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HealthPayerIntelligence News

CVS Closes $69B Acquisition of Aetna, Altering Consumer Landscape

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CVS Health has announced that its $69 billion takeover of Aetna has been completed.  The acquisition promises to radically transform the healthcare industry by creating new care delivery options for consumers. “Today marks...

Humana Tops List for Member Satisfaction, Net Promoter Score

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Customer service has been a perennial pain point for the health insurance industry, but a renewed focus on personalized experiences, member satisfaction, and consumer engagement appears to be paying off for some of the nation’s...

High-Deductible Plans Lead Diabetics to Forgo, Delay Treatment

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Workers with diabetes who switched to high-deductible health plans requiring additional out-of-pocket expenses are more apt to put off necessary check-ups, a new Annals of Internal Medicine study finds. A growing proportion of Americans...

Proposed Rule Seeks Lower Medicare Advantage, Part D Drug Prices

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CMS has opened comments on a proposed rule with the purpose of lowering the cost of prescription drugs and out-of-pocket expenses under Medicare Part C (Medicare Advantage) and Part D. The proposed rule aligns with the Trump...

AHIP Eyes Solutions to Assist Consumers Shopping for Health Plans

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American Health Insurance Plans (AHIP) recently issued a dozen solutions aimed at assisting families with an income over 400 percent of the federal poverty level afford comprehensive coverage covering their pre-existing conditions. Last...

Insured Consumers Struggling With Prescription Drug Costs

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Despite having access to health benefits, 40 percent or more of United States citizens have difficulty affording their prescription drugs. A GoodRx survey of 1,060 respondents about their prescriptions between October 29 and November 2...

CVS-Aetna Merger Now Expected to Close After Thanksgiving

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Close to a year has passed since CVS Health announced its plan to acquire Aetna in a $69-billion acquisition. Now only the approval of two state departments of insurance stands in its way. In a recent filing to the Securities and Exchange...

Atrium Settlement Ends Steering Restrictions in Payer Contracts

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The Department of Justice reached a settlement agreement with Atrium Health (formerly Carolinas HealthCare System) over alleged anti-competition in the form of steering restrictions in commercial payer contracts. “By eliminating...

Regulatory Changes Needed To Expand Medicare Telehealth Use

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A new report on Medicare telehealth between 2014 and 2016 shows increased utilization of telehealth services by Medicare beneficiaries but largely remains an untapped resource because of restrictive federal rules and...

HHS Sets Sights on Addressing Social Determinants of Health

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Speaking at the Hatch Foundation for Civility and Solutions in Washington, DC, early this month, Azar pointed to social determinants of health as “the root cause of so much of our health spending,” contributing to the $1...

Data from Health Plans, PBMs Helps Lower Prescription Drug Costs

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The health information network Surescripts is using data from both payers and PBMs to give prescribers access to patient-specific and formulary-based benefit and cost information for nearly three-quarters of all covered lives in the...

Regulatory Uncertainty Continues to Disrupt ACA Marketplaces

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New research published by the Kaiser Family Foundation provides insight into the forces driving health payers to participate in certain ACA marketplaces while wholly quitting others. Insurer participation in the Affordable Care Act health...

HHS Looks to Medicaid Demonstrations to Improve Mental Health

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Medicaid beneficiaries with mental health conditions are the targets of recent CMS efforts to boost health outcomes. In recent remarks to the National Association of Medicaid Directors in the national capital, HHS Secretary Alex Azar said...

CMS Demonstrations Target Mental Health Services Under Medicaid

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Medicaid beneficiaries with serious mental illness (SMI) or serious emotional disturbance (SED) are the targets of recent CMS efforts to improve health outcomes. In a letter to Medicaid directors across the country, the federal agency...

Addressing Healthcare Literacy Key to Health Plans Reducing Costs

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The inability of consumers to successfully navigate the healthcare system, which costs employers and health plans billions in administrative costs. In a recent article in the Harvard Business Review, members of Accenture’s...

Robocalls Targeted Consumers During Health Plan Enrollment Period

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Health insurance open enrollment’s kicked off, accompanied by a spike in automated calls with offers of Affordable Care Act or other health plans, much to the chagrin of consumers. “It’s at epidemic levels at this time...

FTC Clamps Down on Allegedly Fraudulent Health Plans

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A federal judge temporarily closed a Florida-based firm accused of fraudulently collecting over $100 million from Americans. Simple Health allegedly collected more than $100 million by preying on consumers shopping for health insurance by...

HealthCare.gov Breach Exposes Data of 75K Individuals

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Last month, a breach of HealthCare.gov took place that affected those applying for coverage under the Affordable Care Act, HHS reported last Friday. The intrusion led to inappropriate access to the personal information of about 75,000...

Strategies for Designing Consumer-Centric Health Plans

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The Health Care Transformation Task Force recently released a new set of guiding principles to help healthcare industry leaders and policymakers better integrate consumer needs into benefit design. The goal of the task force, a consortium...

CMS Proposes to Deregulate, Fast Track Medicaid Managed Care Programs

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CMS has proposed a new rule to reduce regulation around Medicaid managed care programs and allow states to contract with private payers to deliver managed care at faster rates. CMS developed the rule in coordination with the National...

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