Did UnitedHealthcare’s risk adjustment department actually “turn on the gas,” as one executive put it, in an illegal effort to increase revenue? That’s the claim at the heart of two cases the federal Department of Justice brought this spring against the nation’s largest health insurer. The industry is watching closely.
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Fashioning health care IT so it protects patients against medical mistakes requires a sustained effort that should be funded by both the private and public sectors, according to a report by the Bipartisan Policy Center. The cost would be a “nominal” amount of between $3 million and $4 million a year

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The Democratic governor and the Republican legislature have moved to shore up the individual market, but Minnesotans are leaving it in droves. About 167,000 residents bought individual coverage this year, compared with 270,000 in 2016. Premium hikes have been caused, in part, by the consolidation of providers.

For the first time, researchers say that certain behaviors can prevent cognitive decline.

Value-based health care may be getting rave reviews in some places where it’s been tried but many hospital systems still cling to the fee-for-service system, Modern Healthcare reports.

Employers should do their best to accommodate workers with disabilities or who are recovering from injuries, but there’s been little change in the total unemployment numbers of such workers since the passage of the Americans With Disabilities Act in 1990, Workforce reports.

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Joseph Burns
Maine presents some daunting challenges when it comes to insurance coverage and health care costs because it’s both the most rural state in the country and the one with the highest median age, two factors that drive up health spending.

Health plans are pleased that, at least for now, the major gains in enrollment under Medicaid that the ACA facilitated will be left intact.

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The lowest rate of uninsured, but costs are a concern. That’s due, in part, to the clout of the state’s large prestigious health care systems, especially Partners Healthcare in Boston, which includes Harvard-affiliated Massachusetts General Hospital, and Brigham and Women’s hospitals.

At least one health plan nudges the value-based payment system toward an approach that many experts believe has to happen if the scheme is to succeed. Most value-based payment systems reward doctors for keeping costs down, but don’t detract from their pay if costs go up.

For those of us who admit to needing a gossip fix now and then, this story aught to keep us satisfied for at least a year. It’s an old formula, though.

UnitedHealth Group’s net profit for the second quarter rose to $2.28 billion, or $2.32 a share, from $1.75 billion, or $1.81 a share, in last year’s second quarter, the Wall Street Journal reports. Profit from premiums rose from $36.4 billion to $39.4 billion, according to experts.

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After premiums for 2017 increased, on average, by 32.5% over premiums for coverage in 2016, rate filings by insurers for 2018 show rates going up by only 8.8% over 2017 rates. But it could take at least five years for the ACA exchanges to shake all the bugs out.

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Those who say the ACA is collapsing often point to Tennessee as evidence. And Gov. Bill Haslam has called it “ground zero” for plans pulling out of the ACA marketplaces. To give just one example, UnitedHealthcare left the individual market in the state at the end of 2016.

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The ACA drove down the uninsured rate despite the lack of Medicare expansion, but major insurers have left the market. In some rural areas, Florida Blue is the only health plan in the game. Also in the mix: Consumers here usually pick the lowest-cost plan available.

Road Trip

Charlotte Huff
The Lone Star State continues to lead the country in the percentage of its residents without health insurance, although a dent has been made. As of 2015, 17% of Texans were uninsured, compared with 22% two years before, according to the most recent census bureau data.