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HealthPayerIntelligence News

Better State Policy Needed to Address Social Determinants of Health

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A report on social determinants of health (SDOH) has five recommendations for addressing these important but often overlooked health factors with effective policymaking. The Center for Health Care Strategies (CHCS) recently published...

Cigna-Express Scripts Deal Secures Approval from CA, NY Officials

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Cigna secured approvals from New York and California to acquire Express Scripts, according to multiple reports. Zachary Vasile of the Journal Inquirer reports that New Jersey is the remaining state whose approval will enable the...

Coalition of State AGs Challenge Ruling of Unconstitutional ACA

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Following a December 14 ruling stating the Affordable Care Act to be unconstitutional without its individual mandate, attorney generals from 16 states and the District of Columbia filed an expedited motion to bring clarity to the...

TX Judge Rules ACA Unconstitutional in Highly Charged Court Case

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In a highly politically court case brought by a number of Republican officials, US District Judge Reed O'Connor has issued a ruling stating that the Affordable Care Act as a whole is unconstitutional. The ruling stems from the notion...

Does Medicare Advantage Bidding Hold the Key to Reducing Costs?

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In light of future research on Medicare Advantage spending compared to Medicare fee-for-service, a trio of researchers writing on the Health Affairs blog see the promise in competitive bidding to drive down healthcare...

Risk Scores at Center of Sutter-DoJ Medicare Advantage Dispute

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A complaint against Sutter Health and Palo Alto Medical Foundation over appropriate risk scores has drawn the attention of the Department of Justice. The federal agency officially announced its intervention into a lawsuit that alleges...

BlueCross BlueShield Strikes Deal to Improve Health Data Exchange

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In an agreement that will support physicians and upgrade health outcomes for its members, BlueCross BlueShield of Western New York has announced a partnership with HEALTHeLINK. It will enable local participating physicians to access...

PwC: Digital Experiences, High Costs Will Challenge Payers in 2019

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Healthcare payers that hope to succeed in 2019’s competitive business environment will need to meet the strong demand for more consumer-centered digital experiences that help members control their spending and understand how to...

Employers to Address Healthcare Consumerism, Innovation in 2019

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The National Business Group on Health has released its top-five trends for the coming year, and employers clearly want to play a more involved role in healthcare transformation. Chief among their expectations over the next twelve months...

AHIP, Payer Groups Agree to Focus on Nixing Surprise Billing

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Nine of the nation’s most influential payer organizations, including AHIP and the Blue Cross Blue Shield Association (BCBSA), have released a new set of guiding principles aimed at eliminating surprise billing. Unexpected medical...

Health Payers Targeting Improved Consumer Experiences in 2019

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Improving the consumer experience is top of mind for health payers heading into the new year, according to a multi-industry survey of senior leaders by North Highland. “The concepts of culture and change are often at the foundation...

Employer-Sponsored Health Plans Prove Costly to Consumers

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Workers and their families are spending a larger share of their income on their employer-sponsored health plans, according to a new study from the Commonwealth Fund. Coauthored by Sara Collins, Vice President of Health Care Coverage and...

Trump Administration Touts IPI Model for Reining In Drug Prices

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On average, Americans pay 80 percent more for the costliest physician-administered drugs than patients in other developed countries, according to a key HHS advisor. “Free market advocates and those who have philosophical concerns...

CMS Reports Slowed Growth of National Health Spending in 2017

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Last year, healthcare spending in the US jumped at an estimated rate of 3.9 percent to $3.5 trillion – or $10,739 per person, according to a new analysis from the Office of the Actuary at the Centers for Medicare and Medicare...

CVS Unveils New Pricing Tool for Pharmacy Benefit Management

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CVS Health has introduced a new approach to the pricing of pharmacy benefit management services, the company announced. The Guaranteed Net Cost model simplifies the financial arrangements underlying pharmacy benefit management (PBM)...

Consumers Maintaining Positive Health Savings Accounts

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Today, there are more than 23.4 million health savings accounts (HSAs) across the country, with assets of more than $51 billion, according to the 2018 Midyear Devenir Report. “We are continuing to see a growing market for HSAs, and...

Narrow Network Health Plans Continue to Dominate ACA Exchanges

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New analysis of available health plans on ACA exchanges in 2019 shows that narrow networks remain a dominant force. Avalere researchers found that more restrictive networks own nearly three-quarters of all health plans on health insurance...

Kaiser Awards $6M to Support Mental, Behavioral Health Services

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Kaiser is making a five-year, $6-million investment in community health, the health system and payer announced earlier this week. Kaiser Permanente Southern California’s Community Mental Health and Wellness will $6 million to 16...

Private Medicare Advantage Plans Receive Marketing Boost from DC

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While officials claim to not be pivoting patients to private plans, the subject lines of recent emails appear to suggest differently, according to a report by Robert Pear in The New York Times. With the open enrollment period for the plan...

Aetna Joins Healthcare Blockchain Alliance, Pilot Project

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Not long after closing its deal to be acquired by CVS Health, health payer Aetna has signed on to pilot the use of blockchain technology as part of the Synaptic Health Alliance. In a statement with new fellow participants Ascension, the...

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