Insurer Archives - Mediarabe

Priority Health first insurer in Michigan to offer provider-based incentives for tracking SDoH data

October 6, 2020

Priority Health announced today its plans to pilot new incentives for providers who screen patients and submit information on Social Determinants of Health (SDoH), making them the first insurer in the state to financially support this type of data tracking. According to the Centers for Disease Control and Prevention, SDoH are conditions in the places where people live, learn, work and play that affect a wide range of health and quality-of-life risks and outcomes. The new incentives for eligible providers will begin on January 1, 2021.

“We understand that to effectively manage the health and wellness of a patient population, you need to look outside of the clinic walls. Being able to reward providers who are identifying these specific needs based on social factors is a step in the right direction,” said Mike Jasperson, Senior Vice President of Provider Network Strategy at Priority Health. “Having access to this type of

Clover Health, a Next-Generation Medicare Advantage Insurer, Announces Plans to Become Publicly-traded via Merger with Social Capital Hedosophia

October 6, 2020

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| Health Plans

Clover is a next-generation Medicare Advantage insurance company offering best-in-class plans that combine wide access to healthcare and rich supplemental benefits with low out-of-pocket expenses
A unique model in health insurance, Clover partners with primary care physicians using its software platform, the Clover Assistant, to deliver data-driven, personalized insights at the point of care
The transaction is expected to fuel Clover’s trajectory as one of the nation’s fastest growing Medicare Advantage plans
Transaction values Clover at an enterprise value of $3.7 billion and is expected to provide up to $1.2 billion in cash proceeds, including a fully committed PIPE of $400 million and up to $828 million of cash held in the trust account of Social Capital Hedosophia Holdings Corp. III (“SCH”)
PIPE led by $100 million from Chamath Palihapitiya, Founder and CEO of SCH, and $50 million from Hedosophia, as well as commitments from Fidelity Management & Research Company,

Multi-billion-dollar Medicaid contract at stake in legal filing by Aetna Better Health. Insurer asks for review of DHHS selection process. | Local News

September 28, 2020

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| Better Health

“The state also has failed to fulfill its own well-documented commitments to the federal government and the public.”

Moving ahead

The main launch challenge is getting the four statewide PHPs operational by the enrollment date.

Managed care is a system under which people agree to see only certain doctors or go to certain hospitals, as in a health maintenance organization, or HMO, or a preferred provider organization, or PPO, health-insurance plan.

Under the current Medicaid system, providers are paid on a fee-for-service model administered by DHHS.

By contrast, the PHPs will pay health-care providers a set amount per month for each patient’s costs. There will be a limited number of special-needs individuals who will remain with fee-for-service providers.

The next big rollout step for DHHS is formulating the per-patient rates for providers by November and submitting them to CMS.

DHHS will reimburse the PHPs, and people will be able to

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