14 Aug Health Data News Roundup: Medicare Advantage Quality Bonus Payments to Increase; AI Risks and Potential for Payers; and Two Payers Account for Half of Medicare Advantage Enrollees

Welcome to the Health Data Weekly News Roundup from IMAT Solutions. As the power of data continues to grow in the healthcare arena, today’s care organizations need to be on the forefront of all news and trends to help ensure that their data analytics efforts deliver accountable and informed care. Each week, we will provide you with the actionable news you need to meet these goals.

Generative AI Brings Great Potential—and Risks—to Payer Space
While gives payers the opportunity to automate call center interactions, pre-authorizations and claims denials and appeals, there are still concerns among experts about the safety in using generative AI tools, according to this recent Fierce Healthcare article.

Medicare Advantage Quality Bonus Payments on Track to Grow 30 Percent in 2023
Federal spending on Medicare Advantage bonus payments has increased every year since 2015 and will reach at least $12.8 billion in 2023, an increase of nearly 30 percent ($2.8 billion) since 2022, according to the KFF.

The 2 Payers That Account for Nearly Half of Medicare Advantage Enrollees
Two payers are accounting for 47 percent of all Medicare Advantage enrollees in 2023. UnitedHealthcare accounts for 29 percent of all Medicare Advantage enrollees in 2023, and Humana accounts for 18 percent.

How Payers Can Reduce Emergency Department Admission Rates, Costs
Payers can leverage telehealth capabilities, use machine learning and advanced analytics tools, and implement value-based contracts to lower emergency department use and spending, according to this recent Health Payer Intelligence article.

Payers, Employers Support the No Surprises Act IDR Process in Court
While providers disapprove of basing out-of-network payment rates on the qualifying payment amount, payers and employers have defended the No Surprises Act policy, according to this recent Health Payer Intelligence article.

ACA Marketplace Premiums Set to Rise Again, Inflation a Key Factor
Even as inflation seems to be plunging from its peak, the ongoing pressure from high medical costs is set to push ACA Marketplace premiums up to an average of 6 percent in 2024, according to preliminary data from KFF.

Legislators Introduce Act for Behavioral Health IT Adoption
New bipartisan legislation aims to provide $20 million a year in grant funding over five fiscal years to finance behavioral health IT adoption, as previous federal funding efforts to promote the adoption of EHRs have historically excluded mental health and substance use disorder providers.