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Anthem to Acquire FL Medicare Advantage Organization HealthSun

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Anthem entered into an agreement to acquire Florida-based HealthSun, a payer and integrated health system that provides care and coverage to 40,000 Medicare Advantage beneficiaries, the payer announced in a press release.   Leaders at Anthem...

Pharmaceutical Industry Slow to Embrace Value-Based Contracts

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Sixty-one percent of pharmaceutical companies are not yet participating in value-based contracts due largely to the belief that current policies make it too difficult to negotiate with payers and see a return on investment, according to a PricewaterhouseCoopers...

Top 10 Healthcare Spending Categories in the United States

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The upward trajectory of US healthcare spending doesn’t seem to be slowing down anytime soon, leaving payers, providers, and beneficiaries wondering how to control costs while maintaining a high level of quality. Value-based contracting...

How Pharmacy Benefit Managers Lower Prescription Drug Prices

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Payers in both the private and public sectors require new strategies that offset the rising cost of prescription drugs. Pharmacy benefit managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS...

Arkansas Slips Up on Supplemental Medicaid Payments

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A lack of administrative oversight led Arkansas to miss supplemental Medicaid payments, make several payments to Medicaid-ineligible providers, and receive excess Medicaid dollars, found a report from the Office of the Inspector General (OIG)....

More Payers, More Providers Increase Price Negotiation Power

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Payers that operate within healthcare markets with a high concentration of payers and providers prices can negotiate the price of services up to 19 percent lower than those operating in low-concentration payer-provider markets, found a new study...

Pharmacy Benefit Manager Accountability is Key for Employers

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As prescription drug costs continue to rise employers should ensure that they have strong pharmacy benefit manager (PBM) accountability measures in place to maximize cost-savings and plan efficiency, according to a report from the Midwest Business...

Veterans Gained Coverage under ACA, but May Lose Big from Repeal

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While the Affordable Care Act (ACA) produced significant coverage gains for veterans, currently proposed repeal actions could hit this population particularly hard, according to a study from RAND Corporation. Prior to the ACA, 9.1 percent of...

Medicaid Analytics Support Social Determinant Incentive Payments

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Payers looking for innovative ways to control the costs of care have been turning their attention to the social determinants of health, the non-clinical factors that often lead to issues with care access, non-adherence, and the development of...

Healthcare Coverage, Access Disparities Remain Even After ACA

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While the Affordable Care Act has helped to significantly reduce care and access disparities between socioeconomic groups, more work is needed to create true coverage equity, according to a new study from Oregon Health and Sciences University....

AARP: Congress Must Take Action on ACA Market Stabilization Solutions

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In order to protect healthcare consumers and stabilize the ACA marketplace, Congress must pass legislation that creates affordable and accessible coverage options, protects Medicaid and Medicare program funding, and expands prescription drug...

State Medicaid Orgs Struggle to Provide Behavioral Health Services

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State Medicaid organizations may need more than flexible funding in order to provide for the growing behavioral healthcare needs of their adult populations. In a report from the Government Accountability Office (GAO), six state Medicaid programs...

NY Medicaid Inspector General Assists in $125M Fraud Takedown

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The New York Office of the Medicaid Inspector General (OMIG) assisted the Medicaid Fraud Strike Force in uncovering Medicaid fraud totaled $125 million, the office announced in a press release. OMIG and the Strike Force helped other law enforcement...

AHIP: Permanently Renew Medicare Advantage Special Needs Plans

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Congress should consider a permanent renewal of the Medicare Advantage Special Needs Plans (SNPs) because of the consumer protections they provide and their market implications, AHIP wrote in a letter to the House of Representatives. A permanent...

Narrow Provider Networks are 16% Cheaper for ACA Plans

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Economists from Harvard Business School and Northeastern University found individual ACA silver plans with narrow provider networks were 16 percent cheaper for consumers and offer payers a promising savings opportunity in the commercial market....

AHIP, AMA, AHA to Congress: Fund Cost Sharing Reductions to 2019

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AHIP, AMA, and AHA and four other healthcare organizations urged Congress to continue funding cost sharing reductions (CSRs) through 2019, warning of continued instability in the health insurance marketplace and higher premiums if the CSRs were...

Cost of Implementing Quality Measures Key for Value-Based Care

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Healthcare payers and providers must develop a better sense of the costs and burdens of implementing quality measures if they are to succeed with value-based care, according to the authors of a recent commentary in JAMA. Leaders from Boston Children’s...

GAO: Veterans Affairs Insurance Enrollment Standards Lacking

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The Department of Veterans Affairs is one of the largest healthcare organizations that provides health benefits, but their enrollment standards and processes lead to delays and errors, according to a new report from the Government Accountability...

Governors Propose Health Insurance Market Stabilization Plan

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Eight state governors have outlined their proposals for a health insurance market stabilization plan that would control premium increases and improve competition in the federal and state health insurance exchanges. In a letter sent to Congress,...

HHS to Spend $10M on Affordable Care Act Navigator Program

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HHS and CMS announced that they will allocate $10 million to support the Affordable Care Act Navigator program, which helps health insurance consumers find coverage solutions during the Open Enrollment period. Launched in 2013, the Navigator...

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