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Population Health Approach to Prenatal Care Cuts Payer Costs

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Health insurance payers can improve patient outcomes and reduce spending by expanding the use of population health management models for expectant mothers.  Early intervention and preventive care can lower costs in high-risk birth situations,...

PA Seeks Increased Payer Coverage of Emergency Air Ambulances

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Emergency air ambulances save lives, but they can also leave patients in a mountain of debt.  Pennsylvania Insurance Commissioner Teresa Miller would like payers to shoulder more of the costs of these critical services, and has accordingly...

Senator Calls for Scrutiny of Health Payers, Medicare Fraud

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Senator Chuck Grassley (R-Iowa) is asking federal officials to investigate charges that Medicare Advantage plans were overcharged by health payers. In a letter to CMS Acting Administrator Seema Verma, Grassely cited an improper...

Health Insurance Actuaries Propose Ways to Stabilize Market

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A stable health insurance marketplace is good for payers and consumers. Speculation over potential payer mergers, repeal or modification of the ACA, and the future of high-risk and low income subsidy payments have left premium rates and coverage...

OR May Cut ACA Medicaid Expansion Funds to Favor State Budget

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The Oregon state legislature is considering a retraction of Medicaid expansion and benefits to address an anticipated $1.8 billion budget shortfall between 2017 and 2019.  The move to cut back Medicaid could potentially leave more than 355,000...

Humana Expands Medicare Orthopedic Bundled Payment Programs

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The nation’s fourth largest healthcare payer recently announced it will be expanding its orthopedic bundled payment programs to eight new groups in Indiana and Kentucky.  The value-based care model will also offer participating providers...

Affordable Care Act Cuts Uninsured Rate by 6.4% Since 2013

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From 2013 to the end of 2016, the percentage of individuals without health insurance dropped across the nation, according to a recent Gallup-Healthways study. The national percentage of those without health insurance went from 17.3 percent in...

Payer Groups Urge Congress to Keep ACA Cost Sharing Reductions

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In a recent letter to the President and leading members of Congress, insurance payer groups and the nation’s largest provider organizations detailed their case to retain the cost sharing reductions (CSR) provision in the ACA.  Payers...

UnitedHealth Grows by 11.8% Despite ACA Marketplace Withdrawal

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Despite its very public near-total withdrawal from the Affordable Care Act marketplace in 2017, the nation’s largest healthcare payer recently reported substantial Q1 profit growth.     Revenues at UnitedHealth were...

NY Senate Considers Proposal for Single Payer Healthcare

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Since the future of the Affordable Care Act (ACA) remains unclear, and GOP plans to repeal and replace have stalled, states are taking the lead in finding solutions to the rising costs of health care.  New York has joined California as the...

CMS Issues ACA Health Insurance Exchange Stabilization Rule

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CMS  issued the final version of the 2018 Market Stabilization rule for the Affordable Care Act (ACA) health insurance exchange.   The rule focuses on stabilizing the individual and small group health insurance markets while lowering...

Payers, Providers Collaborate to Combat Opioid Abuse, Addiction

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Insufficient control of opioid prescriptions is one of the key reasons why opioid abuse and addiction have risen dramatically over the past few years.    To mitigate the epidemic, payers have developed programs to directly establish...

Top 5 Largest Health Insurance Payers in the United States

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The Affordable Care Act has been a divisive policy for the public and politicians, but since 2010 it has been a financial boon for the top five giants of the health insurance payer industry.  The expanding customer base created by the ACA,...

Healthcare Payers Seek Passage of Bill to Lower Drug Costs

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The recently introduced the Fair Access for Safe and Timely (FAST) Generics Act seeks to reduce the timeline of bringing generic prescriptions to market and enjoys the support of healthcare payers. The philosophy behind the bipartisan bill is...

Independence Blue Cross, UPenn Partner to Enhance Care Delivery

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A five-year partnership between Independence Blue Cross and the University of Pennsylvania Health Systems (UPHS) should help strengthen multiple aspects of care delivery for beneficiaries in the state. Both organizations are under contract to...

OK Legislature Keeps Interstate Health Insurance Bill Viable

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A bill that would allow interstate health insurance options for Oklahoma residents is still on the table following a House committee vote. Senate Bill 478, or the Health Care Choice Act, would authorize Oklahoma’s Insurance Commissioner...

Proposed MA State Budget Targets Medicaid Program Funding

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The Massachusetts House of Ways and Means Committee approved a state budget for fiscal year (FY) 2018 that funds MassHealth, the state’s Medicaid program, through new tax revenues. The committee budget follows the one proposed by Governor...

Medicare Fee-for-Service Program Improperly Paid $41.1B

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Due to problems with oversight and contract issues, the Medicare Fee-for-Service Program wrongly made payments of $41.1 billion in 2016, according to a GAO report. Following an HHS report that initially found the inappropriate payments in the...

House GOP Renewing Interest in American Health Care Act

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House Republicans are attempting to keep the American Health Care Act (AHCA) viable by adding a new amendment to the bill prior to Congress taking its spring recess. GOP lawmakers submitted an amendment to the House of Ways and Means Committee...

Texas Wrongly Claimed $3.8M in Medicaid Reimbursements

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Texas’s Department of Health and Human Services failed to adhere to federal guidelines and inappropriately claimed $3.8 million in Medicaid managed care reimbursement.    The Office of Inspector General (OIG) recently published...

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