HealthPayerIntelligence News

Verily Launches Tech-Focused Payer for Self-Funded Employers

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Verily, Alphabet’s life sciences and healthcare subsidiary, and Swiss Re Corporate Solutions have announced that it will launch a payer for self-funded employers called Coefficient Insurance...

Aetna Fined $500,000 for Denying Emergency Room Claims in CA

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Aetna has been fined by California’s Department of Managed Health Care for denying emergency room claims against the state’s standards. “The plan’s failure to follow California...

How COVID-19 Affected Member Engagement in Wellness Programs

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The coronavirus pandemic may be having an effect on Americans’ exercise life, a recent UnitedHealthcare survey discovered, which may in turn impact payer wellness programming to meet employee...

Hits to Employer-Sponsored Insurance May Affect Healthcare Jobs

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If the federal government wants to prevent more healthcare workers from becoming unemployed, it needs to do more to bolster employer-sponsored insurance, pushed a report from FamiliesUSA. Because...

Top 4 Recent Health Payer Innovative Consolidations, Partnerships

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Although not as active as prior years due to the coronavirus pandemic, the landscape of payer dealmaking continues to show signs of life through innovative consolidations and partnerships. Payers...

Louisiana Will Issue New Medicaid Managed Care RFP, Ends Protest

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Louisiana Department of Health will issue a new request for proposals (RFP) for Medicaid managed care organization contracts, ending a bitter legal battle over the 2019 RFP process, the department...

ACA Special Enrollment Members Have Higher Healthcare Spending

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Affordable Care Act marketplace beneficiaries who enroll in plans during special enrollment periods tend to exhibit higher healthcare spending, a recent Health Affairs article revealed. The...

Payers Redesign Referral Networks for Social Determinants of Health

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As Blue Cross and Blue Shield of Kansas City (Blue KC) relied on its social needs referral network to meet regional social determinants of health demands during the coronavirus pandemic, the payer...

Payers Have Various Strategies for COVID-19 Treatment Cost-Sharing

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While by and large patients were under the same waivers for coronavirus testing, payers have implemented a broad range of strategies to handle coronavirus treatment cost-sharing for the long term, a...

What the Interoperability Rule Will Mean for Payers in 2021

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Although the interoperability rule will not be implemented until mid-2021, payers can be aware of what to expect regarding how this rule will change their processes, as outlined in a recent AHIP...

Aetna, Cleveland Clinic Form Low Cost, Narrow Network Health Plan

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CVS Health’s Aetna has formed a new partnership with Cleveland Clinic which involves a new narrow network health plan and new provider programs, the payer and provider announced. “As part...

Many Working-Age Americans Face Unstable Coverage, Medical Debt

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Two out of every five working-age adults in the first half of 2020 had unstable healthcare coverage and a third faced medical debt, a Commonwealth Fund study recently uncovered. The survey is a part...

How Employers Are Accelerating Virtual Care, Telehealth Adoption

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Employers are emphasizing virtual care and telehealth in their healthcare benefit and care delivery strategies during the coronavirus pandemic, a recent survey by the Business Group on Health...

Payer Value-Based Care Program Ups Savings, Provider Participation

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A value-based care program from Blue Cross and Blue Shield North Carolina (Blue Cross NC) saw cost savings and quality improvement and increased provider participation in its first year, the payer...

Court Affirms CSR Reimbursement, But Amount Still Questionable

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On August 14, the Federal Circuit court made two decisions affecting payers which centered around practices meant to lower costs for Affordable Care Act marketplace enrollees: government reimbursement...

NY Announces Record Low Individual, Small Group 2021 Premium Rates

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New York has announced 2021 premium rates and the state appears to be following CMS’s lead for 2020 rates by keeping 2021 rates low. The New York State Department of Financial Services announced...

How Payers Use Whole Person, Palliative Care to Address Serious Illness

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Payers can play a significant role in decreasing the expense and complexity of serious illness care for patients through whole person care and palliative care, a study from America’s Health...

Rewards, Cash-Back Programs Incentivize Lower Healthcare Spending

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Payers can reduce unnecessary healthcare spending by incentivizing consumers to choose lower cost healthcare providers, a study from the Pioneer Institute focusing on Massachusetts-based payers...

Sentara Healthcare, Cone Health Announce Value-Based Care Merger

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Sentara Healthcare, an integrated, non-profit health system, has announced a value-based care merger with the nonprofit integrated healthcare network Cone Health. “Sentara Healthcare and Cone...