Journal of Urgent Care Medicine

UnitedHealthcare Tries to Cut Costs with ‘Free’ Primary Care

UnitedHealthcare (UHC) is testing a no-cost primary care model to see if it equates to greater use of preventive care and, ultimately, lower costs for the company. It farmed out the program to Harken Health, which gives members unlimited no-fee access to primary care services and a 24-hour helpline, a personal health coach, psychological counseling, and classes in fitness and nutrition. Access is limited at this point, however, as Harken has just six clinics in …

‘Rampant’ Medicare Overbilling Highlights Need for Cost-Efficient Care

Medicare was overbilled by 12.1% in 2015, thanks to improper fee-for-service reimbursements in 21 states, according to the Centers for Medicare & Medicaid Services (CMS). That’s up from 8.6% just five years ago, making it one of the highest error rates in history. Louisiana was the worst offender, with an overbilling average of 19.4%—equating to over $1.2 billion in excess fees. Texas and Georgia also showed over a billion dollars in overcharges to Medicare last …

Tab for ‘Affordable’ Care Act Jumps $136 Billion

Six years after its inception, government forecasts concerning the cost of the Affordable Care Act (ACA, or “Obamacare”) continue to climb. Now the Congressional Budget Office (CBO) says the bill over the next decade will be approximately 11% higher than predicted just a year ago—that’s an extra $136 billion, for a total of $1.34 trillion over that time. The CBO chalks the greater cost up to higher-than-expected enrollment in the expanded Medicaid program established by …

Can Cost Control Be Profitable for New-Model Insurers?

Runaway healthcare spending that amounts to 17.5% of the U.S. economy is inspiring some entrepreneurial insurers to launch new models aimed at bridging the gap between patients and health systems—instead of creating friction between those two interdependent parties, which some claim traditional insurers are doing. One, ZOOM+, is headed by a physician and owns its own neighborhood medical clinics. Another, Clover Health, raised $135 million in venture capital to build a company that sells only …

Study: High Deductibles May Inhibit Adequate Care

High deductibles may be keeping some patients from getting the care they really need—clearly a risk for them but also a possible impediment to healthcare reform in the U.S., according to a new study published in the New England Journal of Medicine. Not mentioned is the fact that urgent care may offer a solution to at least one of those challenges by offering care whose cost is scaled to the appropriate acuity level. The study …

Denial Rate Low—But Costly—4 Months Into ICD-10

The denial rate for claims initiated after the crossover from the ICD-9 system to ICD-10 codes in October has been steady—and lower than hysterics predicted it would be—if the 262 million claims processed by one company are any indication. RelayHealth Financial, a revenue cycle management provider, found a denial rate of 1.6% in each month from November 2015 through the first 3 weeks of February 2016. That reflects claims involving 630,000 healthcare providers. The financial …

Cost Concerns Have Medicare Lagging in Telemedicine

Medicare has more restrictive rules for telehealth payments than Medicaid and many private insurers, despite the fact that virtual doctor visits are perceived to be of particular benefit to seniors who have a hard time making it to the clinic. The concern—expressed by some private payers, as well—is that patients would access telemedicine then end up seeing a clinician in person anyway, resulting in a double-hit for the insurer. Medicare reserves telehealth payment mainly for …

‘Balance Billing’ Complaints Keep Rising

Texas is the latest state to report a dramatic jump in patients complaining about “surprise” medical bills after a trip to the hospital—on the order of a 1,000% increase between 2012 and 2015, according to the Texas Department of Insurance. The Centers for Public Policy Priorities in Austin notes that while there is no state law against “balance billing” in place, federal lawmakers are working on a bill that would make the practice illegal. Several …

CDC: Public Exchange Coverage Up, Off-exchange Coverage Down

As public exchange coverage climbed in the third quarter of 2015, use of off-exchange private coverage dropped, according to new data from the Centers for Disease Control and Prevention. This see-saw effect seems to indicate that U.S. health carriers had more trouble holding on to enrollees in group plans and off-exchange individual policies than they did holding on to enrollees in public exchange plans. Critics of the Affordable Care Act exchange system have noted that …

Health Cost Containment Makes for Strange Bedfellows

HCA is joining with Coca-Cola, Verizon, American Express, and other major companies in diverse industries in a new initiative aimed at stemming skyrocketing healthcare costs. The 20 member companies of the Health Transformation Alliance will pool data on the population health of their workers as a first step toward making “smarter and better decisions” when it comes to employee health plans, according to Tevi Troy, president of the American Health Policy Institute (which came up …