Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

Patient Incentives from Payers Encourage Preventive Care Visits

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To reduce payer claim costs, would you pay members to go see their doctor once a year?  That’s the premise for a wave of patient incentive programs currently being offered by health insurance companies. For healthcare insurance payers,...

Medicaid Waiver Adds More Beds For Drug Addiction Treatment

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To circumvent an obscure Medicaid requirement, seven more states applied to join California, Maryland, Massachusetts and New York to receive a Medicaid waiver to expand drug addiction treatment.   Current federal policy prohibits the...

MD Health Insurance Exchange Rates Up Double-Digits for 2018

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Patients in Maryland looking for insurance in 2018 may have bigger bills than they bargained for. The health insurance exchange rates for individual and group plans in the state have risen by up to 58 percent as payers try to cope with uncertainty,...

Are Health Insurance Subsidies Enough for Low-Income Patients?

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Despite financial penalties designed to prompt consumers to keep their health insurance, current efforts to subsidize care for low-income individuals may not be enough to incentivize patients, according to a recent study by economists at MIT...

Healthcare Orgs React to House Vote on American Health Care Act

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The House vote to pass the American Health Care Act (AHCA) has drawn responses from across the healthcare industry.    The bill was passed 217-213, and immediately created a firestorm of commentary.  The passage of the bill...

Anthem Pursues Cigna Merger Up to the Supreme Court

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Just seven days after a court upheld the initial ruling which blocked Anthem’s acquisition of Cigna, the nation’s second largest insurer is not giving up.   Anthem has confirmed that it is filing a writ of certiorari with...

Pharmacy Benefit Managers Help Reduce Payer Drug Spending

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Pharmacy benefit managers (PBMs) are instrumental in helping payers provide appropriate access to prescriptions, expand access, and rein in drug spending, according to a recent report from the Pharmaceutical Care Management Association (PCMA)....

House Passes AHCA To Repeal and Replace ACA By 1 Vote Margin

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The House has successfully passed the American Health Care Act (AHCA) to repeal-and-replace the ACA.  This was the House GOP’s second attempt to pass the bill, after the first vote was abruptly cancelled by Speaker Paul Ryan in...

Aetna Posts Q1 Loss After ACA Withdrawal, Merger Collapse

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After a tumultuous 2016, Aetna announced a first-quarter 2017 net loss of $381 million, a significant  reversal from a $737 million profit a year ago. Aetna blamed the loss on costs associated with its attempted merger with Humana,...

AHIP Sees 28% Increase in Medigap Enrollment Among Seniors

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AHIP has released data showing that enrollment in the Medicare Supplement, Medigap, has seen a steady increase from 2014 to December 2015.   The data represents statistics from 11.8 million enrollees with policies from 305 separate...

Chronic Care Management Fund Aids Underinsured Patients

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The HealthWell Foundation has launched the Movement Disorders Fund to provide financial support for those patients unable to pay insurance premiums or copays for necessary chronic care management. The fund is available to qualifying Medicare...

Payers Offer 10 Ways to Improve Cost, Quality of Long-Term Care

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The National Association of Insurance Commissioners (NAIC) issued ten long term care (LTC) federal policy recommendations to Congress.   The report was completed as part of the group’s Retirement Security Initiative.  NAIC...

Aetna to Offer New HMO Option for Delaware State Employees

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Health insurer Aetna was recently awarded a three-year contract as a provider of Delaware’s health plan offerings for its employees and pensioners.  Aetna has chosen a coordinated care approach partnering with local innovators to move...

Tufts Health Plan Sees Opportunities as New RI Medicaid Option

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Rhode Island will add Tufts Health Plan (THP) as its first new Medicaid option in seven years, according to the Rhode Island Executive Office of Health & Human Services (EOHHS).  The new program, RITogether, will allow Medicaid...

Court Upholds Antitrust Ruling Against Anthem-Cigna Merger

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On Friday, a federal DC district appeals court upheld a February 2017 decision which blocked the acquisition of Cigna by health insurance giant Anthem.  Antitrust concerns led 11 states and the District of Columbia to join the US Justice...

Patient-Centered Medical Home Benefits Payers, Providers, Patients

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Blue Cross-Blue Shield of Michigan has one of the nation’s most successful patient-centered medical home (PCMH) networks.  The model has improved patient outcomes, lowered payer costs and increased provider satisfaction and revenue. ...

Medicaid Service Equals or Surpasses Private Health Payers

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A new report by the Commonwealth Fund found that Medicaid provides equal or better quality health coverage to private health insurance plans.  The Commonwealth Fund’s 2016 Biennial Health Insurance Survey measured statistics related...

Provider-Owned Health Plans Adopt Interoperability Standards

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Three provider-owned health plans have recently completed multiple phases and been awarded CAQH CORE certification.  This achievement places the provider-owned health plans at a level that supersedes present regulatory requirements...

Population Health Approach to Prenatal Care Cuts Payer Costs

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Health insurance payers can improve patient outcomes and reduce spending by expanding the use of population health management models for expectant mothers.  Early intervention and preventive care can lower costs in high-risk birth situations,...

PA Seeks Increased Payer Coverage of Emergency Air Ambulances

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Emergency air ambulances save lives, but they can also leave patients in a mountain of debt.  Pennsylvania Insurance Commissioner Teresa Miller would like payers to shoulder more of the costs of these critical services, and has accordingly...

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