"Gov. Jerry Brown has signed legislation that requires weekly updates to health-service provider directories so people know what doctors and hospitals are in their network when they they shop for coverage or seek care.
Senate Bill 137 by West Covina Democrat Ed Hernandez responds to consumer complaints about inaccurate online directories. This has been a problem for years, but things got worse when thousands of consumers tried to pick a plan and provider after signing up for new insurance under the Affordable Care Act.
The problem got so bad that Covered California took its provider search tool down in February 2014. It still isn’t up — consumers are directed to individual health plan websites instead. The Department of Managed Health Care slammed Anthem Blue Cross and Blue Shield of California last year for failing to provide accurate provider lists. The agency is preparing to do follow-up surveys to see if inaccuracies have been fixed, spokesman Rodger Butler said."
Read more at Modern Healthcare
"WASHINGTON -- Two of the largest names in healthcare insurance are buying out their competition, triggering an investigation by the U.S. Department of Justice (DOJ) and expressions of concern from hospital and physician groups, as well as Congress.
In July, Aetna announced plans to acquire Humana for $37 billion. Just a few weeks later, Anthem revealed it was merging with Cigna in a $48 billion deal.
Critics say merging four of the five biggest insurers in the nation will kill competition, causing premiums to rise, benefits to narrow ,and provider payments to decline.
"Once [these deals are] consummated, there is simply no going back," said Andrew Gurman, MD, president-elect of the American Medical Association, in testimony before the House Judiciary Committee last week.
"You cannot unscramble an egg," said Gurman, who is an orthopedic hand surgeon based in Altoona, Pa.
Proponents of the mergers (namely, industry executives) argued that consolidating these four businesses would reduce administrative costs and expand networks, allowing companies to provide a broader array of products and services. The mergers would also accelerate the transition to value-based care and strengthen healthcare analytics, they said."
Read More at MedPage Today
"Super-utilizers are the frequent fliers of the health care system, whose serious illnesses send them to the hospital multiple times every year and cost the system hundreds of thousands of dollars annually. Figuring out how best to address these patients’ needs and reduce their financial impact on the health care system is a subject of intense interest among policymakers. Now a new study has found that, in contrast to the notion that “once a super-utilizer, always a super-utilizer,” many patients who use health care services intensely do so for a relatively brief period of time.
Research and news reports often point out that super-utilizers are often uninsured or on Medicare and Medicaid and account for a large percentage of health care spending. Federal officials have suggested that their “large numbers of emergency department [ED] visits and hospital admissions … might have been prevented by relatively inexpensive early interventions and primary care.” Many of the programs that have been developed to reduce super-utilizer health care use have focused on the needs of people with multiple chronic conditions, ensuring they have a medical home through which their care is coordinated, for example, or addressing their social services needs."
Read more on Kaiser Health News
"Health insurance giant Blue Shield of California owes $82.8 million in rebates to consumers and small employers under requirements of the federal health law.
The majority of that money, $61.7 million, will be divvied up among 454,000 individual policyholders who had Blue Shield coverage in 2014. The average rebate is $136.
The remaining rebates of $21.1 million are owed to about 19,000 small employers. Customers will receive their money by the end of next month, according to the San Francisco insurer."
Read more on LA Times
"Pager, a Manhattan-based doctor-on-demand service, has raised $14 million in Series A funding from Maryland-based New Enterprise Associates and Ashton Kutcher's Sound Ventures.
The funding will be used to expand to cities outside New York, including San Francisco within two months, and to upgrade the company's technology, said co-founders Gaspard de Dreuzy and Philip Eytan. Mr. de Dreuzy and Mr. Eytan founded the company in May 2014 with Oscar Salazar, a co-founder of Uber. Other investors in the round included Goodwater Capital, Lux Capital and Montage Ventures.
The service, available in all five boroughs, gives patients the option of forgoing the emergency room or an urgent-care center and summoning a doctor for a house call for treatment of, for example, common infections such as bronchitis. A home visit costs $50 for first-time users and $200 thereafter. Patients can consult a doctor by phone for $25 and exchange text messages with photos in the case of a condition such as a rash or insect bite."
Read more on Craine's New York Business
"Los Angeles-based managed care provider Health Net is being acquired by Centene Corp. in a deal valued at $6.8 billion. The deal could mean job losses at Health Net offices in Rancho Cordova, where more than 2,400 of the Woodland Hills-based health insurer's employees work.
The deal, which is expected to close by early 2016, will add Health Net's Medicare platform to Centene's existing Medicaid programs and create a managed care firm with more than 10 million members nationwide and approximately $37 billion in revenue."
Read more at Biz Journals.
"In a scathing audit, state tax officials slammed nonprofit health insurer Blue Shield of California for stockpiling "extraordinarily high surpluses" — more than $4 billion — and for failing to offer more affordable coverage or other public benefits.
The California Franchise Tax Board cited those reasons, among others, for revoking Blue Shield's state tax exemption last year, according to documents related to the audit that were reviewed by The Times. These details have remained secret until now because the insurer and tax board have refused to make public the audit and related records."
Read more at LA Times