Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Affordable Care Act Cuts Uninsured Rate by 6.4% Since 2013

April 20, 2017 - 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 2013 to 10.9 percent in the fourth quarter of 2016.    All 10 states with the greatest reductions in their uninsured rates had expanded...


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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...

Wellmark BCBS Latest to Exit ACA Health Insurance Exchanges

by Thomas Beaton

Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, will not renew or sell individual plans on the Affordable Care Act health insurance exchanges effective Jan 1, 2018. The decision follows three-year losses of approximately...

BCBS of Minn. Cites Risk Pools for $322.4M in 2016 Losses

by Thomas Beaton

Blue Cross Blue Shield (BCBS) of Minnesota reported a net operating loss of $322.4 million in their 2016 financial audit, citing unbalanced risk pools and rising premium pricing as a current and future detriment to profitability. At the end of...

Anthem Appeals Cigna Merger with Cost, Quality Arguments

by Thomas Beaton

Anthem has opened an appeal in the U.S District Court citing opportunities for increased consumer savings and quality of care weeks after the DOJ blocked its planned merger with Cigna. Anthem argued that the DoJ’s ruling neglected a possible...

House Votes to Boost Health Insurance Options for Businesses

by Thomas Beaton

The House of Representatives has voted 236-175 to move the Small Business Health Fairness Act of 2017 to the Senate in an effort to increase health insurance options for small businesses. The Act is designed to promote the growth of Association...

Payers Face 9.6% Underwriting Loss on Health Insurance Exchange

by Jacqueline Belliveau

Underwriting margins for payers selling individual plans on the health insurance exchange dropped from a 6 percent earned premium loss in 2014 to a 9.6 percent loss in 2015, Milliman recently reported. The financial losses stemmed from the Affordable...

APMs, Health Data Exchange among Top Payer Reform Goals

by Thomas Beaton

The National Academy of Medicine (NAM) offered policymakers and stakeholders healthcare reform priorities, including alternative payment models (APMs) and health data exchange, that aim to lower overall healthcare costs and improve patient...

HFPP Provides New Resource for Payers to Combat Opioid Abuse

by Thomas Beaton

A new 64-page report from the Healthcare Fraud Prevention Partnership (HFPP), a public-private partnership which includes CMS, gives payers resources that treat, educate, and develop improvements for combating opioid harm to patients. CMS has...

AHA Urges D.C Appeals Court to “Uphold Cigna-Anthem Ruling”

by Thomas Beaton

The American Hospital Association (AHA) released a public document urging the U.S Court of Appeals in Washington D.C, to affirm the block on the Cigna-Anthem merger. In an amicus barae, the AHA outlined various antitrust violations and inhibitions...

Price, Verma Push for Better State Control of Medicaid Programs

by Jacqueline Belliveau

As one of her first actions as CMS Administrator, Seema Verma collaborated with the Department of Health and Human Services (HHS) Secretary Tom Price to detail how the federal government plans to improve its state partnerships to enhance state...

HHS Offers Waivers for Health Insurance Exchange Stability

by Jacqueline Belliveau

The Department of Health and Human Services (HHS) recently encouraged states to apply for State Innovation Waivers as a way to stabilize the health insurance exchanges and boost consumer access health plans and services. States should particularly...

Aetna, Cigna Join 300 Organizations in CAQH CORE Phase III

by Thomas Beaton

A new press release confirmed that Aetna and Cigna are now certified under CAQH CORE Phase III Operating Rules. Their certification will provide the entire CAQH CORE collaboration interoperable access to two of the largest payers in the US. Under...

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