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HealthPayerIntelligence News

44% of Employees Don’t Know Value of Health Plan Benefits

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Employers must increase their efforts to educate members about the value of their health plan benefits based on recent findings that only 44 percent of employees fully comprehend their benefits. That is the leading takeaway from research published...

Payer Strategies for Improving Member Medication Adherence Rates

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Payers are spending billions of dollars annually on medications that aren’t improving the health outcomes, with financial and health literacy proving to be the most common barriers to adherence. Avoidable healthcare spending totaling between...

Providers Caught in Medicare Fraud Schemes Topping $200M

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Law enforcement officials continue to crack down on Medicare fraud schemes that siphon millions of dollars from the programs, as individuals submit fraudulent claims or overcharge for unnecessary healthcare utilization. Federal law enforcement...

Top 4 Consumer Wellness Benefits for Payers to Add to Health Plans

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As payers explore innovative ways to improve beneficiary engagement and satisfaction, they may wish to consider adding enhanced consumer wellness benefits to their health plan offerings. Health plans that take a proactive approach to engaging...

Maine Referendum Expands Medicaid Despite Governor Opposition

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The state of Maine has become the first state to expand Medicaid through a ballot vote that overrides Governor Paul R. LePage’s (ME-R) previous decisions to block the expansion, according to national news outlets. On Tuesday, Maine residents...

More Choices for Federal Health Plans Doesn’t Spread Market Share

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The federal health plan market contracted under the Office of Personnel Management (OPM) has remained heavily concentrated over the last decade, despite OPM’s efforts to improve health plan choice for employees enrolled in the Federal Employees...

CMS Adjusts Medicaid 1115 State Innovation Waiver Processes

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CMS is attempting to streamline the approval process for Medicaid 1115 state innovation waivers by implementing new policies that prioritize transparency, the agency announced in a bulletin. The agency has adjusted 1115 waiver policies in an...

Why the Generic Drug Market is a Growing Payer Opportunity

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As payers try to ease the rising costs of prescription drugs, which account for 10 percent of national healthcare spending, they may wish to turn to the generic drug market to help curb unnecessary spending and improve profitability.   Generics...

Improving Price Transparency around Generic Drugs for Payers

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Increasing pricing transparency around generic drugs could offer significant advantages to payers, including lower prices and more favorable reimbursement negotiations, according to a report from USC Brookings. Better understanding of contracting...

Reinsurance Changes Payers Can Expect Under the ACA in 2018

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ACA federal reinsurance policies have undergone a transformation since their introduction from four years ago. Payers should continue to prepare for larger changes of federal and state ACA reinsurance in 2018. Reinsurance programs have gone from...

Emergency Response Devices Add Value to Medicare Advantage Plan

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Anthem BlueCross BlueShield plans to add value onto consumer Medicare Advantage (MA) plans by offering personal emergency response systems (PERS) to beneficiaries, the payer announced in a series of press releases. MA beneficiaries in several...

3 Value-Based Pharmaceutical Contracting Options for Payers

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Value-based pharmaceutical contracting offers health payers the option to lower drug prices while improving patient outcomes. These contracts come in several different forms, according to Dr. Surya Singh, Chief Medical Officer of CVS Specialty,...

ACA Open Enrollment Rate Expected to Drop Up to 13% in 2018

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Analysts expect up to a 13 percent drop in open enrollment on the ACA marketplace exchange in 2018,  according to Standard and Poor’s Global (S&P Global). Only 10.1 million to 11.4 million individuals are expected in enroll in...

AHIP Launches Initiative To Combat Nationwide Opioid Crisis

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AHIP launched the Safe, Transparent Opioid Prescribing (STOP) Initiative to support health plans’ widespread adoption of clinical guidelines for pain care and opioid prescribing, and combat the national opioid crisis, the organization announced...

How the Medicare Advantage Market Can Offer Payer Opportunities

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Medicare Advantage (MA) market data from A.M Best and the Kaiser Family Foundation reveals that the MA market has remained profitable and provides financial opportunity, but payers looking to enter into the market should expect to address developing...

Providers Seeing Even Mix of Public, Commercially Insured Patients

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Providers are seeing a fairly even mix of Medicare, Medicaid, and commercially insured patients with fewer uninsured individuals than before the ACA, according to the AMA’s Physician Practice Benchmark Survey. In 2016, forty-three percent...

Before CSR Cuts, ACA Health Plans Expected Stable Premiums

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Had cost-sharing reductions (CSRs) under the Affordable Care Act remained in place payers would only expect modest premium increases with some continued profitability, a USC Brookings report found. However, the uncertainty resulting...

Mercy Health, Centene Form Medicaid Accountable Care Organization

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Mercy Health of Arkansas and the Centene Corporation have received approval to operate an accountable care organization within the state focusing on Medicaid beneficiaries, the organizations announced in a press release. Centene subsidiaries...

CBO: Alexander-Murray Healthcare Bill Could Save $3.8B

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The Bipartisan Health Care Stabilization Act of 2017, also known as the Alexander-Murray compromise bill, would save the federal government $3.8 billion without drastically changing the number of individuals with health insurance, the Congressional...

Only 30% of Employers Get Pharmacy Benefit Manager Contracts

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Only 30 percent of employers have a complete understanding of their pharmacy benefit manager (PBM) contracts, according to a new survey from the National Pharmaceutical Council (NPC). Just 40 percent of the 88 employers participating in the survey...

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