Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Costs

CVS, Aetna Merger May Face Antitrust, Consumer Protection Issues

by Thomas Beaton

The American Antitrust Institute (AAI) has warned the Department of Justice (DoJ) that the proposed CVS and Aetna merger would violate consumer protections and damage competition in the healthcare industry. AAI believes that the merger of...

Aetna Will Apply Pharmacy Rebates to Prescription Drugs in 2019

by Thomas Beaton

Aetna has announced plans to automatically apply pharmacy rebates to eligible prescription drug benefits by 2019 in an effort to increase pricing transparency and control costs. Nearly three million Aetna members are likely to experience...

Payers Form Coalition to Address Social Determinants of Health

by Thomas Beaton

A group of commercial payers and other healthcare organizations have formed a coalition to explore how addressing the social determinants of health can lower care costs and improve outcomes. A number of large payer companies have joined...

Humana Bold Goal Targets Members’ Social Determinants of Health

by Thomas Beaton

Humana is improving the overall physical and mental health of its Medicare members by addressing social determinants of health and targeting problematic community health behaviors under its Bold Goal initiative. The Bold Goal 2018...

Urgent Care Center Utilization Skyrocketed by 1725% in Last Decade

by Thomas Beaton

Healthcare payers saw urgent care center utilization grow by 1725 percent from 2007 to 2016, indicating that urgent care may the one of the fastest-growing choices for receiving healthcare. A white paper from FAIR Health found that...

Member Engagement is Key for High-Deductible Health Plan Success

by Thomas Beaton

Payers and employers who offer high-deductible health plans (HDHPs) to attract low-cost members may need member engagement strategies to generate higher value for these beneficiaries. Member engagement is critical for HDHP success because...

Payment Cuts Drive Medicare Advantage Plans to Contain Costs

by Thomas Beaton

Medicare Advantage (MA) plans contained beneficiary costs and remained profitable despite reductions to federal MA payments from 2009 to 2014, according to new research from the Commonwealth Fund. The report found that as Medicare reduced...

BCBS Launches Institute to Address Social Determinants of Health

by Thomas Beaton

The BlueCross BlueShield Association has created a new subsidiary called the BlueCross BlueShield Institute to help identify and address the social determinants of health (SDOH) for its beneficiaries. BCBS credits the Institute as the...

Payer Input is Key for High Performance Provider Networks

by Thomas Beaton

Payer input is critical for developing high performance networks (HPNs) that are efficient and cost-effective while delivering high quality care, says the Academy of Actuaries in a new report.   HPNs are narrow provider networks...

Cigna, Amazon Alexa Offer Voice Control Beneficiary Education

by Thomas Beaton

Cigna is entering the voice control product space with an Amazon Alexa feature called “Answers by Cigna” that educates beneficiaries about complex health insurance terminology and customizes health benefits...

UnitedHealthcare Finds Value-Based Care Closed 50M Gaps in Care

by Thomas Beaton

Value-based care helped close 50 million gaps in care between 2013 and 2017 while reducing care costs, lowering ED utilization, and increasing provider care quality, according to a new report from UnitedHealthcare (UHC). UHC examined data...

Cigna to Acquire Express Scripts for $67B to Expand Consumer Value

by Thomas Beaton

Update 8/24/2018: Cigna shareholders have overwhelmingly voted to approve the acquisition of Express Scripts.  Approximately 90 percent of shareholders voted in favor of the deal, which is anticipated to close before the end of...

Centene to Acquire Medicaid, Medicare Advantage Provider Group

by Thomas Beaton

Centene signed an agreement to acquire Florida-based Community Medical Holdings Corp (CMG), a community medical group, to expand Centene’s Medicaid, Medicare Advantage (MA), and marketplace health plan businesses. Centene stated in...

HCSC Invests $1.5B to Develop Insurance Affordability Solutions

by Thomas Beaton

HCSC is investing $1.5 billion to develop health insurance affordability solutions including employee wellness programs, ways to address social determinants of health, and collaborative care. Dubbed Affordability Cures, the initiative...

Uninsured Adults Apprehensive About Health Insurance Costs

by Thomas Beaton

About 71 percent of uninsured adults aware of open enrollment periods did not enroll in state or federally-based health plans because of apprehension to rising health insurance costs and waning confidence that the ACA will remain in...

Payer Meal Program Addresses Social Determinants of Health

by Thomas Beaton

Philadelphia-based Health Partners Plan (HPP) reduced blood glucose levels of diabetics and care utilization of other chronically ill members by implementing a healthy meal program to address food-related social determinants of health...

Aetna Highlights Emerging Drivers of Value-Based Care

by Thomas Beaton

Payer-provider collaboration, holistic healthcare approaches that address the social determinants of health (SDOH), and the use of health IT tools will be among the most important drivers of value-based care, Aetna says in a new report....

Medicare Wellness Programs Promise Better Health Outcomes

by Thomas Beaton

Medicare wellness programs have the potential to improve physical and mental health for beneficiaries with chronic conditions, according to a new report from the Center for Medicare and Medicaid Innovation (CMMI). Medicare members that...

Payers Address Opioid Safety Via Education, $0 Narcan Co-Pays

by Thomas Beaton

Commercial payers are addressing the nation’s opioid crisis and promoting opioid safety by funding patient education programs and waiving Narcan co-pays to reduce barriers to access. Patient-centered strategies have allowed payers...

Reinsurance, CSR Reinstatement May Stabilize Individual Premiums

by Thomas Beaton

AHIP supports a number of policy solutions that could reverse Trump Administration actions that have resulted in higher premiums and unstable markets. In a new policy brief, the payer advocacy group suggests that lawmakers focus on the...

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