L.A. Care Health Plan Streamlines Preauthorization Process
The insurer has removed about 14,000 billing codes that would require prior authorization, including for lab tests and specialty care visits. Also in health industry news: the No Surprises Act, McLaren Health Care cyberattack, VillageMD, and more.
Modern Healthcare:
L.A. Care Health Plan Cuts Some Prior Authorization Requirements
L.A. Care Health Plan has cut 24% of its prior authorization requirements in what the insurance company characterized as an effort to lighten administrative burdens for providers, reduce discharge times and avoid care delays. Some specialty care visits, laboratory tests, medical equipment and catheter supplies will no longer require prior authorization, the insurer said in a news release Wednesday. (DeSilva, 8/7)
Modern Healthcare:
What The No Surprises Act Ruling Means For Providers, Insurers
Providers notched another win in the legal battle over the No Surprises Act, forcing regulators to rework how the law is implemented. The U.S. Court of Appeals for the 5th Circuit on Friday upheld a lower court ruling and voided parts of the law related to settling out-of-network reimbursement disputes, since the process skewed negotiations in insurers’ favor. (Kacik, 8/7)
Axios:
Insurers’ Big Profits Stem From Care Delivery, Not Core Business
For insurers like UnitedHealth Group and Cigna, the road to ever-larger profits increasingly leads through anything but health insurance. (Reed, 8/8)
More health industry news —
CBS News:
McLaren Health Care Confirms Criminal Cyber Attack Caused Disruptions To IT, Phone Systems
McLaren Health Care confirmed on Wednesday that a criminal cyber attack caused disruptions to information technology and phone systems reported on Tuesday. Officials say it is unknown if any patient or employee data was compromised. The IT team is working with security experts to investigate the cyber attack. (Booth-Singleton, 8/7)
Stat:
Orlando Health Expanding Into Alabama
As for-profit Tenet Healthcare slims its hospital portfolio, it found an unlikely buyer for its Alabama hospitals: Florida’s Orlando Health. (Bannow, 8/8)
Modern Healthcare:
Prospect Medical Holdings To Sell Crozer Health To CHA Partners
Prospect Medical Holdings signed a letter of intent to sell Crozer Health to CHA Partners, Crozer CEO Tony Esposito said Wednesday. The proposed transaction, which requires the execution of a definitive agreement and regulatory approvals, is expected to close in several months and would transition Upland, Pennsylvania-based Crozer to nonprofit status, Esposito said in a statement. Financial details were not disclosed. (Hudson, 8/7)
The Boston Globe:
Among Massachusetts Hospitals, The Gap Between Rich And Poor Widens
The latest state review of hospital payment data, released this month by the Center for Health Information and Analysis, underscores a persistent gap in the fortunes of acute care facilities. Community hospitals that see a high proportion of people with public insurance commanded prices that are 7 percent below the state average. It’s a twofold problem: Those insurance programs — such as Medicaid and Medicare — pay below-market rates. On top of that, private payers such as Blue Cross Blue Shield, Tufts, and Harvard Pilgrim Health Care pay less to community hospitals than they do academic facilities. (Lee, 8/7)
Modern Healthcare:
Walgreens May Sell Entire VillageMD Stake
Walgreens is considering selling its entire majority stake in primary care provider VillageMD, a move that would be a dramatic about-face from its previous commitment to the care model. The company is evaluating "a variety of options" in light of "VillageMD’s substantial ongoing and expected future cash requirements," Walgreens said in a Securities and Exchange Commission filing Wednesday. Options include selling all or part of its stake in VillageMD, a restructuring or other opportunities, the company said. (Hudson, 8/7)
