Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Aetna, Humana Terminate Merger Deal After Court Defeat

by Thomas Beaton

Aetna and Humana have scrapped their merger plans after the Department of Justice blocked the deal due to antitrust concerns.  Aetna will pay Humana a $1 billion termination fee, included as part of the original agreement. The DOJ lawsuit,...

Federal Judge Strikes Down Cigna-Anthem Health Insurance Merger

by Jacqueline Belliveau

A federal judge in Washington DC recently blocked a potential $48 billion health insurance merger between Cigna and Anthem, according to a Department of Justice (DoJ) press release. The two payers started the merger process back in the summer...

Proposed ACA Replacement Moves Coverage Choices to the States

by Thomas Beaton

Several Republican lawmakers have introduced the “Patient Freedom Act” as a proposed replacement of the Affordable Care Act, emphasizing state authority and local decision-making in the health insurance market. Senators Bill Cassidy,...

Shareholder Class Action Lawsuit Filed Against Aetna

by Vera Gruessner

A shareholder class action lawsuit has been filed against the national health insurance company Aetna Inc., according to a press release from the law firm of Kessler Topaz Meltzer & Check, LLP. The announcement came earlier this...

Top 4 Ways Payers Could Improve Patient Health Outcomes

by Vera Gruessner

Health insurance companies have been putting more focus on preventive care, a reduction in unnecessary medical testing, and better patient health outcomes by transitioning to value-based care reimbursement. National payers have utilized a number...

Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement

by Vera Gruessner

  In recent years, the national health payer Anthem has been advancing value-based care reimbursement by collaborating with primary care providers and operating the Enhanced Personal Health Care program, according to a report released...

How Payers Could Assist Primary Care Docs with Value-Based Care

by Vera Gruessner

How can health insurance companies improve their relationship with primary care practices? How can payers work with primary care providers to expand value-based care reimbursement?  For answers to these questions,

Why a Court Stopped the Aetna-Humana Health Insurance Merger

by Vera Gruessner

On January 23, Judge John D. Bates of the Federal District Court for the District of Columbia ruled that the Aetna-Humana health insurance merger would lead to antitrust problems and was not allowed to continue. The Coalition to Protect Patient...

Federal Court Blocks Aetna-Humana Health Insurance Merger

by Vera Gruessner

Today, a federal judge ruled that the health insurance merger between the healthcare payers Aetna and Humana should be blocked on the grounds that it would create antitrust issues, according to The New York Times. The health insurance...

Aetna, Humana, Harvard Pilgrim Target Patient Health Outcomes

by Vera Gruessner

Commercial health insurance companies have pursued a number of different approaches to improve patient health outcomes and reduce wasteful medical spending. The payers Aetna, Humana, and Harvard Pilgrim conducted some key collaborations to achieve...

Why Payers Should Reduce Cost Sharing for High-Value Care

by Vera Gruessner

Today, more healthcare payers are positioning greater cost-sharing onto the consumers to keep from raising premium rates, according to commentary published in JAMA Internal Medicine. The 2016 National Health Insurance Survey discovered that 40...

Humana, Aetna, Cigna Invest in Value-Based Care Payment Models

by Vera Gruessner

Value-based care payment models are continuing to make headlines among major health insurance companies around the nation. Last month, Humana entered into a value-based care arrangement with the population health management company Fullwell,...

Payers See High Financial Losses on Health Insurance Exchanges

by Vera Gruessner

Healthcare payers have been facing significant financial losses on the health insurance exchanges in recent years. UnitedHealth Group lost $475 million in 2015 and was predicting a loss of $650 million in 2016, according to Kaiser Health News....

How the 21st Century Cures Act will Impact Healthcare Payers

by Vera Gruessner

Last week, the House of Representatives passed the 21st Century Cures Act by 392-26 votes. The 21st Century Cures Act affects the health insurance market through a provision that establishes small business health reimbursement arrangements (HRAs),...

Payers Continue to Drop Out of the Health Insurance Exchanges

by Vera Gruessner

Healthcare payers have seen significant obstacles when it comes to operating on the public health insurance exchanges with large, national insurance companies losing money through this marketplace. Below we outline some key insurers that have...

Health Payer Solutions for Improving HEDIS Quality Scores

by Vera Gruessner

Payers and providers transitioning to value-based care reimbursement need to commit to meeting and improving their HEDIS quality scores. However, the documentation involved in reporting HEDIS quality scores tends to become complex. Johns...

Healthcare Insurance Literacy Vital for Higher Coverage Rate

by Vera Gruessner

New research from the RAND Corporation shows that uninsured Americans who have better healthcare insurance literacy were more likely to purchase coverage when the Affordable Care Act’s health insurance exchanges opened in 2014, according...

Humana’s Value-Based Care Platform Decreased Costs by 20%

by Vera Gruessner

The health payer Humana released positive results within its Medicare Advantage program for the third year in a row, according to a company press release. The value-based care platform used at Humana indicated 19 percent higher HEDIS scores among...

Vermont’s All-Payer Model Limits Medical Spending Growth

by Vera Gruessner

Vermont has been working on regulatory actions that would reform healthcare payment throughout the state specifically through an all-payer model. Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a press release the...

Healthcare Payers Struggle with Price Transparency, Technology

by Vera Gruessner

Health insurance companies are still struggling with improving price transparency in order to gain greater trust from their consumer base. One survey has shown low customer service satisfaction and a need for payers to inform consumers on their...


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