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HealthPayerIntelligence News

Anthem to Withdraw from ACA Individual Market Exchanges in NV

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Anthem BlueCross BlueShield (BCBS) will completely withdraw from Nevada’s ACA exchange for individual health plans in 2018, the health payer announced on Monday. The payer’s decision follows discussion with state leaders and regulators....

Low Medicaid Payment Rates Decrease Residential Care Quality

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Low Medicaid payment rates discourage providers to serve Medicaid beneficiaries in residential care services (RCS) that in turn can cause beneficiaries to purchase more expensive long-term support services (LTSS) according to a new study from...

Payers, Providers Highlight the Pros of Cost-Sharing Reductions

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A joint group of America’s Health Insurance Plans (AHIP) and provider organizations came together to promote the benefits of cost-sharing reductions (CSRs) on consumer and payer healthcare costs, the group announced in a joint statement....

Latest Earnings Reports Show State of Health Payers in 2017

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At the half-year mark, payers have a good sense of how well their efforts to promote value-based care have fared and the opportunity to make the necessary adjusts where they have not. As part of the business-facing side of value-based care, payers...

CMS Approves State Capitated Medicaid Program in Florida

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Florida received CMS approval to operate a state capitated Medicaid program and a low-income pool (LIP) to improve care for uninsured individuals, the federal agency announced. The state submitted a request to extend Florida’s Managed Medicaid...

Medicaid Tops Private Insurance in Consumer Satisfaction KPIs

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Medicaid critics have argued that enrollees are not receiving adequate care under the program, but recent consumer surveys indicate that beneficiaries are highly satisfied with their options.   According to a new J.D. Power poll, Medicaid...

Employer Cost Management Strategies Combat High Insurance Costs

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Employers expect healthcare spending to increase by 5.5 percent in 2018, up from a 4.6 percent increase in 2017, according to a Willis Towers Watson survey. The continued rise in costs has turned health cost management as a top employer concern,...

Socioeconomic Data Improves Public Health, Payer Programs

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CMS programs recognize that the social determinants of health (SDOH) play a large role in the health of their beneficiaries and, when neglected, can create negative health implications for beneficiaries covered by Medicare, Medicaid, and CHIP....

Anthem Blue Cross Engages in Medicare Advantage Risk-Sharing

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Anthem Blue Cross and America's Health Plan (AHP) have announced a risk sharing partnership aimed at improving services for Medicare Advantage beneficiaries in California. AHP and Anthem view the partnership as a gateway for promoting value-based...

Payer Collaboration Can Address Social Determinants of Health

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Billions in overspending on medical costs are attributed to social determinants of health (SDOH), and SDOH can identify if beneficiaries covered by insurance plans are at risk for adverse health conditions outside their coverage. SDOH include...

Amerigroup Creates Risk-Based Partnerships for Medicare Advantage

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Amerigroup has announced two risk-based partnerships between health systems in Houston and El Paso that aim to enhance quality of care and increase provider access for Medicare Advantage (MA) beneficiaries. Renaissance Physicians Organization...

KPMG: Cybersecurity Breaches on the Rise for Healthcare Payers

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Healthcare payers are increasingly becoming targets of cybersecurity breaches, both malicious and accidental, according to a new survey from KPMG.  Cybersecurity incidents resulting in compromised data and HIPAA violations affected 47 percent...

Effective Steps for Health Insurance Marketing, Consumer Engagement

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Creating and deploying effective health insurance marketing and consumer engagement plans can be difficult for payers in today’s complex purchasing landscape.   Payers must focus on building strong brands, clear messaging, and effective...

Boston Children’s, Cleveland Clinic Partner for Pediatric Care

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Boston Children’s Hospital and Cleveland Clinic have announced a partnership to provide complex pediatric heart care through Cleveland Clinic’s national employer-based insurance network. “Together, our goal to develop and provide...

How Can Health Savings Accounts Help, Hinder Patients and Payers?

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Health savings accounts (HSAs) have been widely discussed as lawmakers consider policy reforms, at the federal level, and have become a fixture in conversations about healthcare spending among payers and patients alike.   HSAs are consumer...

ACA “Skinny Repeal” Dies in Senate, Leaving Next Steps Uncertain

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In the early hours of Friday morning, the Senate failed to pass its attempt at a “skinny repeal” of the Affordable Care Act, which would have eliminated the tax penalties associated with the individual mandate for insurance coverage...

Large Employers Aim to DRIVE the Expansion of Value-Based Care

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Large employers are deeply invested in bringing down healthcare spending rates, and have embraced value-based care strategies for ensuring that their employees stay as healthy and productive as possible. As care costs continue to rise across...

Can Healthcare Payers Inspire ACOs to Take on Two-Sided Risk?

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While two-sided risk arrangements are attractive for healthcare payers, even experienced accountable care organizations (ACOs) are wary of jumping into contracts which make them financially responsible for falling short of their quality benchmarks. ...

CMS Proposes Medicare Home Health Agency Payment Changes

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CMS proposed Medicare home health agency payment changes in a new rule intended to reduce provider burdens and advance flexible, transparent payment models in the next two years. “CMS is committed to helping patients and their doctors make...

Senate Nixes Better Care Reconciliation Act, But Isn’t Done Yet

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After a nail-biting procedural vote on Tuesday afternoon that required Vice President Mike Pence to break the tie, the Senate continued its tumultuous afternoon by voting down the Better Care Reconciliation Act, which included deep cuts to Medicaid...

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