HealthPayerIntelligence News

Humana Launches Two More Value-Based Program for Specialty Care

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The Louisville-based health payer is looking to build on its success in transitioning providers and members to value-based care with the announcement of two new models and twelve inaugural...

UnitedHealthcare Launches Concierge-Style Plan, Free Primary Care

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UnitedHealthcare and Canopy Health are introducing a new employer-sponsored, concierge-style health plan that incorporates free access to primary care services. “In designing the California...

MA Special Needs Plans May Lower ESRD Spending, Improve Outcomes

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Medicare Advantage special needs plans (SNPs) may help control healthcare spending for patients with end-stage renal disease (ESRD), a recent study published by Health Affairs found. CMS established a...

How States, Employers Control ESI Healthcare Spending Long-Term

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States, employers, and the federal government must each play a role in supporting sustainable employer-sponsored insurance spending solutions during the coronavirus pandemic, a recent United States of...

Payer Empowers Grassroots Movement to Tackle Opioids Epidemic

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While payers are pursuing high quality substance abuse care for their members, supporting employees through substance abuse and reducing stigmas around the opioids epidemic is equally critical,...

Tobacco Surcharge Hinders Coverage Access for Low-Income Seniors

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Smoking can lead to higher premiums, a recent study on the tobacco surcharge and tobacco users’ Affordable Care Act marketplace premiums revealed. According to the Centers for Disease Control...

CA Legislature Expands Behavioral, Mental Healthcare Parity Law

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Under a newly revised bill from the California state legislature, California health plans will have to cover mental health conditions to the same extent they do medical services in an effort to achieve...

GA’s Affordable Care Act Exchange Model Moves to Public Comment

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CMS has confirmed that Georgia’s Section 1332 state innovation waiver, which changes the Affordable Care Act exchange model, is complete. The waiver will now move into a public comment...

How COVID-19 Policies May Affect Medicare Advantage Star Ratings

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As the coronavirus pandemic continues to rage across the US, the payer industry must consider how the current environment will affect Medicare Advantage Star Ratings for years to come. The industry may...

How States Handled Medicaid LTSS Coverage, Benefits for COVID-19

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Most states have had to expand their Medicaid long-term supports and services coverage and benefits in order to protect some of the most vulnerable populations from the coronavirus, which could have...

How Payers Can Leverage Centers of Excellence to Boost Quality

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For the past couple of years, employers have increasingly used centers or excellence (COE) to bolster the quality of healthcare benefits, but health plans can leverage these centers as well to improve...

Payer Seeks to Democratize Social Determinants of Health Data

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Blue Shield of California has partnered with a third-party vendor to make social determinants of health data accessible to anyone. Payers and providers talk extensively about sharing social...

Employers Unaware of How to Compare Health Plan Quality Measures

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Employers find the health plan selection process cumbersome and are not aware of how to compare health plan quality measures using the National Committee for Quality Assurance (NCQA) tools, two NCQA...

Neither Anthem, Cigna to Receive Damages in Merger Disputes

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Chancery Court Judge Travis Laster laid to rest the merger dispute between Cigna and Anthem on the last day in August 2020, a little over five years after the two payers originally announced the...

New Aetna Health Plan Leverages CVS HealthHUBs, Narrow Networks

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Aetna is initiating a new employer-sponsored health plan in Kansas and Missouri that will combine a narrow network with CVS Health services, the payer announced. “This plan is just one example...

Payer, Provider Value-Based Contract Targets 10% Lower Cost Trend

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Blue Cross and Blue Shield of Minnesota (Blue Cross) struck a six-year value-based contract with Allina Health that focuses on quality improvement and cost savings through care coordination,...

How Payers Can Calm Member Fears, Push Virtual Care Adoption

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As the healthcare landscape is becoming more digitized, payers can take steps to prevent members from falling back into old, non-digital forms of care, a recent Accenture report highlighted. The...

How to Assess Potential COVID-19 Employer-Sponsored Insurance Loss

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Coronavirus-related employer-sponsored insurance losses could be loser than initially expected, although it’s still unclear due to a lack of definitive data, according to a report from the Robert...

4 Population Health Strategies Payers Use for Back to School

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As fall approaches and the coronavirus continues to affect daily life, parents must decide whether and how to send their children back to school and payers must consider population health strategies...

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