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HealthPayerIntelligence News

CMS: Individual Health Plan, Federal Exchange Challenges Remain

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CMS has released three new reports indicating that the individual health plan and federal exchange markets faltered somewhat in 2017 because of increasing premiums, decreasing competition, and stagnant enrollment. The agency believes that...

Medicare, Medicaid Home Health Benefits Stabilize Care Costs

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Providing extended home health benefits for Medicare beneficiaries is likely to stabilize care costs for public payer programs, according to a new analysis from the Commonwealth Fund. Researchers from the Hilltop Institute and Johns...

DOJ Nabs 601 Defendants in Biggest Healthcare Fraud Takedown Yet

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HHS Secretary Alex Azar and Attorney General Jeff Sessions have announced the largest healthcare fraud takedown yet after HHS, the Department of Justice (DOJ), and other law enforcement agencies charged 601 healthcare professionals for $2...

Federal Court Strikes KY 1115 Medicaid Waiver Work Requirements

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The US District Court for the District of Columbia has blocked Kentucky from implementing work requirements within its 1115 Medicaid waiver demonstration, despite CMS approval of the community engagement provisions. The court ruled that...

Highmark BCBS Saves $260M Using Value-Based Reimbursement

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Highmark BlueCross BlueShield has saved $260 million in avoidable care costs by using value-based reimbursement and provider performance standards to hold healthcare organizations accountable for improving beneficiary...

Aetna Takes Amerigroup Spot in Kansas Managed Medicaid Contract

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Aetna has received a Managed Medicaid contract from the state of Kansas for plan year 2019 and will replace Amerigroup as one of the state’s three managed care payers. The state received six bids from commercial payers and...

Can Retail Clinics Improve Patient Access, Reduce Costs for Payers?

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Retail clinics are gaining in popularity among patients looking for quick, convenient care for minor ailments. Kiosks and no-appointment-needed offices located in corner pharmacies and big box stores have the potential to keep patients...

CMS Approves Okla. Value-Based Drug Purchasing for Medicaid

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CMS has approved the nation’s first value-based drug purchasing agreement for Medicaid by allowing Oklahoma’s state program to negotiate supplemental prescription drug rebates based on treatment outcomes. CMS allows state...

Partners HealthCare to Self-Insure 100K Employees

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Partners HealthCare has announced it will self-insure 100,000 of its employees, transitioning coverage from BlueCross BlueShield of Massachusetts to its own Neighborhood Health Plan, according to The Boston Globe. “Neighborhood...

CMS to Develop New Medicaid Program Integrity Initiatives

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CMS has announced a new set of Medicaid program integrity initiatives that leverage enhanced data sharing, claims auditing, and provider education to reduce the incidence of improper payments and help secure program finances. In 2016,...

How to Drive Enrollment in the ACA Health Plan Marketplaces

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Payers and states wishing to increase enrollment in the ACA health plan marketplaces should  create targeted advertisements, benchmark silver-tier plans as their primary exchange plan, and help consumers navigate health plan...

Customer Satisfaction with Medicare Advantage Health Plans Remain Low

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Medicare Advantage (MA) plans are not meeting their customer satisfaction goals, and tend to leave consumers feeling less-than-pleased with the way health plans communicate and the availability of financial information, according to a new...

MedPAC: Value-Based Payment, Post-Acute Care Boost Medicare Savings

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MedPAC has advised Congress that value-based payment reform and encouraging the use of post-acute care can help the Medicare program increase savings and improve beneficiary outcomes, the group said in a new report. Revisions to payment...

Senators: Stop $89B in Medicare, Medicaid Improper Payments

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The US Senate Budget Committee has penned a letter to HHS Secretary Alex Azar urging the department to address approximately $89 billion in improper payments within Medicare and Medicaid. The Senators referenced a recent GAO report...

Narrow Networks, Customer Satisfaction Contain Payer Spending

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Payers can curb spending on medical care by investing in narrow networks and customer satisfaction tools, says a new PricewaterhouseCoopers (PwC) Health Research Institute (HRI) analysis. PwC found that medical costs for...

Humana, Walgreens Offer Primary Care Clinics for Medicare Members

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Humana and Walgreens have announced the launch of two primary care clinics, designed to meet the needs of Medicare beneficiaries, that will operate within Walgreens locations in the Kansas City area. The collaboration, led by a Humana...

Beneficiaries Want More Holistic Health, Wellness Benefit Options

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Health plan beneficiaries are increasing their demand for holistic health and wellness benefits, which can help payers deliver value and improve outcomes, according to a new report from Aetna. The Health Ambitions Study found that...

Amazon, Berkshire, JPMorgan Name Atul Gawande Healthcare CEO

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Amazon, Berkshire Hathaway, and JPMorgan Chase have named Atul Gawande, a surgeon at Brigham & Women’s Hospital, as the CEO of their joint healthcare company. The company will be headquartered in Boston, Massachusetts. Gawande...

Customer Service is Primary Driver of Health Plan Satisfaction

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Health plan members are seeking high-quality customer service experiences from their insurers, and will use positive interactions to make decisions about continued loyalty, according to a new Forrester analysis emailed to members of the...

Department of Labor Finalizes Association Health Plan Expansion

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The Department of Labor (DOL) has issued a final rule that expands consumer availability of association health plans (AHPs) starting on September 1, 2018. The rule comes months after President Trump and the DOL proposed executive changes...

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