Health plan accreditation programs can help payers highlight offerings that deliver on key quality, efficiency, and beneficiary satisfaction measures.
Many health plans currently participate in the...
The challenges of lowering care costs and improving healthcare quality may lead payers to consider the use of capitated payments as part of their value-based payment model strategies.
Capitated...
Next Generation Accountable Care Organizations (ACO) saved the Medicare program $62 million during their first year of operation in 2016, encouraging CMS to expand downside risk models across...
BlueCross BlueShield of Kansas has seen significantly lower per member per month costs for beneficiaries participating in value-based care arrangements, including accountable care organizations (ACOs)...
New Medicare Advantage plans, many born of innovative partnerships between payers and providers, are creating more options for beneficiaries to supplement their existing coverage with high-value...
A new partnership between Anthem and Walmart will allow Medicare Advantage beneficiaries to purchase over-the-counter drugs and other drug store necessities with a plan allowance.
Starting in January...
CMS is asking state insurance departments to offer more off-exchange health plans in order to reduce silver-loading of qualified health plans (QHP).
Silver-loading is the practice of raising premiums...
CMS has announced that an agency initiative to streamline state Medicaid approvals and state plan amendments (SPAs) has increased approval processing speed by 23 percent.
In 2017, CMS sent a bulletin...
Google’s parent company, Alphabet, has invested $375 million in Oscar Health to help the tech-focused payer enter into Medicare Advantage markets by 2020, according to multiple news outlets,...
Ohio’s Medicaid program has issued a mandate that requires managed care health plans to re-negotiate pharmacy benefit manager (PBM) contracts to transition from a spread-pricing drug purchasing...
The Diabetes Prevention Program could offer commercial payers an impactful way to prevent chronic disease for beneficiaries, according to a new report from AHIP.
In 2012, AHIP recruited seven...
CMS is allowing Medicare Advantage (MA) health plans to implement step therapy protocols in order to decrease prescription drug spending.
On January 1, 2019, MA health plans can apply step therapy...
The American Medical Association is urging the Department of Justice to squash the proposed merger between CVS Health and Aetna.
The combined entity would drastically reduce competition in many...
Only 22 percent of Medicare Advantage (MA) beneficiaries are familiar with how star ratings work and increasing consumer awareness about star ratings would help beneficiaries choose high quality plans,...
Healthcare provider systems tend to be bigger, more consolidated, and have more market share than payers in the same metropolitan areas, leaving some payers with less power to negotiate pricing and...
Centene and Ascension have partnered to offer a Medicare Advantage plan across multiple geographic markets in 2020.
Centene Chairman and CEO Michael F. Neidorff believes that the partnership...
CAQH CORE is urging healthcare payers, providers, and other stakeholders to promote industry-wide collaboration on how to improve prior authorizations.
Leading provider and payer organizations,...
CMS has issued a final rule that will allow the agency to disburse $10 billion in 2017 risk adjustment payments that had been in doubt due to a court ruling.
To comply with the initial outcome...
Close to 90 percent of employees in large and mid-size private businesses are offered medical benefits, according to data released by the Bureau of Labor Statistics. Larger businesses tend to see...
Medicare Advantage (MA) and Medicare supplemental insurance, or Medigap, are both intended to enhance the value of traditional Medicare coverage for seniors and other eligible beneficiaries.
Both...
