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HealthPayerIntelligence News

Can Value-Based Purchasing Work with Pharmaceutical Companies?

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The Network for Excellence in Health Innovation (NEHI) believes that developing value-based purchasing contracts between payers and pharmaceutical companies will be a critical next step for healthcare reform. Having payer and pharma companies...

Payers Face 9.6% Underwriting Loss on Health Insurance Exchange

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Underwriting margins for payers selling individual plans on the health insurance exchange dropped from a 6 percent earned premium loss in 2014 to a 9.6 percent loss in 2015, Milliman recently reported. The financial losses stemmed from the Affordable...

House Reps Add Amendments to the American Health Care Act

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House Republicans recently added 21 pages of  updates and changes to the American Health Care Act (AHCA) to push forward the potential Affordable Care Act (ACA) repeal and replace bill. Many of the legislation’s changes would make...

APMs, Health Data Exchange among Top Payer Reform Goals

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The National Academy of Medicine (NAM) offered policymakers and stakeholders healthcare reform priorities, including alternative payment models (APMs) and health data exchange, that aim to lower overall healthcare costs and improve patient...

Out-Of-Pocket Healthcare Spending on the Decline Since 2000

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The Agency for Healthcare Research and Quality (AHRQ) reported that out-of-pocket healthcare spending decreased for all age groups between 2000 and 2014. A statistical brief of the report presents data from the Household Component of the Medical...

HHS Launches Webpage Detailing ACA Repeal Actions

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HHS created a new online resource that highlights the regulatory and administrative actions the federal department has taken for an Affordable Care Act (ACA) repeal. HHS believes that these actions are necessary to relieve burdens of the...

HFPP Provides New Resource for Payers to Combat Opioid Abuse

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A new 64-page report from the Healthcare Fraud Prevention Partnership (HFPP), a public-private partnership which includes CMS, gives payers resources that treat, educate, and develop improvements for combating opioid harm to patients. CMS has...

AHA Urges D.C Appeals Court to “Uphold Cigna-Anthem Ruling”

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The American Hospital Association (AHA) released a public document urging the U.S Court of Appeals in Washington D.C, to affirm the block on the Cigna-Anthem merger. In an amicus barae, the AHA outlined various antitrust violations and inhibitions...

Healthcare Leaders Air Concerns about NQF SDS Trial Period

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A group of healthcare organizations wrote a letter to the National Quality Forum (NQF) calling for a one-year extension of the Sociodemographic (SDS) Trial Period that evaluates how social factors impact a hospital's or provider’s ability...

Emergency Coverage Top Healthcare Consumer Demand For Payers

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A new poll from the American College Of Emergency Physicians (ACEP) and Morning Consult found that 95 percent of healthcare consumers say payers should cover emergency services. Out of the 1,791 healthcare consumers surveyed, about 31 percent...

Patient Satisfaction Key for Payer Measurement of ACO Quality

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An article from the American Journal of Managed Care reveals that patient satisfaction within an accountable care organization (ACO) is a strong indicator of the care quality level the organization delivers, giving payers an opportunity to use...

2017 ACA Open Enrollment Data Shows 12.2M Marketplace Signups

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During the 2017 ACA Open Enrollment Period (OEP), more than 12.2 million healthcare consumers purchased or renewed insurance through Healthcare.gov or their local state exchanges, said CMS in a new data brief.   Marketplace consumers either...

Price, Verma Push for Better State Control of Medicaid Programs

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As one of her first actions as CMS Administrator, Seema Verma collaborated with the Department of Health and Human Services (HHS) Secretary Tom Price to detail how the federal government plans to improve its state partnerships to enhance state...

Tom Price: American Health Care Act CBO Score is Inaccurate

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HHS Secretary Tom Price, MD, released a statement that decried several findings from the Congressional Budget Office’s (CBO) score of the American Health Care Act (AHCA). The CBO estimates that over 14 million Americans will lose health...

CBO Score Confirms Industry’s American Health Care Act Concerns

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After the Congressional Budget Office released their cost estimate on the American Health Care Act (AHCA) several healthcare industry leadership groups reaffirmed their concerns about the bill, which may leave approximately  14 million Americans...

HHS Offers Waivers for Health Insurance Exchange Stability

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The Department of Health and Human Services (HHS) recently encouraged states to apply for State Innovation Waivers as a way to stabilize the health insurance exchanges and boost consumer access health plans and services. States should particularly...

Aetna, Cigna Join 300 Organizations in CAQH CORE Phase III

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A new press release confirmed that Aetna and Cigna are now certified under CAQH CORE Phase III Operating Rules. Their certification will provide the entire CAQH CORE collaboration interoperable access to two of the largest payers in the US. Under...

Doctors Provide 5 Alternative Payment Model Improvements

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A journal article published in the American Journal of Managed Care, outlines recommendations from several doctors on significant ways alternative payment models (APMs) can be improved and better designed. APMs are being promoted throughout the...

Wait Times Still High for Veterans in VA Choice Program

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Research from the Government Accountability Office (GAO) found that veterans waited an average 24 days to receive care at any care facility that is administered by the Veterans Choice Program. The program allows veterans to receive care from...

Industry Groups Express Concerns Over Proposed ACA Repeal Bills

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Earlier this week, House Republicans started a potential Affordable Care Act repeal by introducing the American Health Care Act. But some industry groups recently expressed concerns that the legislation would inappropriately shift more healthcare...

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