Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

UPMC, AstraZeneca Enter Value-Based Pharmaceutical Contract

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UPMC Health Plan and AstraZeneca are taking on the challenge of a value-based pharmaceutical contract for one of the manufacturer’s cardiovascular medications. Reimbursement for prescriptions of BRILINTA, a drug intended to help...

CA Payers Tackle Provider Directories with Data, Collaboration

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Provider directories are often a patient’s primary source of information when making decisions about their care and coverage. Healthcare consumers use these directories to find out which providers are in their health plan’s...

Apple, Aetna Create Wellness Program Based on Apple Watch

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Apple and Aetna, newly acquired by CVS Health, have announced a new collaboration that will offer wearable-based wellness services to members.  The new program, called “Attain,” will leverage the Apple Watch to offer...

Optum Sues Over Alleged Trade Secrets Brought to Amazon

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Optum is suing former employee David Smith over allegations that Smith has shared Optum’s trade secrets with his new employer, the as-yet-unnamed collaboration between Amazon, JP Morgan Chase, and Berkshire Hathaway. Optum is...

Gallup Reports 4-Year High in Number of Uninsured Americans

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Earlier this week, the Gallup National Health and Well-Being Index reported that the percentage of adults without health insurance reached 13.7 percent by the close of 2018. The polling group sampled more than 115,000 adults across the...

Walgreens Agrees to $296M Settlement in Healthcare Fraud Cases

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Walgreens has agreed to pay a total of $296.2 million in settlements for two separate healthcare fraud cases. The first settlement, approved on January 16, 2019, requires the pharmacy chain to pay $209.2 million to resolve allegations...

Aetna, Anthem, HCSC Back Healthcare Blockchain Initiative

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Aetna, Anthem, and Health Care Service Corporation announced a new partnership with IBM and PNC Bank focused on bringing blockchain technology to healthcare. “The aim is to create an inclusive blockchain network that can benefit...

Price of Insulin Doubles, Increasing Spending for Members, Payers

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Dramatic increases in the price of insulin are driving a rapid uptick in overall spending for diabetes care, according to new data from the Health Care Cost Institute (HCCI). Between 2012 and 2016, the point of sale price for insulin...

CMS Approves Arizona Medicaid Community Engagement Requirement

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CMS has approved Arizona’s request to add a community engagement requirement to its section 1115 Medicaid demonstration project, called “Arizona Health Care Cost Containment System” (AHCCCS). After consulting with Native...

86% of Payers Fail to Deliver Readable Medicare Communications

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Most documents intended for Medicare and Medicare Advantage members do not meet accessibility standards for the average reader, according to a new report from VisibleThread, a text analysis company. More than 86 percent of payers offering...

Bipartisan Bill Suggests Another Health Insurance Tax Delay

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Senators from both sides of the aisle have sponsored a bill that would delay implementation of the ACA’s health insurance tax (HIT) once again, this time for two years. The $16 billion tax, designed to be levied on payers, would...

CMS Tackles Drug Costs with New Medicare Advantage, Part D Models

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CMS’s Center for Medicare and Medicaid Innovation has launched a new payment model and updated an existing model aimed at helping Medicare Part D and Medicare Advantage plans to lower drug prices and better serve...

Walmart, CVS Health Agree on PBM Pharmacy Network Rates

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Walmart and CVS Health have signed a multi-year agreement to keep Walmart participating in the CVS Caremark pharmacy benefit management (PBM) commercial and Managed Medicaid pharmacy networks. Walmart will continue to offer services to...

CMS Mulls End of Auto-Reenrollment, Silver Loading in ACA Market

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CMS has issued its proposed Payment Notice for the 2020 plan year, which contains provisions that would significantly alter the operations and structure of the ACA individual marketplace. Continuing a pattern of using CMS regulatory...

Payer Investment May Improve Delaware Primary Care Access

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Payers can expand primary care access in Delaware by progressively increasing primary care spending until it accounts for 12 percent of all healthcare investment, according to a report from Delaware’s Primary Care...

Blue Cross of NC, Major Health Systems Partner for Value-Based Care

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Blue Cross and Blue Shield of North Carolina has launched Blue Premier, a new value-based care model that increases accountability for participating providers and their accountable care organizations (ACOs). Beginning in January of 2019,...

Apple Floats Idea of Subsidizing Watches for Medicare Advantage

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Apple has approached several Medicare Advantage plan providers to discuss the idea of subsidizing its Apple Watch for at-risk seniors, according to industry reports. CNBC reporter Christina Farr states that at least three Medicare...

HCTTF Offers Clinical Episode Grouper Resources for Bundled Payments

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The Health Care Transformation Task Force (HCTTF) has released a new set of resources to support payers as they develop innovative bundled payment programs. In a white paper titled Episode Groupers: Key Considerations for Implementing...

After Buying Aetna, CVS Health Commits $100M to Address SDOHs

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With its $69 billion acquisition of Aetna in the books, the newly expanded CVS Health is now investing heavily in developing and deploying new models to address community wellness and the social determinants of health (SDOH). The...

Anthem Medicare Advantage Members Can Use OTC Allowance at CVS

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Anthem Blue Cross (Anthem) Medicare Advantage members in California will now be allowed to purchase over-the-counter products at CVS Pharmacy stores using their health plan allowance. The partnership, launched on January 1, is intended to...

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