Morning Briefing
Summaries of health policy coverage from major news organizations
With 'Gold Card' Program, Centene Aims To Make Prior Authorization Easier For Providers, Patients
Modern Healthcare: Centene To Launch Gold Card Program For Prior Authorizations
Centene is launching a new program next month aimed at streamlining the prior authorization process for some providers. The health insurance company will allow more than 160,000 providers nationwide to use a simplified process for select outpatient services, the company announced in a news release Tuesday. Centene will assess providers’ eligibility based on their approval history, documentation quality, compliance with medical policy and adherence to regulatory requirements. The insurer will offer its “gold card” program across its commercial, Medicare Advantage and Medicaid business lines, a company spokesperson said. (Tepper, 10/13)
More news about Medicare and Medicaid —
Modern Healthcare: CMS Gains Broader Power To Remove Medicare, Medicaid Participants
The Centers for Medicare and Medicaid Services has gained unprecedented authority to remove providers, insurers and suppliers from federal health programs over fraud concerns. Health and Human Services Secretary Robert F. Kennedy Jr. published a notice Tuesday announcing he is officially delegating those powers, which had been solely held by the HHS Office of Inspector General, to CMS. (Early, 10/13)
Modern Healthcare: CMS Insurer Price Transparency Rule Targets Ghost Rates
A regulation designed to reduce health insurance companies’ administrative expenses may dampen their competitive edge. The Health and Human Services, Labor and Treasury departments finalized a rule last week intended to clean up the pricing information insurance companies disclose. (Tepper, 10/13)
The Hill: 43 Percent Of Americans Support 'Medicare For All' As Healthcare Costs Mount: Poll
Nearly 43 percent of Americans support the idea of “Medicare for all,” according to an Axios/Ipsos poll released Tuesday, as concerns over health costs mount ahead of the midterm elections. People who said they support Medicare for all outnumbered its opponents by a nearly 2-to-1 margin, while a bipartisan majority of Americans said they think the federal government should be willing to spend more tax dollars to lower healthcare costs. While respondents said they support federal involvement, they are losing trust in the government. (Weixel, 10/13)
More healthcare industry developments —
Modern Healthcare: UnitedHealth, Cigna, Aetna Unite On Shared Provider Data Standard
Health insurers are partnering to tackle common issues plaguing provider data quality. DataSpring, formerly known as the Council for Affordable Quality Care and owned by major health insurers, has established a standard framework to improve the accuracy of provider data, the organization announced Tuesday. Founding members of the Provider Data Collective include publicly traded insurers Centene, Cigna Group, CVS Health’s Aetna, Elevance Health, Humana and UnitedHealth Group. Other members are the American Medical Association and the National Committee for Quality Assurance. (Tong, 10/13)
Stat: BlackRock Pays $2.8 Billion For Majority Stake In Humana's CenterWell
Humana is swapping out private equity sponsors for its CenterWell Senior Primary Care clinics. Good bye, Welsh, Carson, Anderson & Stowe. Hello, BlackRock. (Bannow, 10/13)
Bloomberg: Blackstone Sells ZO Skin Health To Galderma For $1.5 Billion
Galderma Group AG agreed to buy ZO Skin Health Inc. for an enterprise value of $1.5 billion in an all-cash deal that expands the Swiss dermatology company’s physician-dispensed skincare portfolio in the US. California-based ZO is being sold to Galderma by shareholders including Blackstone Inc. and the founding Obagi family, according to a statement Wednesday. Blackstone bought a majority stake in ZO in 2020 through its tactical opportunities fund for an undisclosed sum. (Catelli, 10/14)
Modern Healthcare: MultiCare, Samaritan Health Services Merger To Close Nov. 1
MultiCare Health System and Samaritan Health Services will merge on Nov. 1 after securing regulatory approval for the deal. Under the the terms of the deal, Tacoma, Washington-based MultiCare will invest $700 million over 10 years in Corvallis, Oregon-based Samaritan to increase access to care, recruit and retain providers, improve infrastructure, and upgrade technology, MultiCare announced in August. Samaritan will retain its name and local leadership, according to a news release the health system issued Monday. (Kacik, 10/13)
Modern Healthcare: How AI Could Make It Harder For Hospitals To Switch EHR Vendors
Providers are often reluctant to switch electronic health record vendors, and the advent of artificial intelligence may make it even harder for them to make a move. Over the years, many key EHR players have added AI tools to their platforms, including features for ambient listening, revenue cycle management, coding, chart review and more. As generative AI advances, many providers think it will drive up the costs of switching vendors, according to a survey published last month by Bain & Company and KLAS. (Famakinwa, 10/13)
Also —
Chicago Tribune: Nurses At Endeavor Health Edward Hospital Seek To Unionize
Nurses at Endeavor Health Edward Hospital have filed a petition with the National Labor Relations Board to hold a union election – part of a broader effort by nurses across the health system to organize. (Stein and Schencker, 10/13)
KFF Health News: Aging Life Care Managers Can Be A ‘Godsend’ For Families
Kristin Martinelli began her workday at 7:30 a.m. on a recent Monday, completing an online Medicaid recertification form for a client in a nursing home in Austin, Texas. Next, she drove to meet an 85-year-old and her daughter, who had come in from out of town. The older woman had “pretty advanced dementia” and was scheduled to move into the secure memory care unit of a senior living facility that day, said Martinelli, who works as an aging life care manager with Mir Care Consultants in Central Texas. The three of them had a 9 a.m. meeting with the primary care doctor who would complete the paperwork for the move. (Span, 10/14)
