A bundled payment model born from a payer-provider partnership between Blue Cross Blue Shield Rhode Island (BCBSRI) and University Orthopedics has helped deliver a holistic, outpatient delivery of a...
The healthcare industry is moving away from fee-for-service reimbursement. Healthcare professionals recognize that this payment structure is fraught with misuse and overuse, incentivizing providers to...
Three in four adults would not support a federal regulation that improved healthcare price transparency if the rule raised the cost of health insurance premiums, according to a new Morning Consult...
The Humana Foundation announced it is investing $7.6 million in eight communities across the southeastern United States to address social determinants of health (SDOH), according to a recent press...
Centene and WellCare announced they have finalized a major health payer merger deal that will combine the two organizations into the largest health insurer by membership with more than 24 million...
The clash between healthcare expectations and the reality of the health system leads Americans wanting healthcare reform. This presents a roadblock when the political system is resistant to change the...
The Health Care Cost Institute and Blue Health Intelligence, a data division of Blue Cross Blue Shield Association, have struck a multiyear data partnership that will see the latter’s medical...
Recent guidance released by CMS is enabling the expansion of supplemental benefits in Medicare Advantage plans for contract year 2020, including adult day care services, according to a new study.
The...
The 4th Annual Value-Based Care Summit brought payers and providers together from across the country together to discuss best practices in value-based care. Open and frank discussions provided valuable...
Humana filed a 600-page lawsuit against 37 pharmaceutical companies over an alleged conspiracy to drive up the cost of generic drugs. Among the defendants are industry giants such as Teva...
Oscar Insurance Company of Florida (Oscar) has appealed the federal court’s dismissal of the company’s anti-trust lawsuit against Florida Blue, the company announced in an emailed...
Update 10/11/2019: This article has been updated to include a statement from the Michigan Association of Health Plans.
Michigan is the latest among state Medicaid programs to back away from...
Payers are trying to understand their role in addressing the social determinants of health. These non-clinical factors that impact an individual’s health include environment, housing, food...
CMS will allow states to expand their wellness programs for the individual marketplace either through state-run or payer-designed programs, CMS announced.
The goal of the demonstration is two-fold,...
Alignment Health Plan will offer qualified Medicare Advantage members concierge services and social determinants of health benefits in 2020.
The Southern California-based Medicare Advantage plan will...
UPMC Health Plan’s new diabetes wellness program targets Medicare Advantage members with diabetes or at-risk of diabetes to help drive chronic care management at an affordable cost, the health...
Cigna and Humana announced their 2020 Medicare Advantage plans will now include coverage for social determinants of health.
These social determinants of health include the environment, economic, and...
Employers are looking for broader provider networks, but healthcare payers who want to decrease the high cost-sharing must look for less expensive and fewer providers, a recent study by Kaiser Family...
After seven years of instability and decreasing involvement from payers, the Affordable Care Act exchanges, or the federal health insurance marketplace, will expand in 2020, the Robert Wood Johnson...
Seventy-five percent of the payer industry is made up of highly concentrated markets, a number that has been rising since 2014, an American Medical Association (AMA) study found. And in turn, public...
