Consumerism in Healthcare

How Payers Can Improve Care Management To Enhance Quality, ROI

by Kelsey Waddill

Payers are not leveraging care management to its fullest capacity and they have an opportunity reform their care management programs to improve quality of care and return on investment, a report from...

Key Fixes to NY Commercial Payer Exchange to Ease New Enrollment

by Sara Heath

New York’s off-exchange insurance market needs revamping in light of the coronavirus pandemic, as more residents and immigrants face job loss and fall off their employer-sponsored health plans,...

Using Member Engagement to Create Personalized Payer Experience

by Kelsey Waddill

Two Blue Cross Blue Shield Association companies are demonstrating how personalization of healthcare solutions continues to be the golden fleece for healthcare payers. “Employers are rethinking...

Volatility Drives Payer Technological Innovation, Partnerships

by Kelsey Waddill

Best’s Special Report, which HealthPayerIntelligence obtained by email, has discovered that healthcare payer technological innovations and partnerships often thrive under change and urgency,...

How to Implement AI Platform to Fight Commercial Insurance Fraud

by Kelsey Waddill

“How do we get in front of commercial insurance fraud issues as early in the scheme as possible?” That is what Kurt Spears constantly asks himself as the vice president of financial...

Payer Consumerism Strategies Rely On Data, SDOH, Simpler Language

by Kelsey Waddill

Data sharing, social determinants of health, and simpler language are common priorities as payers seek to strengthen and expand their consumerism strategies, the tenth annual 2020 Industry Pulse Report...

In 2020 Consumerism Will Steer Payer Decisions in Deals, Spending

by Kelsey Waddill

Consumerism in healthcare will steer many payer decisions in 2020, perhaps more obviously than in the past. “There are a lot of pressures out there in 2020. It’s the time to step up and...

In-Person Care Still Valued in Digital Age, Consumer Survey Finds

by Kelsey Waddill

While virtual care is attractive, patients still value in-person care, according to a consumer survey conducted by Blue Cross Blue Shield Arizona (BCBSAZ) and USC Schaeffer Center. "It's our job...

5 Strategies for 5 Stars: Cigna’s Approach to CMS Star Ratings

by Emily Sokol, MPH

Achieving five stars in all three domains – Medicare Advantage, Part D, and overall - is difficult. The work of Cigna’s HealthSpring of Florida plan in 2018 earned them five-stars across the board, making them one of only two...

Taking a Personalized, Digital Approach to Wellness Programs

by Kelsey Waddill

Blue Shield California (BSC) recently announced its new platform Wellvolution and in doing so it emphasized payers’ movement away from solely brick-and-mortar wellness programs to...

Proposed Public Health Option in Connecticut Proves Divisive

by Kyle Murphy, PhD

A proposed bill to allow Connecticut small businesses and their employees to buy into the state’s public health plan has advanced favorably through the state legislature, but not without...

State Policies Protect Consumers from Short-Term Health Plans

by Sara Heath

States are taking action to protect consumers from low-value health payer plans, including short-term health plans, according to a new issue brief from the Commonwealth Fund. Short-term health plans...

FTC Charges Surescripts with Monopolizing e-Prescribing Market

by Jessica Kent

The Federal Trade Commission (FTC) is suing Surescripts, alleging that the health information exchange company is using illegal vertical and horizontal restraints to maintain its monopoly over two key...

What’s the Role of Medicare Advantage for Payers and Consumers?

by Jessica Kent

As the US population continues to age, older individuals are seeking out comprehensive, affordable care options that meet their specific health needs. Medicare Advantage is one of the most popular ways for consumers to round out their...

Health Plans Ask Congress for Unified Action on Surprise Billing

by Jennifer Bresnick

Health plans are asking Congress to take swift action on surprise billing, which can leave consumers with enormous out-of-pocket expenses for unexpected or out-of-network services. In a letter to...

Congress Opens Probe into Short-Term Limited Duration Insurance

by Jennifer Bresnick

The House Energy & Commerce Committee (E&C) has opened an inquiry into short-term limited duration insurance (STLDI) plans and companies that may be acting against consumer interests by selling...

Amazon-Backed Health Venture Reveals Name: Haven Healthcare

by Jennifer Bresnick

The partnership between Amazon, Berkshire Hathaway, and JPMorgan Chase now has a name in addition to a high-profile executive team.  The venture, which aims to reduce costs and develop innovative...

Marketing for Short-Term Health Plans May Mislead Consumers

by Jessica Kent

Websites and brokers that sell short-term health plans as a replacement for ACA-compliant coverage often fail to give consumers the detailed plan information necessary to inform their purchase,...

Verma: Price Transparency Rule a “First Step” for Consumerism

by Jennifer Bresnick

The hospital price transparency mandate that went into effect on January 1 is still ruffling feathers among healthcare providers, leading CMS Administrator Seema Verma to reiterate the importance of...

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