Market Insights Newsletter

Latest Headlines

Each week we deliver news, information, and resources. Is there a focus you'd like to see? Share your insights with us at marketing@skygenusa.com. 

News from the week of april 22, 2024

• TEN THINGS TO KNOW ABOUT CONSOLIDATION IN HEALTH CARE PROVIDER MARKETS (KFF) – A recent KFF report looks at ten key topics related to health care provider market consolidation including trends, benefits and harms and policy options for increasing competition.


• 7 ESSENTIAL ORAL-SYSTEMIC ASSESSMENTS FOR YOUR DENTAL PATIENTS (Dentistry IQ) – Dentistry IQ has published a list of seven essential medical conditions for dentists to assess with their patients including sleep apnea, oral cancer and other conditions.


• MORE THAN 200K WEST VIRGINIANS LOST MEDICAID OR CHIP OVER PAST YEAR, MOST FOR PROCEDURAL ISSUES (News From The States) – West Virginia has wrapped up the Medicaid unwinding process with more than 200,000 losing Medicaid or CHIP coverage. Close to 80% of these lost coverage for procedural issues. It is not yet clear how many of these have been able to reenroll in Medicaid. In addition, the state Medicaid program is facing a $147 million shortfall for the 2025 fiscal year. 


• FEWER AMERICANS ARE OPTING FOR DUAL HEALTH INSURANCE COVERAGE, U.S. CENSUS BUREAU REPORT SAYS (Vision Monday) – A US Census Bureau report reveals that fewer seniors are relying on a mix of private and Medicare coverage, while overall rates of private coverage for seniors has been falling.


• ADA UNVEILS NEW SEAL OF ACCEPTANCE CATEGORY (Becker’s Dental) – The ADA has announced a new program to help identify non-opioid products for dental pain management through their Seal of Acceptance program.


• PATIENT ENGAGEMENT IS ESSENTIAL FOR ACHIEVING THE GOALS OF VALUE-BASED CARE (Med City News) – Effective value based care models move beyond the clinic walls to improve access, quality and cost effectiveness of health services through broad-based programs that impact social determinants of health and other factors.

News from the week of april 15, 2024

• ECONOMIC OUTLOOK AND EMERGING ISSUES IN DENTISTRY INSIGHTS FROM Q1 2024 (ADA HPI) – The ADA’s HPI economic outlook report has returned as a quarterly report. Dentist confidence in the US economy continues to rise. In addition, more than one-third of dentists report having trouble meeting demand for patient appointment requests.


• GAPS IN MEDICARE ADVANTAGE DATA REMAIN DESPITE CMS ACTIONS TO INCREASE TRANSPARENCY (KFF) – CMS is starting to require reporting for Medicare Advantage on how dental, vision and hearing benefits are used including information on medical loss ratios as well as limited data collection on utilization measures, plan net costs and enrollee out of pocket costs. 


• NEARLY A QUARTER OF PEOPLE WHO SAY THEY WERE DISENROLLED FROM MEDICAID DURING THE UNWINDING ARE NOW UNINSURED (KFF) – A recent KFF survey found 19% of adults with Medicaid, prior to the start of unwinding, lost coverage. 70% of this group were left at least temporarily uninsured. Nearly a quarter of the people who were disenrolled from Medicaid remain uninsured.


• WHY HOMELESS PEOPLE ARE LOSING HEALTH COVERAGE IN MEDICAID MIX-UPS (NPR) – NPR finds homeless people in Montana and other states have faced several hurdles in keeping Medicaid coverage and it could take years to get eligible recipients reenrolled..


• NEBRASKA INCREASES REIMBURSEMENT RATES FOR MEDICAID DENTAL SERVICES (Becker’s Dental) – Nebraska has increased reimbursement rates for Medicaid dental by 12%.


• DENTAL LOSS RATIO MODEL LEGISLATION RECEIVES FINAL STAMP OF APPROVAL (ADA News) – The National Council of Insurance Legislators approved model legislation addressing a dental loss ratio. Ohio, Utah and Tennessee have indicated that this model may prompt them to push forward with legislation.


• WALMART TO EXPAND DENTAL CARE IN TEXAS WITH 18 NEW LOCATIONS (Becker’s Dental) – Walmart is set to open an additional 18 dental care locations in Texas by the end of the year, bringing the nationwide total to 50.


• ADA COMMENTS ON CONGRESSIONAL CYBERATTACK HEARING (ADA News) – The ADA submitted comments to a congressional committee reviewing health sector security. Recommendations included assessments of financial impacts, cybersecurity support for dental practices and measures to prevent future attacks.

