Dual eligible beneficiaries who are in “aligned enrollment”—or are enrolled in both a dual eligible special needs plan and a Medicaid managed care organization under the same...
Aetna Whole Health will offer employers access to self-insured and fully-insured plan options that focus on better care coordination through accountable care organizations (ACOs) and incorporating...
The industry’s transition into value-based care is characterized by a focus on data and patient centered care. By driving strong population health management, payers can excel in this value-based...
The America’s Health Insurance Plans (AHIP) recently espoused the Social Determinants Accelerator Act and urged a hearing to discuss how it might help the healthcare industry’s fight...
Eleven gene therapies could cost an individual as much as $45 billion over the next five years, but payers can bring that cost to a more manageable price range through methods such as value-based...
Humana announced that it is pursuing a vertical consolidation deal with Enclara Healthcare, one of the largest hospice pharmacy and benefit management providers (PBMs) in the country.
Humana will...
Payers are using coordinated care and precision medicine to make diagnoses more quickly and ensure a strong treatment plan for severe and chronic disease management.
Early detection of chronic and...
Inpatient healthcare costs and emergency department visits went down for chronically ill children when they received coordinated care but these results were potentially also achievable through usual...
The American healthcare industry unnecessarily spent over $250 billion on tangled administrative complexity, out of the $760 billion to $935 billion that healthcare professionals consider wasteful each...
Better care management and risk stratification can help state Medicaid agencies cut spending on high-cost patients, according to a recent report from the Government Accountability Office...
Among publicly insured patients with the potentially chronic condition hepatocellular carcinoma (HCC), 35 percent had a longer wait time for a liver transplant, possibly indicating poor care...
Not price, not incumbency, but functionality is the key to winning and losing payers’ business, the KLAS Decision Insights Report 2019 indicated. Payers want highly functional, integrated,...
Cigna and Memorial Sloan Kettering (MSK) Cancer Center are collaborating to provide members with value-based, coordinated cancer care, Cigna announced.
“We’re pleased to partner with...
CVS Health is expanding its diabetes care model to incorporate preventive care and treat hypertension.
This move comes after CVS Health has reported considerable success with the first iteration of...
CVS Health has announced new efforts to address social determinants of health in key areas, including within the community, workplace, and housing.
CVS Health has partnered with Unite Us to confront...
Bright Health will be expanding its Medicare Advantage plan into 13 new markets across seven states, nearly doubling its footprint. The health plan will be expanding its product offerings by about 300...
Henry Ford Health System and Health Alliance Plan (HAP) will be acquiring Trusted HP – Michigan, a Detroit-based Medicaid plan currently serving nearly 9,000 beneficiaries, the organizations...
While beneficiary satisfaction with commercial health plans continues to climb, there are still key areas for improvement to drive an overall better consumer experience, according to a recent survey...
Customer satisfaction with commercial health plans is improving nationwide, but members are still not content with co-pay costs or care coordination, a JD Power consumer survey revealed.
While...
CMS has issued a letter to state Medicaid directors inviting them to test new, integrated care models for individuals dually eligible for Medicare and Medicaid.
There are 12 million dual eligible...
