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HealthPayerIntelligence News

State Medicaid 1115 Waivers Expand Eligibility, Stabilize Premiums

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A number of state governments have submitted Medicaid 1115 waivers to CMS in order to expand Medicaid eligibility requirements, stabilize their in-state premium rates, manage public health issues, and improve behavioral health access. Currently,...

Aetna to Waive Narcan Co-Pays, Combat Opioid Overprescribing

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Aetna will be the first national payer to waive Narcan co-pays for fully-insured members as part of a larger effort to address the nation’s opioid crisis, the payer announced in a press release. Narcan is considered a preferred branded...

Senate Hearing Opens Policy Discussion on Prescription Drug Costs

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At a Senate HELP Committee hearing this month, policy experts and advocacy groups suggested several strategies that could lower prescription drug costs, including removing Medicare Part D cost-sharing, increasing federal oversight of the pharmaceutical...

Individual Mandate Repeal Would Lead to Payer Financial Losses

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A repeal of the individual mandate, as included in the current GOP Senate tax reform plan, would result in financial losses for payers that could not be offset by cost-sharing reduction payments, the Academy of American Actuaries says.  ...

UnitedHealthcare Assists Phoenix Children’s Value-Based Care Goals

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UnitedHealthcare and Phoenix Children’s Care Network (PCCN) have launched an accountable care program aimed at a lowering costs and improving care quality. UnitedHealthcare will share data with PCCN to inform providers of a patient’s...

Medicare Advantage, Consumer Engagement Top Payer Trends for 2018

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Payers will face a number of industry challenges in 2018, including improving Medicare Advantage (MA) member satisfaction, expanding access to community outreach programs for individuals, and creating more drug pricing transparency for consumers,...

How Payers Address the Four Domains of Chronic Disease Prevention

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Payers have an opportunity to improve chronic disease prevention and limit chronic disease spending by addressing the both medical and non-medical factors of chronic conditions. Payers can determine their chronic disease costs, and lower those...

Why Bundled Payments Are a Popular Option for Healthcare Payers

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Bundled payments are ideal for payers that want to participate in value-based care. Bundled payments tend to have lower financial risks than other payment models for payers and are beneficial to providers as well as payers. In a bundled payment...

Member Engagement, Payer Spending Lead Top 10 Stories of 2017

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The 2017 news cycle was a constant flurry of political and financial developments for payers. From the turbulent efforts to repeal and replace the ACA in the House and Senate to challenges with member engagement, population health, and cost cutting,...

2016 Healthcare Spending Growth Slowed, Totaled $3.3 Trillion

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US healthcare spending totaled $3.3 trillion in 2016, representing a 4.3 increase in the spending growth rate since 2015. While spending continued to rise, the rate of increase was actually slower than the 5.8 percent growth rate between...

Integrated Care Model Lowers Health System Medical Costs

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Cigna’s integrated care model partnership with Texas-based Catalyst Health helped reduce the health system’s total medical costs to 5.6 percent below industry averages, the organizations announced in a press release. The Cigna Collaborative...

61% of Employees Dissatisfied with Employer Wellness Programs

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Fifty-two percent of employers believe their wellness programs improve their employee’s health behaviors, but only 32 percent of employees agree, according to a new survey from Willis Towers Watson. More than 60 percent are actively dissatisfied...

Optum to Purchase DaVita Medical Group for $4.9B

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Optum, a subsidiary of UnitedHealth Group, has agreed to acquire DaVita Medical Group for $4.9 billion, expanding the health care services company’s footprint in the direct care delivery environment. The acquisition, expected to be finalized...

Prescription Drug Spending Cuts Require Payer Policy Changes

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The US’s current prescription drug policies require updates that cut prescription drug spending while increasing competition in the market, a new report from the National Academies of Sciences, Engineering, and Medicine (NASEM) found. A...

Commercial Payer, Medicare, Medicaid Fraud Cases Top $49.1M

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The Department of Justice (DoJ) recently detailed three cases of healthcare fraud targeting private payers, Medicaid, and Medicare that totaled $49.1 million. The schemes involved common fraud tactics such as illegal kickback operations and the...

How Provider-Sponsored Health Plans Can Find Consumer Success

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Provider-sponsored health plans (PSHPs) are seen as a way for provider organizations to compete with commercial payers while lowering their own costs and improving care quality, because provider organizations can manage the cost of healthcare...

CVS Health to Buy Aetna for $69B, Altering Payer Landscape

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CVS Health is continuing its quest to become a major force in the growing world of consumer-centric healthcare by announcing that it will buy Aetna for $69 billion.  "This combination brings together the expertise of two great companies...

Ridesharing Benefit May Help Payers Improve Patient Engagement

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Payers looking to help members overcome negative social determinants of health, such as transportation issues, may be able to offer beneficiaries a ridesharing benefit to improve patient engagement. The emergence of healthcare partnerships and...

Senate Passes Tax Bill, Individual Mandate Repeal in 51-49 Vote

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The US Senate voted 51-49 to reform national tax policy and simultaneously repeal the Affordable Care Act’s individual mandate, major news outlets reported at the end of last week. GOP senators only lost one Republican vote and were able...

Most High-Deductible Health Plan Consumers Lack Financial Management

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Less than half of high-deductible health plan (HDHP) consumers engage in positive financial management tasks such as negotiating costs for healthcare services or saving for future healthcare expenses, says a research letter published in JAMA...

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