AHIP

CQMC Revises Quality Measures, AHIP Advocates for Better Alignment

August 18, 2023 - Core Quality Measures Collaborative (CQMC) released new core quality measures and the implementation guidelines for certain core sets. More than 75 healthcare organizations, including payers, purchasers, and medical and consumer groups, shape and maintain the CQMC core measure sets. The sets are based on hundreds of quality measures. They cover 10...

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AHIP, BCBSA Voice Concerns About Proposed Prior Authorization Rule

by Kelsey Waddill

AHIP joined the American Hospital Association (AHA), American Medical Association (AMA), and Blue Cross Blue Shield Association (BCBSA) in opposing the prior authorization reformation efforts from CMS...

AHIP Urges 4 Types of Policies to Reduce Healthcare Spending

by Kelsey Waddill

AHIP offered four recommendations to the Senate Finance Committee on Consolidation and Competition (the Committee) to support healthy competition and lower healthcare spending in the healthcare...

AHIP: Most Consumers Are Satisfied with Employer-Provided Coverage

by Mark Melchionna

Conducted by LSG on behalf of America’s Health Insurance Plans (AHIP), a survey on the opinions of US consumers in 2023 found that many prefer to receive coverage from their employer rather than...

AHIP Marketing Campaign Targets Pharma’s Prescription Drug Pricing

by Kelsey Waddill

AHIP has launched a marketing campaign targeting pharmaceutical companies and the role of prescription drug pricing in healthcare spending. “Let’s be clear, Big Pharma continues to...

How Specialty Pharmacies Compare to Provider, Hospital on Drug Pricing

by Kelsey Waddill

AHIP released updated data on drug pricing increases, comparing hospital costs and the prices that physician offices pay compared to specialty pharmacies. The payer organization analyzed price...

AHIP: More Medicare Beneficiaries Have Medicare Supplement Insurance

by Victoria Bailey

More Medicare beneficiaries are purchasing Medicare Supplement insurance, as the share of individuals with the additional coverage option grew from 38 percent to 41 percent in 2021, an AHIP report...

AHIP Argues In Favor of the Copay Coupon Accumulator Rule

by Kelsey Waddill

AHIP submitted an amicus brief in favor of the HHS copay coupon accumulator rule, which would allow states to decide whether pharmaceutical manufacturers’ copay coupons should contribute to...

Americans Who Lose Medicaid Post-PHE May Choose Employer-Sponsored Coverage

by Kelsey Waddill

In most states, beneficiaries who lose Medicaid coverage when the public health emergency ends are likely to transition into employer-sponsored health plans, according to a study funded by AHIP from...

AHIP Reveals Org to Support Stakeholders during Medicaid Redetermination

by Kelsey Waddill

AHIP has introduced a new outlet for healthcare industry collaboration around the Medicaid redetermination process: the Connecting to Coverage Coalition (CCC). The payer organization and its partners...

AHIP: Proposed 2024 Medicare Advantage Advance Notice Cuts MA Rates

by Kelsey Waddill

AHIP is pushing back on the proposed 2024 Medicare Advantage advance notice because it presents a dramatic rate cut that would impact beneficiaries, Matt Eyles, president and chief executive officer of...

AHIP Asks CMS to Reconsider Proposed Medicare Advantage Policy Changes

by Victoria Bailey

AHIP is urging CMS to consider the potential adverse impacts of its proposed rule for Medicare Advantage policy and technical changes, specifically raising concerns about the star rating changes, new...

Overview of the 2024 Medicare Advantage Advance Notice, Payer Reactions

by Kelsey Waddill

CMS released the 2024 Medicare Advantage Advance Notice with changes for Medicare Advantage plans and Medicare Part D, stirring up concerns among some large payer organizations. “Medicare...

Payer, Provider Orgs React to Prior Authorization Proposed Rule

by Kelsey Waddill

Payer and provider organizations are responding positively to the CMS proposed rule that would change the prior authorization process to better support electronic prior authorization. “CMS is...

Gold Carding Has Mixed Effects on Streamlining Prior Authorization Processes

by Kelsey Waddill

While more plans have turned to gold carding as a method for streamlining prior authorization for medical services in the past three years, the approach has a mixed success rate, according to an AHIP...

No Surprises Act Leads to 9M Averted Surprise Bills, 275K Arbitration Claims

by Kelsey Waddill

The No Surprises Act effectively averted surprise bills for 9 million Americans in the first nine months of 2022, but the federal independent dispute resolution process is overwhelmed, according to a...

AHIP Envisions Race, Ethnicity Data Collection Standardization Improvements

by Kelsey Waddill

AHIP has introduced race and ethnicity data collection standardization recommendations for demographic data collection with the aim of empowering health equity efforts nationwide. “Robust,...

Payers Leverage Technology to Boost Maternal Health Outcomes

by Sarai Rodriguez

Payers are implementing new programs that capitalize on telehealth and partnerships with technology companies to better engage pregnant members and improve maternal health outcomes. There has been an...

Most of Premium Dollar Used for Prescription Drugs, Medical Services

by Victoria Bailey

Almost 83 cents of the average healthcare premium dollar goes towards prescription drugs and medical services, including inpatient and outpatient costs, emergency room costs, and doctor visits,...

7 Ways That Payers Help Members Manage Their Mental Health Needs

by Kelsey Waddill

As the nation continues to experience a mental health crisis, health insurers have developed numerous strategies to help members manage their mental health needs, according to a resource from...

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