News from the week of april 8, 2024

• DOCTORS TAKE ON DENTAL DUTIES TO REACH LOW-INCOME AND UNINSURED PATIENTS (Kaiser Health News) – Kaiser Health looks at a wide range of medical dental integration programs including training primary care providers in basic oral health care, embedding dental hygienists in medical centers, integrating dental care into prenatal visits, interpretation services and a sliding pay scale for those without insurance.  


• MA ENROLLEES LIKE BREADTH OF PLAN OPTIONS, HARVARD RESEARCH FINDS (Fierce Healthcare) – A Harvard white paper finds that the wide range of benefit plans available for Medicare Advantage have helped attract a growing number of enrollees, more than 50% in 2023, of all Medicare beneficiaries.


• ONE YEAR AFTER UNWINDING, COMMUNITY HEALTH CENTERS STRUGGLE WITH MEDICAID REENROLLMENT (Fierce Healthcare) – Community health clinics are reporting that nearly a quarter of their Medicaid patients have lost coverage through the unwinding process.


• CMS STREAMLINES MEDICAID, CHIP (ADA News) – CMS has finalized a rule overhauling the enrollment, cost-sharing and eligibility processes for Medicaid, the Basic Health Program, and CHIP with impacts for dental. 


• CMS FINAL RULE ON BROKER COMP, HEALTH EQUITY COULD SHAKE UP MEDICARE ADVANTAGE (Fierce Healthcare) – CMS also finalized rules related to broker compensation, health equity and supplemental benefits which will impact Medicare Advantage plans.


• REPORT: PAYERS AREN’T PROVIDING AN ADEQUATE DIGITAL EXPERIENCE (Med City News) – A new JD Power report finds many health sites and apps are falling short in providing a great digital experience for members.


• FOCUS ON MEDICARE ADVANTAGE DENTAL BENEFITS – WHAT IS DRIVING REGULATOR SCRUTINY AND NEW REPORTING REQUIREMENTS? (NADP Webinar) – NADP has an upcoming webinar on Medicare Advantage dental regulatory changes.

News from the week of april 1, 2024

• AN ESTIMATED 12 MILLION CHILDREN AND ADULTS LOST MEDICAID DENTAL INSURANCE AFTER THE COVID-19 PUBLIC HEALTH EMERGENCY EXPIRED (CareQuest) – A new report finds that after Medicaid redeterminations are completed,  dental coverage losses may end up exceeding medical coverage losses.


• EXPERIENCE OF THE FIVE LARGEST PUBLICLY TRADED COMPANIES OPERATING MEDICAID MANAGED CARE PLANS DURING UNWINDING (KFF) – KFF reports on the experience of the largest MCOs in the Medicaid unwinding process, their membership profile and opportunities to reengage the newly uninsured.


• BIDEN ADMINISTRATION ISSUES FINAL RULE ON MEDICAID, CHIP ENROLLMENT: 6 NOTES FOR DENTISTS (Becker’s Dental) – CMS’s recent Medicaid and CHIP-related final rule eliminates annual and lifetime limits on CHIP coverage and provides stronger enrollment protections.


• CMS FINALIZES NETWORK ADEQUACY STANDARDS, EXPANDS DENTAL BENEFITS FOR ACA EXCHANGE (Fierce Healthcare) – Expanded dental benefits may now be offered in state ACA exchanges. In addition, lower income consumers will be able to enroll in ACA plans throughout the year, not just during open enrollment.


• PRESIDENT BIDEN SIGNS $1.2T SPENDING BILL INTO LAW (ADA News) – The ADA summarizes oral health related elements of the new $1.2T spending bill.


• CLOSING THE CARE DIVIDE WITH PRENATAL VISIT DENTAL PHOTOS (Dr. Bicuspid) – A pilot medical dental integration project helped identify patients in need of dental care with a combination of intraoral photos taken during community health prenatal visits with dental reviews, teledentistry consultations and in-person visits as needed.


• END OF INTERNET SUBSIDIES FOR LOW-INCOME HOUSEHOLDS THREATENS TELEHEALTH ACCESS (KFF Health News) – The Affordable Connectivity Program, which previously helped low-income households access discounted internet, is now facing a funding shortage. This situation could have significant implications for telehealth services, potentially affecting millions of people who rely on remote medical consultations and support. 


