About health insurance/insurers
Optum, Aetna agree to settle 'dummy code' lawsuit “Aetna and Optum have agreed to settle a class-action lawsuit that accused the companies of improperly charging administrative fees as medical expenses.
The lawsuit, initially filed in 2015, claimed that Aetna and Optum used misleading billing practices — specifically, employing ‘dummy codes’ to disguise administrative fees for chiropractic services as medical charges — thereby causing plan participants and their employers to pay the fees unknowingly.”
Oscar Health’s Obamacare Business Continues To Grow As Trump’s Return Looms “Oscar Health Thursday reported a $54 million third quarter loss despite continued growth, heading into what could be an uncertain political period under Donald Trump and Republicans in Congress.
But those running the provider of individual coverage under the Affordable Care Act say they believe such health insurance, also known as Obamacare, is ‘positioned for long-term growth — appealing to GOP desires for consumer choice and a free market approach,’ Oscar said in a statement accompanying its third quarter earnings report.”
Millions at risk of losing health insurance after Trump's victory “Millions of Americans risk losing subsidies next year that help them pay for health insurance following President-elect Donald Trump’s election win and Republicans’ victory in the Senate.
The subsidies — which expire at the end of 2025 — came out of the 2021 American Rescue Plan, and increased the amount of assistance available to people who want to buy health insurance through the Affordable Care Act. The American Rescue Plan also broadened the number of people eligible for subsidies, extending them to many in the middle class.
The looming expiration date means that the incoming Congress and next president will need to decide whether to extend them — something Trump and Republicans have already signaled they don’t support, said Chris Meekins, a health policy research analyst at the investment firm Raymond James.”
About hospitals and healthcare systems
Characteristics of Health Systems Operating Medicare Advantage Plans “Nearly 1 in 7 MA beneficiaries are enrolled in system-operated MA plans, which remain a consistent source of Medicare enrollment. The findings of this study suggest that larger and church-affiliated health systems are associated with a higher likelihood of operating an MA plan. System-operated MA plans were associated with higher quality ratings and patient satisfaction than unaffiliated MA plans. This aligns with prior research suggesting system-operated plans may be more cost-effective, efficient, and of higher quality.”
About pharma
Pharma giant GSK is quitting BIO in latest setback for the lobbying group GSK is the latest pharmaceutical company to quit this trade organization.
About healthcare IT
Primary Care Practice Telehealth Use and Low-Value Care Services “In this cohort study of Medicare fee-for-service beneficiaries who received care from primary care practices in Michigan, some low-value care services (ie, cervical cancer screening among women older than 65 years and low-value thyroid testing) were lower among practices with high telehealth use, and there was no association between practice-level telehealth use in rates of most other low-value care services not delivered in the office. As telehealth continues to be an important part of care delivery, evaluating how it may encourage or discourage low-value care services is critical to understanding its impact on quality of care.”