Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

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...

AHA Questions CMS Medicare Advantage Risk Score Calculation

by Kyle Murphy, PhD

The American Hospital Association (AHA) has voiced concerns about the methodology the Centers for Medicare & Medicaid Services (CMS) intends to use to calculate risk scores for health plans under the Medicare Advantage and Part D prescription...

Bill Would Make Health Insurance Liable for Antitrust Laws

by Thomas Beaton

Proposed legislation supported by the American Hospital Association passed the House Judiciary Committee earlier that if approved by Congress make health insurance companies liable for anti-competitive business practices. The Competitive Health...

ACA Consumers Dissatisfied After Private Payer Exchange Exit

by Thomas Beaton

Consumer satisfaction with the Affordable Care Act fell following the departure of three private payers from the health insurance exchange, according to recent findings from Black Book. The survey comprises feedback from 34,800 consumers continually...

Social Determinant Data Key to Successful Risk-Based Contracts

by Jacqueline Belliveau

From bundled payment models to capitated healthcare payments, payers implement risk contracts to financially motivate providers to target high-cost and high-utilization patient populations to reduce overall healthcare costs. But increasing payer...

CMS Continues Extension of Transitional Coverage into 2018

by Thomas Beaton

The Centers for Medicare & Medicaid Services (CMS) has again extended its policy enabling states to permit health plans additional time to bring coverage into compliance with the Affordable Care Act. Jeff Wu, Acting Director of the Center...

Market Monopoly Cause of Court Blocking Cigna-Anthem Merger

by Thomas Beaton

The full opinion of United States District Court for the District of Columbia blocking Anthem’s acquisition of Cigna became publicly available earlier this week and provides details into the court’s decision. In the memorandum opinion,...

Single-Payer Reform Purported to Save Estimated $504 Billion

by Thomas Beaton

A possible repeal of the ACA threatens to eliminate the coverage of 26 million Americans, but the authors of a recent commentary in the Annals of Internal Medicine contend that reforming to a single-payer system would allow for a Medicare expansion...

GOP Leaders Unveil Proposed ACA Repeal, Replacement Plans

by Thomas Beaton

GOP leaders have unveiled their latest proposal to repeal and replace the Affordable Care Act with new health insurance regulations. The outline includes cutting federal Medicaid expansion, moving more Medicaid control to the states, and restructuring...

After Terminated Merger, Cigna Demands $13B from Anthem

by Thomas Beaton

UPDATE: Anthem has secured a restraining order against Cigna preventing the final dissolusion of the merger.  The temporary order will be reviewed during a Delaware Chancery Court hearing on April 10. After a court ruling ended the...

CMS Proposes New Rule to Stabilize Health Insurance Exchanges

by Jacqueline Belliveau

CMS recently announced a proposed rule designed to help stabilize health insurance exchanges by promoting more coverage options and improving the risk pool for insurers. The proposed rule comes just one day after Humana publicized its decision...

Humana to Leave ACA Health Insurance Exchanges by 2018

by Thomas Beaton

Humana will halt sales of individual health insurance plans through the Affordable Care Act’s exchanges by 2018, which will leave more than 150,000 Humana customers without a carrier.   Amid ongoing political uncertainty, Humana said...

Aetna, Humana Terminate Merger Deal After Court Defeat

by Thomas Beaton

Aetna and Humana have scrapped their merger plans after the Department of Justice blocked the deal due to antitrust concerns.  Aetna will pay Humana a $1 billion termination fee, included as part of the original agreement. The DOJ lawsuit,...

Federal Judge Strikes Down Cigna-Anthem Health Insurance Merger

by Jacqueline Belliveau

A federal judge in Washington DC recently blocked a potential $48 billion health insurance merger between Cigna and Anthem, according to a Department of Justice (DoJ) press release. The two payers started the merger process back in the summer...

Proposed ACA Replacement Moves Coverage Choices to the States

by Thomas Beaton

Several Republican lawmakers have introduced the “Patient Freedom Act” as a proposed replacement of the Affordable Care Act, emphasizing state authority and local decision-making in the health insurance market. Senators Bill Cassidy,...

Shareholder Class Action Lawsuit Filed Against Aetna

by Vera Gruessner

A shareholder class action lawsuit has been filed against the national health insurance company Aetna Inc., according to a press release from the law firm of Kessler Topaz Meltzer & Check, LLP. The announcement came earlier this...

Top 4 Ways Payers Could Improve Patient Health Outcomes

by Vera Gruessner

Health insurance companies have been putting more focus on preventive care, a reduction in unnecessary medical testing, and better patient health outcomes by transitioning to value-based care reimbursement. National payers have utilized a number...

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