• TEXTING MAY BE KEY TO IMPROVING CHILDREN’S DENTAL HEALTH (Dr. Bicuspid) – A study by the International Association for Dental, Oral, and Craniofacial Research (IADR) found that targeted oral health text messages sent to caregivers not only improved the children’s dental habits but also had a positive impact on caregiver oral health habits.


• POWERING A HOLISTIC BENEFITS STRATEGY: THREE AREAS OF OPPORTUNITY (Benefits Pro) – An article by SKYGEN’s Kyle Koltz provides brokers three strategies to manage economic change, rising costs and consumer expectations when working with employers to design benefit plans.

News from the week of march 25, 2024

• CMS SIMPLIFYING MEDICAID, CHIP ENROLLMENT AND RENEWAL PROCESSES (Fierce Healthcare) – CMS released a final rule Wednesday to help broaden Medicaid and CHIP eligibility and enrollment. In addition, this morning a new special enrollment period through HealthCare.gov was added for late summer 2024 to assist people who have lost Medicaid or CHIP coverage obtain marketplace plans.


• A PUSH IS UNDERWAY FOR VOTERS TO MAKE FLORIDA THE NEXT STATE TO EXPAND MEDICAID (NPR) – In Florida advocates are organizing around a proposed ballot initiative that would amend the constitution to expand Medicaid eligibility. If supporters are able to get the petition on the ballot 60% of voters would need to approve the measure.


• GOVERNOR SIGNS MEDICAID DENTURE BILL; LAW WILL BECOME EFFECTIVE JULY 1 (News From the States) – West Virginia’s governor has signed a new Medicaid denture bill which changes the dental coverage cap effective July 1st  from $1,000 per year to $2,000 over two years, allowing members to get both sets of dentures at the same time. 


• CALIFORNIA’S EXPANDED HEALTH COVERAGE FOR IMMIGRANTS COLLIDES WITH MEDICAID REVIEWS (KFF Health News) – In California, the Medicaid redetermination process has especially impacted Latinos. In addition, some only recently gained coverage as the state expanded Medicaid to residents without legal residency. Organizations that assist with health care enrollment and questions have seek a huge uptick in requests for help.


• WHERE ORAL HEALTH FUNDING STANDS IN BIDEN'S $1.2 TRILLION SPENDING BILL (Becker’s Dental) – Several oral health initiatives were funded in the recent $1.2 trillion spending package including  specific funding for oral health training programs and oral health support block grant programs and research programs.


• ORAL HEALTH IS ESSENTIAL TO VETERAN PRODUCTIVITY AND WELL-BEING (CareQuest & AIDPH) – A recent CareQuest report details gaps in oral care coverage for veterans and the impacts on overall health and productivity.


• AS AI EYE EXAMS PROVE THEIR WORTH, LESSONS FOR FUTURE TECH EMERGE (KFF Health News) – A quick and easy AI-based screening for diabetic retinopathy, the leading cause of blindness among working-age adults is gaining acceptance and seeing better results with patient follow up.


• CONSUMERS MORE DISCERNING ABOUT HEALTH DATA SHARING: SURVEY (Healthcare Dive) – A survey from Rock Health finds consumers are getting more hesitant to share health data with doctors, insurance companies and others. The survey also tracks attitudes towards virtual care.

News from the week of march 18, 2024

• MEDICARE HOUSEHOLDS SPEND MORE ON HEALTHCARE THAN OTHER HOUSEHOLDS (KFF) – KFF reports that out-of-pocket spending on healthcare was twice as large among Medicare households than non-Medicare households in 2022.


• WHAT DO PEOPLE ON MEDICARE REALLY THINK ABOUT MEDICARE? NEW SURVEY REVEALS CHALLENGES AND FRUSTRATIONS (Fortune) – Fortune looks at several recent surveys of Medicare recipients and finds that 3 in 10 didn’t use any of their supplemental benefits. Respondents reasons for not using dental and other coverage included: benefits were not needed, lack of awareness of benefits and benefits were difficult to use or too expensive. 


• GEORGIA’S MEDICAID WORK REQUIREMENTS COSTING TAXPAYERS MILLIONS DESPITE LOW ENROLLMENT (KFF Health News) – Georgia’s Medicaid expansion program, which requires documentation of work or school, has so far seen high costs and low enrollment in comparison with states without Medicaid work requirements.


• MEDICAID: 6 WAYS COORDINATION OF BENEFITS PROTECTS THE ESSENTIAL SAFETY-NET PROGRAM (Fortune) – Coordination of benefits is a key Medicare process, ensuring that these alternative funding sources are used efficiently and accurately.


