Healthcare Payer Interviews

How One Payer Tackled the No Surprises Act Provider Directory Rule

by Kelsey Waddill

Brian Marsella, president of Health Payment Systems (HPS) and Paymedix, was accustomed to the challenges of maintaining provider directories when he joined HPS and Paymedix in 2022. But two years into his tenure and two years after the No...

2024 Payer Strategies: Population-Based Plans, MA Differentiation

by Kelsey Waddill

The new year may look remarkably like 2023 from the payer perspective with a similar set of headwinds, but payer strategies may change. Health insurers will build on last year’s progress in health equity, care delivery, and other...

How Healthcare Leaders Can Weigh Pros, Cons of Payer Megamergers

by Kelsey Waddill

When rumors circulate about major payers planning to merge, it always stokes the question: are payer megamergers ultimately good for the healthcare system? When the news broke that Cigna and Humana may be in talks about a merger, Richard...

Blue Cross Blue Shield of MA Eliminates More Prior Authorizations

by Kelsey Waddill

Blue Cross Blue Shield of Massachusetts (“Blue Cross”) joined other payers in eradicating prior authorizations for certain services as part of an effort to accelerate members’ access to care and reduce provider burden....

3 Steps One Medicaid MCO Took to Boost Its Patient Experience Score

by Kelsey Waddill

Ease and efficiency in access to care contribute to the patient experience measurement in the National Committee on Quality Assurance’s (NCQA) Health Plan Report Card for Medicaid managed care organizations. For one payer, excelling...

Payer Turns to PBM Coupon Program to Lower Prescription Drug Spending

by Kelsey Waddill

Reducing drug prices is top-of-mind for payers and employers alike. Some payers, like Capital Blue Cross, seek to make drugs more affordable by connecting members with existing coupon solutions. Capital Blue Cross is one of the latest Blue...

The State of Payer, CBO Social Determinants of Health Contracting

by Kelsey Waddill

Social determinants of health contracting with community-based organizations remains a complex and challenging task for payers as the demand for answers grows more pressing. As the industry’s awareness of social determinants of health...

How Payers Can Improve Cancer Patient Navigation, Experience

by Kelsey Waddill

As executive director of state government affairs at the Leukemia and Lymphoma Society (LLS), Lucy Culp has heard a common refrain from cancer patients: securing treatment and coverage has become a full-time job. A frequent characteristic...

Two Critical Impacts of 2021 Special Enrollment Period Gains

by Kelsey Waddill

The 2021 special enrollment period gains on the Affordable Care Act (ACA) marketplaces could have downstream impacts on enrollment-related factors such as customer service investments and risk adjustment, according to Myra Simon, principal...

How Payers Can Improve Attachment Processes in Claims Management

by Kelsey Waddill

Claims management is a multi-step process that provides ample opportunity for errors and delays, but if payers modify their approach to certain steps in the process it could have a positive impact overall. In the most concise language,...

Key Considerations For Implementing Diabetes Management Programs

by Kelsey Waddill

With numerous combinations of comorbidities and lifestyles at play in the member population with diabetes, payers have a lot to consider when creating or expanding their diabetes management programs. Diabetes is one of the most expensive...

Legal, Payer Experts Unpack SCOTUS Affordable Care Act Hearing

by Kelsey Waddill

As the Supreme Court deliberates the fate of the Affordable Care Act after hearing the oral arguments, payers and the public alike are processing the court case and its implications for the healthcare industry. From the district court to...

Collaboration, Patient Education Key to Increasing Medicaid Coverage

by Emily Sokol, MPH

The recent surge in furloughed employees and unemployed individuals is bringing to light one major problem: how are these people going to get health insurance? Made worse by the growing pandemic, industry experts are unsure of the fate for...

How Peer Recovery Increases Medication Adherence, Lowers Spending

by Kelsey Waddill

Update 02/21/2020: This article has been updated to reflect that Blue Cross Blue Shield of Rhode Island partnered with the Anchor Recovery Community Center (a program of The Providence Center) to launch the peer recovery program. A previous...

Virtual Behavioral Health Visits Improve Care Access

by Emily Sokol, MPH

Behavioral healthcare is in high demand. Nearly one in five Americans have behavioral health needs, according to the American Hospital Association. And yet, fewer than 30 percent of them are receiving that care, largely because of...

In 2020 Consumerism Will Steer Payer Decisions in Deals, Spending

by Kelsey Waddill

Consumerism in healthcare will steer many payer decisions in 2020, perhaps more obviously than in the past. “There are a lot of pressures out there in 2020. It’s the time to step up and it's really a call to action,”...

Accessible Data, In-Person Dialogue Key to Value-Based Partnerships

by Kelsey Waddill

There are two elements of value-based care that should come as no surprise to a seasoned healthcare professional regarding value-based partnerships. First, that payer-provider relationships are at the heart of successful value-based care...

Employing Social Workers to Address Social Determinants of Health

by Emily Sokol, MPH

Payers are trying to understand their role in addressing the social determinants of health. These non-clinical factors that impact an individual’s health include environment, housing, food insecurity, and transportation. Some payers...

Optima Health’s Medicaid Addresses Food Security, Social Determinants

by Kelsey Waddill

Optima Health’s Traci Massie can outline the different social determinants of health that impact Virginia’s different Medicaid populations county by county, from the opioid epidemic to food security. Norfolk, for example,...

Using Medically-Tailored Meals to Boost Chronic Disease Care

by Jessica Kent

Chronic diseases are both costly and prevalent, with the healthcare industry shelling out billions each year to manage and treat these conditions. Although illnesses like diabetes, heart disease, and hypertension are preventable, many...