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Humana to Leave ACA Health Insurance Exchanges by 2018

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Humana will halt sales of individual health insurance plans through the Affordable Care Act’s exchanges by 2018, which will leave more than 150,000 Humana customers without a carrier.   Amid ongoing political uncertainty, Humana said...

Does Tiered Cost-Sharing Promote Appropriate Medication Use?

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Health plans have traditionally used tiered formulary cost-sharing arrangements to reduce healthcare spending and incentivize appropriate medication use. But a recent Journal of Managed Care & Specialty Pharmacy study found that stakeholders...

Aetna, Humana Terminate Merger Deal After Court Defeat

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Aetna and Humana have scrapped their merger plans after the Department of Justice blocked the deal due to antitrust concerns.  Aetna will pay Humana a $1 billion termination fee, included as part of the original agreement. The DOJ lawsuit,...

Joint Replacement Bundled Payment Cut Costs, Maintained Volume

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A new Altarum Institute study confirmed previous research that bundled payment models for lower extremity joint replacements decreased care costs without sacrificing care quality or substantially increasing procedure volumes. In September 2016,...

Two-Sided Financial Risk Model Reduces Socioeconomic Disparities

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A two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. Disadvantaged patients receiving...

Federal Judge Strikes Down Cigna-Anthem Health Insurance Merger

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A federal judge in Washington DC recently blocked a potential $48 billion health insurance merger between Cigna and Anthem, according to a Department of Justice (DoJ) press release. The two payers started the merger process back in the summer...

Payers with Larger Market Share Have More Negotiating Power

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Payers that dominate the local market are able to negotiate lower physician office visit prices than their smaller peers, found investigators from Harvard Medical School. Health insurance companies with 15 percent or more of the market share...

Medicaid Expansion Boosts Coverage, Quality at Health Centers

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Federally funded health centers in states that underwent Medicaid expansion through the Affordable Care Act faced higher levels of insured patients and improved care quality compared to their peers in non-expansion states, a recent Health Affairs...

Proposed ACA Replacement Moves Coverage Choices to the States

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Several Republican lawmakers have introduced the “Patient Freedom Act” as a proposed replacement of the Affordable Care Act, emphasizing state authority and local decision-making in the health insurance market. Senators Bill Cassidy,...

Shareholder Class Action Lawsuit Filed Against Aetna

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A shareholder class action lawsuit has been filed against the national health insurance company Aetna Inc., according to a press release from the law firm of Kessler Topaz Meltzer & Check, LLP. The announcement came earlier this...

Bundled Payment Model Attracts More Oncologists than Expected

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The new bundled payment model from the Centers for Medicare & Medicaid Services (CMS) called the Oncology Care Model has shown strong participation numbers among healthcare providers with twice as many medical organizations participating...

State Medicaid Programs Invest in Accountable Care Organizations

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Last month, the Center for Health Care Strategies released a fact sheet outlining the growth of state Medicaid programs operating accountable care organizations (ACOs). Right now, there are 10 states that are managing Medicaid ACO programs...

Congress Votes to Nominate Tom Price as HHS Secretary

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On February 1, House Representative Tom Price, R-Ga., was officially nominated as the Secretary for the Department of Health & Human Services (HHS), according to the US News & World Report. The Senate Finance Committee moved forward with...

Top 4 Ways Payers Could Improve Patient Health Outcomes

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Health insurance companies have been putting more focus on preventive care, a reduction in unnecessary medical testing, and better patient health outcomes by transitioning to value-based care reimbursement. National payers have utilized a number...

Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement

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  In recent years, the national health payer Anthem has been advancing value-based care reimbursement by collaborating with primary care providers and operating the Enhanced Personal Health Care program, according to a report released...

How to Develop HEDIS Quality Measures for Pediatric Care

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The American Academy of Pediatrics (AAP) announced yesterday on its website that it will be partnering with the National Quality Forum (NQF) to connect quality metrics to the interests of children and pediatric care. The National Quality Forum...

Stakeholders Offer Key Principles for Alternative Payment Models

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More than 100 medical organizations sent a letter to President Trump and Vice President Mike Pence on behalf of supporting the healthcare industry’s transition to alternative payment models. The letter outlined the complexities and hindrances...

Are Bundled Payment Models or Capitation the Better Choice?

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  Today, healthcare payers have multiple ways to reimburse providers for performing medical services that move away from the traditional and more costly fee-for-service reimbursement system. Two such possibilities include capitation payment...

Should Accountable Care Organizations Include Social Services?

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While government agencies, healthcare payers, and medical organizations put their efforts and hopes in advancing accountable care organizations (ACOs), these healthcare delivery reforms lack significant social service interventions, according...

74% of PCPs Prefer Affordable Care Act Changes Over Repeal

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Only about 15 percent of primary care providers favored a complete repeal of the Affordable Care Act, a recent New England Journal of Medicine study stated. While some of the 426 primary care providers surveyed between December 2016 and January...

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