• THE NEW ERA OF CONSUMER ENGAGEMENT: INSIGHTS FROM ROCK HEALTH’S NINTH ANNUAL CONSUMER ADOPTION SURVEY (Rock Health) – Virtual care soared during the pandemic, today these digital models are evolving based on consumer preferences. 


• WHAT HAPPENED TO TELEDENTISTRY AFTER COVID-19? (DentistryIQ) – Teledentistry usage has also declined since the pandemic but there are a number of steps that could be taken to increase usage. 


• THE IMPACT OF NEGLECTED ADOLESCENT ORAL CARE ON ADULT HEALTH (Benevis) – A recent paper provides an overview of issues in adolescent oral health as well as steps that can be taken to improve oral health in this group.

News from the week of march 11, 2024

• ACCESS TO ADULT DENTAL CARE GETS RENEWED FOCUS IN ACA MARKETPLACE PROPOSAL (KFF) – An analysis from KFF of the proposal to increase access to adult dental in the ACA Marketplace which could help alleviate price barriers to dental care.  


• A CLOSER LOOK AT MEDICAID EXPANSION EFFORTS IN MISSISSIPPI (KFF) – Medicaid expansion legislation has passed the Mississippi House. However, several roadblocks will need to be overcome for expansion to be implemented in the state.


• STUDY TIGHTENS THE LINK BETWEEN POOR ORAL HEALTH AND SYSTEMIC HEALTH (Dr. Bicuspid) – A recent study found that participants who self-reported their oral health as fair or poor faced elevated risk of heart disease and mortality.


• ELIMINATING MEDICAID DENTAL BENEFITS AND EARLY-STAGE ORAL CANCER DIAGNOSES (Dental News And Technology) – A California study found that eliminating Medicaid dental benefits negatively impacted early detection of oral cancers.


• TELEHEALTH POST-PANDEMIC: HOW IS THE VIRTUAL VISIT FARING? (Medscape) – While the volume of telehealth visits dropped significantly after the pandemic, it remains a valued option for busy providers and patients and technology improvements could help promote broader acceptance.


• BREAKING DOWN BIDEN'S $7.3T PROPOSED BUDGET FOR 2025: HERE ARE HIS TOP HEALTH PRIORITIES (Fierce Healthcare) – Biden’s 2025 budget proposal includes funds for expanding Medicaid in states that have blocked expansion. 

News from the week of march 4, 2024

• MOUNTING HEADWINDS IN MEDICARE ADVANTAGE MARKET HAVEN’T STOPPED GROWTH (Chartis) – A recent report provides a deep dive into trends we are seeing in the Medicare Advantage market including the growth in Special Need Plans (SNPs)


• NEW YORK EXPANDS DENTAL COVERAGE FOR LOW-INCOME RESIDENTS (Becker’s Dental) – New York state has received a waiver to expand Medicaid to residents with incomes up to 25% of the federal poverty line ($37,650). The expanded coverage includes free preventive care, dental and adult vision care.


• WHY SOME DENTISTS WHO ACCEPT MEDICAID ARE STRUGGLING (Becker’s Dental) – Texas dentists are facing a perfect storm of staffing challenges, the end of Medicaid continuous enrollment, inflation and reimbursement rates that haven’t increased since 2007.


• MEDICAID ‘UNWINDING’ LEADING TO MORE HEALTH CARE PURCHASES OFF MD INSURANCE MARKETPLACE (Maryland Matters) – Maryland is sharing data that attributes double digit increases in healthcare exchange signups in large part to individuals who lost Medicaid coverage during the redetermination process. 


• MARCH JADA LOOKS AT CHILDREN’S ORAL HEALTH DURING COVID-19 PANDEMIC (ADA News) – A recent study found pre-pandemic issues with access to care continued through the pandemic and while children from all groups saw reductions in oral care during the pandemic, health impacts were limited.


• SECO KEYNOTE PANEL ASKS, WHAT’S THE FUTURE OF AI IN OPTOMETRY? (Vision Monday) – A recent panel looked at how AI might be integrated into eyecare practice as a diagnostic assistant, a virtual assistant, to help practices participate in clinical trials, and for disease risk prediction


• MEDICARE SHOULD HELP PEOPLE WITH LOW VISION (National Council on Aging) – The National Council on Aging advocates for the inclusion of low vision services as part of Medicare disability services.

