10 updates on payer-provider relationships

Here are 10 recent articles posted by Becker's Hospital Review that concern payer-provider relationships:

1. Oscar partners with HCA, Montefiore, others on Medicare Advantage plans
Oscar will offer Medicare Advantage plans in New York and Houston this fall, pending regulatory approval, the health insurance startup's CEO and co-founder, Mario Schlosser, wrote in a blog post.

2. Humana expands orthopedic bundles: 5 things to know            
Humana added providers to its bundled payment models for spinal fusion surgeries and hip or knee joint replacements, the insurer said July 17.

3. Harvard Med: BCBS of Massachusetts' global payments may slow spending growth        
Blue Cross Blue Shield of Massachusetts' global budget payments were associated with lower spending and higher quality of care, according to a recent study published in The New England Journal of Medicine.

4. Admit or transfer? For children with mental health disorders, hospitals' decision may rest on insurance            
The health insurance status of children is linked to whether they are admitted or transferred to a hospital after presenting to the emergency department with a mental health disorder, according to a study published in Pediatric Emergency Care.

5. Kentucky lab owner admits to defrauding Humana, Aetna, Anthem            
The owner of a toxicology lab in Kentucky pleaded guilty for his role in a conspiracy that defrauded health insurers of more than $1.3 million, according to the Department of Justice.

6. New York insurer opens office in hospital            
CDPHP, a health insurer in New York, opened a branch inside Ellis Medicine in Schenectady, N.Y., to connect patients directly with insurance staff if they have questions during treatment and post-discharge.

7. Minnesota hospitals ask state to investigate BCBS over new policy ending coverage for 7 forms of routine care
Hospitals in Minnesota are calling on the state to look into a new policy enacted by its largest nonprofit health insurer that ends reimbursement for routine colonoscopies and other services under certain circumstances.

8. Beaumont to become key managed care insurer after Summa deal            
If Beaumont Health closes its proposed acquisition of Summa Health, Beaumont could become a major player in Michigan's hospital-owned managed care business.

9. Renown, Anthem still lack resolution            
Reno, Nev.-based Renown Health and Anthem have yet to reach an in-network agreement.

10. Las Vegas hospital will have to contract with Medicare, Medicaid by 2021           
Elite Medical Center, a Las Vegas-based acute care hospital that some experts say is operating similarly to a 24/7 freestanding emergency room, has to contract with Medicare and Medicaid beginning in 2021.

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