Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Humana Foundation Awards $735K To Improve Community Health

July 20, 2017 - The Humana Foundation announced awards totaling $735,000 to help South Florida nonprofits to help improve community health. As part of the payer’s philanthropic pursuits, the grants are being awarded during their 2017 donation cycle to eight organizations that specialize in community health and wellness. These organizations include the Broward Regional Health Planning Council, The Education...


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Humana, Oscar Health to Deliver Small Business Insurance

by Thomas Beaton

Humana and startup insurance provider Oscar Health have entered into a strategic partnership that aims to provide commercial small business insurance to consumers in a nine-county area surrounding Nashville, TN. The partnership merges Humana’s...

What to Look for in Health Insurance Enrollment Technology

by Thomas Beaton

Health insurance enrollment technology is designed to offer payers convenience, cost savings, and administrative ease-of-mind when it comes managing beneficiaries enrolled in health plans. Many Americans face challenges when seeking new health...

HHS Approves Alaska 1332 Waiver for State Reinsurance Program

by Thomas Beaton

Alaska will be able to move ahead with its plans to implement a state reinsurance program under a  1332 State Innovation Waiver, HHS confirmed this week.   The Alaska Reinsurance Program (ARP) will attempt to stabilize the state’s...

Guides Help Employers Decide on Accountable Care Organization Use

by Thomas Beaton

The National Business on Health Group (NBHG) has released two comprehensive guides to help employers evaluate the pros and cons of using accountable care organizations (ACOs). Both resources are part of an ACO toolkit to help employers assess...

BCBS of Louisiana Offers Online Consumer Price Comparison Portal

by Thomas Beaton

In an effort to improve transparency and customer engagement, Blue Cross Blue Shield (BCBS) of Louisiana launched an online consumer price comparison portal. The portal, called SmartShopper, allows any BCBS  customer in Louisiana to compare...

Consumers Voice Opinions on Effective Healthcare Marketing

by Jesse Migneault

Spending for healthcare marketing was $9.7 billion in 2015 alone, a double-digit increase from the previous year.  In all forms of media across the nation, there is no shortage of healthcare messaging being sent towards the public.  ...

DOJ Sues UnitedHealth over Alleged $1B Medicare Fraud

by Jesse Migneault

The Department of Justice is suing UnitedHealth  for alleged Medicare Advantage fraud in a civil case.  The complaint, filed in the Western District court, is “for monies unlawfully obtained or retained from the insurers Medicare...

Employers Seek Clarity, Stability in Health Insurance Market

by Jesse Migneault

The nation’s largest employers are taking a second look at what type of health insurance they buy, and why.  The American Health Policy Institute (AHPI) surveyed over 400 large companies and found issues of transparency, tax credits...

Anthem Terminates Cigna Merger, but Refuses to Pay Out $1.8B

by Jesse Migneault

After a court ruling in Delaware, Anthem has notified Cigna that their proposed $54 billion merger is off, but that doesn’t mean the two insurance companies are amicably parting ways. Anthem has stated that it will not pay Cigna a $1.85...

Aetna Posts Q1 Loss After ACA Withdrawal, Merger Collapse

by Jesse Migneault

After a tumultuous 2016, Aetna announced a first-quarter 2017 net loss of $381 million, a significant  reversal from a $737 million profit a year ago. Aetna blamed the loss on costs associated with its attempted merger with Humana,...

Affordable Care Act Cuts Uninsured Rate by 6.4% Since 2013

by Jesse Migneault

From 2013 to the end of 2016, the percentage of individuals without health insurance dropped across the nation, according to a recent Gallup-Healthways study. The national percentage of those without health insurance went from 17.3 percent in...

Payer Groups Urge Congress to Keep ACA Cost Sharing Reductions

by Jesse Migneault

In a recent letter to the President and leading members of Congress, insurance payer groups and the nation’s largest provider organizations detailed their case to retain the cost sharing reductions (CSR) provision in the ACA.  Payers...

Payers, Providers Collaborate to Combat Opioid Abuse, Addiction

by Jesse Migneault

Insufficient control of opioid prescriptions is one of the key reasons why opioid abuse and addiction have risen dramatically over the past few years.    To mitigate the epidemic, payers have developed programs to directly establish...

Top 5 Largest Health Insurance Payers in the United States

by Jesse Migneault

The Affordable Care Act has been a divisive policy for the public and politicians, but since 2010 it has been a financial boon for the top five giants of the health insurance payer industry.  The expanding customer base created by the ACA,...

Independence Blue Cross, UPenn Partner to Enhance Care Delivery

by Thomas Beaton

A five-year partnership between Independence Blue Cross and the University of Pennsylvania Health Systems (UPHS) should help strengthen multiple aspects of care delivery for beneficiaries in the state. Both organizations are under contract to...

Minn. Healthcare Payers Reported $687M in Financial Losses

by Thomas Beaton

Local healthcare payers in Minnesota reported financial losses of $687 million due to the rising gaps in premiums and healthcare spending. The Minnesota Council of Health Plans gathered statewide data from insurance companies and HMOs, and found...

Aetna Will Exit Iowa ACA Health Insurance Exchange in 2018

by Thomas Beaton

Aetna has announced that it will stop participating in the Iowa health insurance exchange in 2018, citing financial losses and market instability as primary reasons to exit.   "Earlier today we informed the appropriate federal and state...

ACA Risk Adjustment, Reinsurance Improved Payer Financials

by Thomas Beaton

A new study published in Health Affairs found risk adjustment and reinsurance provisions of the Affordable Care Act improved financial outcomes for certain payers with higher risk enrollees.   Researchers from AHRQ and CMS found that before...

House Committee Passes Bill with Healthcare Merger Implications

by Thomas Beaton

The House Judiciary Committee has voted 16-10 in favor of a bill that would revise and standardize part of the process of reviewing mergers for potential antitrust violations.   The Standard Merger and Acquisition Reviews Through Equal Rules...

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