News from the week of february 26, 2024

• DENTAL SALARY SURVEY 2024 (DentalPost) – DentalPost’s annual salary survey uncovers trends in dental staff wages, turnover and retirement plans.


• WHAT DENTAL PRACTICES NEED TO KNOW ABOUT THE CHANGE HEALTHCARE CYBERATTACK (Dr. Bicuspid) – Dental insurance expert, Teresa Duncan discusses what dental practices can do to manage the impact of the recent cybersecurity attack on Change Healthcare.


• THREE QUESTIONS ABOUT MEDICAID UNWINDING: WHAT WE KNOW AND WHAT TO EXPECT (KFF) – KFF provides an update on Medicaid unwinding, showing a 10% drop in membership with about half of the redeterminations completed. 


• DENTAL COVERAGE IN MEDICARE ADVANTAGE PLANS VARIES BY DEMOGRAPHIC (HealthPayerIntelligence.com) – A recent study found that in 2019 about a third of Medicare Advantage members were in plans that lacked dental coverage. However, traditionally underserved populations were more likely to have coverage.


• MEDICARE ADVANTAGE FRAUD IN DOJ'S CROSSHAIRS AFTER AGENCY REPORTS $2.7B IN SETTLEMENTS (Fierce Healthcare) – A recent Department of Justice press release identifies Medicare Advantage plans' risk adjustment practices as the agencies most important healthcare fraud priority.


• DENTAL LIFETIME OF CARE STUDY (Care Credit) – A recent survey looked at consumer views regarding the cost of dental care and how well consumers understand their benefits. A recent SKYGEN-sponsored survey also identified areas where payers might improve the member experience. 


• 14 HEAVY HITTERS TEAM UP TO FORM DIGITAL HEALTH COLLABORATIVE (Fierce Healthcare) – Organizations representing providers, payers, consumer technology companies and employers are have formed a group to identify digital health solutions that can improve outcomes and lower costs.


• VISION IMPAIRMENT ASSOCIATED WITH SYMPTOMS OF DEPRESSION AND ANXIETY IN OLDER ADULTS (Vision Monday) – A recent JAMA Ophthalmology study found that older adults with vision impairment were more likely to experience symptoms of depression and anxiety.

News from the week of february 19, 2024

• US DENTAL PRACTICES GENERATE $478M ANNUALLY (Becker’s Dental) – A new report from the ADA found that dental offices generated roughly $478 billion in economic impact in 2022.


• FUTURE OF CARE: PREDICTIVE. PREVENTIVE. PERSONALIZED. (Tata Consultancy Services) – A new survey looks at how the “connected care ecosystem” impacts payers, providers and other participants. Respondents called out simplified, automated, seamless and intelligent claims management and customer support processes and reimagined member journeys through digital technologies as having the biggest impact on payer transformation. 


• KFF HEALTH TRACKING POLL FEBRUARY 2024: VOTERS ON TWO KEY HEALTH CARE ISSUES: AFFORDABILITY AND ACA (KFF) – KFF’s recent Health Tracking Poll finds health care costs are at the top of the public’s list of financial worries.


• SOUTHERN LAWMAKERS RETHINK LONG-STANDING OPPOSITION TO MEDICAID EXPANSION (KFF Health News) – KFF reports that several states, including Alabama, Georgia and Mississippi, that have refused to adopt Medicaid expansion are now reconsidering due to strong public support and lobbying by the health care industry, especially hospitals.


• INSURERS BRACE FOR CONTINUED MEDICARE ADVANTAGE MEDICAL COSTS (Healthcare Dive) – Healthcare Dive takes a closer look as to why predictions on the impact of Medicare Advantage medical costs in 2024 differ so widely across the industry. 


• STATES GET IN ON THE PRIOR AUTHORIZATION CRACKDOWN (KFF Health News) – States are piggybacking on limited CMS preauthorization rules by considering additional restrictions. The AMA reports that 90 bills were considered in 2023 and additional proposals are expected this year.


• MASSACHUSETTS DENTAL INSURANCE REFORM LAW BENEFITS QUESTIONABLE (Worcester Telegram) – A policy analyst at Boston University’s School of Public Health is skeptical that Massachusetts MLR law will benefit patients and contends the loss ratios are built on slim evidence.


• NO SURPRISES IMPLEMENTATION CREATED UPTICK IN IN-NETWORK CLAIMS: FAIR HEALTH (Healthcare Dive) – Research by Fair Health finds that in-network care increased by 2.3% since the No Surprises Act went into effect in January 2022.