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AMA, AHA Call for Stronger Patient Insurance Protections

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The American Medical Association (AMA) has joined seven prominent health industry groups in calling for the Senate to address patient protection concerns regarding health insurance coverage.  The move by eight of the nation’s leading...

Cigna, CVS MinuteClinics Partner for Expanded Healthcare Access

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Cigna and CVS Health have partnered to launch Cigna Health Works for expanded healthcare access for the payers employer-based health plan members.  The launch is currently limited to certain markets only. Cigna Health Works will align members...

Facing an Empty Exchange, Iowa Suggests Statewide Insurance Plan

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If Iowa’s health insurance exchanges are completely abandoned, the state will request that the federal government allow the establishment of a state health care plan for 2018. If approved by CMS, the stopgap measure would create the Iowa...

Medicaid Enrollment a “Lifeline” for Rural Residents, Children

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Medicaid enrollment rates are highest for adults and children in small town and rural areas, providing a “lifeline” for low-income beneficiaries, according to a new analysis by the Georgetown University Center for Children and...

Centene Will Enter Health Insurance Exchanges in 3 New States

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Centene Corporation will expand its presence in a number of state health insurances exchanges in 2018, building on its successful 2017 marketplace results.  The payer is planning to enter the Kansas, Missouri and Nevada...

Employer Health Plans See Spike In Out-of-Pocket Costs

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The National Center for Health Statistics study found a double-digit increase in the use of high-deductible employer health plans has generated increased economic strain for members. Beneficiaries reported struggling to pay medical bills or delaying...

3 Whistleblower Suits Net over $60 Million in Medicare Fraud

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Whistleblower lawsuits alleging Medicare fraud have been settled against two diagnostic testing companies, and a California doctor who was alleged to have falsely diagnosed cancer as a means to bill Medicare for expensive surgeries. Medicare...

High Costs, Little Return are Hurting Health Insurers under ACA

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High cost beneficiaries, risk adjustment methodologies, and insufficient capital are the top three issues facing health insurers today, according to MinuteMan CEO Tom Policelli.  As the national debate over the future of the ACA and potential...

ACA Medicaid Expansion Boosted Care Access, Patient Outcomes

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Low-income adults taking advantage of the Affordable Care Act’s Medicaid expansion experience more financial stability and better outcomes, according to a new study from the Harvard T. H. Chan School of Public Health. “Our four years...

Payers Leaving Affordable Care Act Insurance Exchanges in 2017

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Questions over the future of the Affordable Care Act (ACA) and its cost-sharing reduction (CSR) payments have prompted many payers to abandon ACA state health insurance exchanges in part or entirely in 2017.  Insurers cited the usual suspects...

PA Payer Market Stable, but OH Loses ACA Exchange Participants

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Pennsylvania and Ohio are having very different experiences with their Affordable Care Act health insurance exchanges as they move into 2018. While Pennsylvania’s existing five payers will continue to offer exchange plans at roughly the...

Nevada Legislature: All Residents Should Have Medicaid Access

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The Nevada State Assembly has passed a bill which would open Medicaid enrollment to all of the state’s residents, regardless of income or health status.   The Nevada Care Plan would allow every state resident without health insurance...

Payers, Providers Differ in Value Based Care, Health IT Opinions

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Payers see the move towards value-based care as a permanent fixture in the nation’s healthcare delivery system, with 82 percent of organizations responding to a Quest Diagnostics and Inovalon survey expecting it to continue despite any...

Two Payers Liable for $32.5M in Medicare Advantage Fraud Suit

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Insurers Freedom Health and Optimum Healthcare have agreed to pay $32.5 million to avoid further litigation in a whistleblower lawsuit which alleges systemic Medicare Advantage fraud.    The insurers will pay the federal government $16.7...

BCBS Georgia Plan to Charge for Unnecessary ER Visits Draws Ire

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Blue Cross of Georgia is facing criticism from the American College of Emergency Physicians (ACEP) for a policy directive that would charge members for emergency department visits that result in a non-emergency diagnosis. The policy, which Blue...

$18M Claimant Case Challenges Affordable Care Act Payers

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In April of 2017, Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, announced it would exit the 2018 health insurance exchanges.  The payer cited higher than expected claims costs, including Member X, who had claims...

Healthcare Costs Vary Widely Across Geographic Regions

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New research from the Health Care Cost Institute (HCCI) shows that healthcare costs for three common procedures, including knee injections, ACL repairs, and knee replacements, varied greatly across 61 metro areas.   The results...

AHIP: Congress Must Stabilize Payer Market, Consider Reforms

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With passage of the AHCA, the insurance industry group AHIP has sent its response to congress and presented its recommendations for what direction to go in with healthcare reform The payer industry organization submitted recommendations in four...

Harvard Pilgrim Enters Outcomes-Based Pharmaceutical Contracts

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Harvard Pilgrim Health Care has signed a three-year value-based care contract with drug maker AstraZeneca for two therapies used to treat acute coronary disease and type 2 diabetes. The arrangements will use patient outcomes as a measure of the...

NC Payer Raises Health Insurance Rates Due to CSR Lawsuit

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Blue Cross Blue Shield of North Carolina announced its 2018 individual premium rates will increase an average of 22.9 percent for coverage on and off the health insurance exchange in all 100 counties it serves.  The increase is a pinch lower...

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