NYSE: HUM) will be exiting 13 Medicare Advantage (MA) markets in 2025, company leaders said during the Wells Fargo Healthcare Conference. The company had already announced that it was planning to leave markets next year, but offered up more specifics last week. Humana CFO Susan Diamond said the company’s exit from those 13 […]
Earlier this year, I had the chance to interview CenterWell President Sanjay Shetty on stage and off stage at the Digital Healthcare Innovation Summit in La Jolla, California. Last month, at Home Health Care News’ FUTURE conference in Nashville, I did the same with Kirk Allen, the president of home solutions at Humana Inc. (NYSE: […]
When examining a Medicare Advantage (MA) population, one unhealthy day was enough to increase 30-day medical costs, a new study found. The study sought to examine the connection between self-reported physically and mentally unhealthy days and health care costs among an MA population. One of the driving forces behind the study was Papa, a company […]
Top home health leaders maintain that they’re operating in a space filled with “tons of opportunity.” Payment uncertainty and other contemporary operating dynamics can muddy the waters, but there’s a way through those challenges, those leaders believe. “I’m going to sound delusional,” Pinnacle Home Care CEO Shane Donaldson told me on stage last week at […]
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