Ritter Insurance Marketing, Craig Ritter

PA MLTSS Contracts Awarded to AmeriHealth Caritas, Centene, & UPMC

Pennsylvania’s Department of Human Services has granted AmeriHealth Caritas, Centene Corp., and UPMC contracts for its new Medicaid program. Community HealthChoices, Pennsylvania’s first-ever program for providing managed long-term services and supports (MLTSS), is scheduled to go live July 1, 2017, in the state’s southwestern region. It will continue to be implemented in zone-based…

16 Sep 16
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State Attorney General Joins FTC in Hospital Merger Opposition

Pennsylvania State Attorney General Kathleen Kane is joining the Federal Trade Commission in a legal block against the proposed merger between Penn State Milton S. Hershey Medical Center and PinnacleHealth System. After reviewing the merger request, the FTC determined that a union of the two largest health systems in Harrisburg area would inflate health costs…

17 Dec 15
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Highmark MA Members Retain Access to UPMC

More than 182,000 seniors in Western Pennsylvania can breathe a sigh of relief. The Pennsylvania Supreme Court has issued a ruling that Highmark Medicare Advantage members will have in-network access to all UPMC hospitals until 2019. With less than a week left in the Medicare Annual Enrollment Period, the timing couldn’t be better for…

3 Dec 15
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UPMC Settles with U.S. Justice Department for $5.4M

UPMC reached a $5.4 million settlement with the U.S. Justice Department as part of a massive investigation into implantation of cardiac devices against Medicare guidelines. The whistleblower-driven lawsuit accused 457 hospitals in 43 states of submitting claims for nearly $258 million for the procedures in violation between 2003 and 2010. Implantation of cardiovector defibrillators…

9 Nov 15
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Highmark Decreasing 2016 MA Plan Premiums

Highmark is decreasing premiums for seven of their nine 2016 Medicare Advantage (MA) plans, according to the Pittsburgh Tribune-Review. The move is part of their attempt to hang onto their existing 182,000 MA members and entice new members as their rival, UPMC, expands its insurance business. Tim Lightner, vice president of product and marketing…

28 Oct 15
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UnitedHealthcare MA Members to Have Access to UPMC

UnitedHealthcare Medicare Advantage members will now have in-network access to care at all UPMC facilities. The new access will shuffle the Medicare market in Western Pennsylvania. While Pittsburgh-based UPMC is already an in-network provider for those on UnitedHealthcare’s employer-sponsored, individual and Medicaid health plans, the network is expanding to those on UnitedHealthcare MA plans for the…

6 Oct 15
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Highmark v. UPMC Dispute Heard by Pa. Supreme Court

UPMC has kept Highmark Medicare Advantage members in-network, as ordered by a Pennsylvania Commonwealth Court judge on May 29, but an appeal to the state’s Supreme Court could still shift the market in Western Pennsylvania. Legal representatives for both companies debated a small section of their consent decree (see figure at right)…

6 Oct 15
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Highmark Takes Huge Financial Hit on ACA Exchange Plans

The federal health exchange hasn’t been kind to Highmark Health. After losing $318 million on health plans sold to exchange consumers, the Pittsburgh-based company reported a total operating loss of $171 million over the first six months of this year.

5 Oct 15
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More Improvements for PA’s CHIP

Effective December 1, 2015, all Children’s Health Insurance Program (CHIP) policies will offer more benefits important to children’s health. The addition of these enhanced benefits ensures that all CHIP plans meet the minimum essential coverage requirements set forth by the Affordable Care Act (ACA). It also provides all 148,000 children using CHIP…

21 Sep 15
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CMS to Begin Trial of Value-Based Insurance Design for MA

Beginning January 1, 2017, CMS will begin testing value-based insurance design (VBID) models to encourage using “high-value” clinical services to improve quality and reduce costs. “High-value” services are those that have the best chance to positively impact enrollee health. For five years, the model will be tested in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and…

4 Sep 15
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