Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Government Shutdown Spares Medicare, Medicaid, But Has Other Impacts

by Jennifer Bresnick

The partial government shutdown will have no impact on Medicare and Medicaid at the federal level, CMS has stressed to industry observers. The nation’s public payers will continue to operate as normal, since funding for CMS is...

Patient-Centered Methods Help Health Plans Boost Cancer Care

by Jessica Kent

Employers and payers should ensure their health plans use patient-centered methods and provider performance measurement strategies to reduce costs and improve cancer care, a report from the National Alliance of Healthcare Purchaser...

60% of Medicare Advantage Members Feel Little Motivation from Plans

by Jennifer Bresnick

Medicare Advantage (MA) plans are not doing enough to motivate their members to improve their personal health, according to a new survey from HealthMine. Sixty percent of members participating in the poll said that their MA plans do not...

AHIP Urges “Careful Planning” of Health Reimbursement Arrangements

by Jennifer Bresnick

AHIP is cautioning federal regulators to move slowly and carefully when expanding the availability of health reimbursement arrangements (HRAs) as a more prominent means of paying for healthcare services. In response to a request for...

DOJ Recovers $2.5B in Healthcare Fraud, False Claims in 2018

by Jennifer Bresnick

2018 was a bad year to be a healthcare fraudster.  The Department of Justice (DOJ) has announced that $2.5 billion of the total $2.8 billion recovered under the False Claims Act can be attributed to fraud and improper claims from...

Hospital Price Transparency Rule Takes Effect January 1, 2019

by Jennifer Bresnick

Starting January 1, 2019, hospitals will be required to post their price lists online in an effort to increase price transparency and empower consumers to make informed choices about their care. The mandate stems from the 2019 inpatient...

47% of Payer, Provider Business Tied to Value-Based Care

by Jennifer Bresnick

Value-based care is nudging the half-way mark as more and more payers and providers shift their contracts away from fee-for-service arrangements, according to the Health Care Transformation Task Force (HCTTF). In a new report, the Task...

Cigna Announces Closing of $67B Purchase of Express Scripts

by Jennifer Bresnick

Cigna is officially the new owner of Express Scripts after announcing on December 20 that the $67 billion acquisition has closed. Cigna calls the acquisition a “blueprint to transform the healthcare system,” indicating that...

ACA, Member Engagement Challenges Led Top 10 Stories of 2018

by Jennifer Bresnick

It’s fair to say that the health payer community had a lot to process in 2018.  Mergers, partnerships, and new entries into the field rocked the traditional industry setup, while federal efforts to chip away at the Affordable...

Prescription Drug Prices Rise Again After Brief Pause

by Jennifer Bresnick

Several dozen pharmaceutical companies are planning to raise their prices again in 2019 after temporarily holding off on increases as a result of federal pressure. Reuters reports that nearly thirty drug makers, including Novartis, Bayer,...

TX Judge Rules ACA Unconstitutional in Highly Charged Court Case

by Jennifer Bresnick

In a highly politically court case brought by a number of Republican officials, US District Judge Reed O'Connor has issued a ruling stating that the Affordable Care Act as a whole is unconstitutional. The ruling stems from the notion...

PwC: Digital Experiences, High Costs Will Challenge Payers in 2019

by Jennifer Bresnick

Healthcare payers that hope to succeed in 2019’s competitive business environment will need to meet the strong demand for more consumer-centered digital experiences that help members control their spending and understand how to...

AHIP, Payer Groups Agree to Focus on Nixing Surprise Billing

by Jennifer Bresnick

Nine of the nation’s most influential payer organizations, including AHIP and the Blue Cross Blue Shield Association (BCBSA), have released a new set of guiding principles aimed at eliminating surprise billing. Unexpected medical...

Aetna Joins Healthcare Blockchain Alliance, Pilot Project

by Kyle Murphy, PhD

Not long after closing its deal to be acquired by CVS Health, health payer Aetna has signed on to pilot the use of blockchain technology as part of the Synaptic Health Alliance. In a statement with new fellow participants Ascension, the...

Robocalls Targeted Consumers During Health Plan Enrollment Period

by Chuck Green

Health insurance open enrollment’s kicked off, accompanied by a spike in automated calls with offers of Affordable Care Act or other health plans, much to the chagrin of consumers. “It’s at epidemic levels at this time...

US District Court Denies Appeal to Resolve Risk Corridor Payments

by Thomas Beaton

Federal judges for the US Federal District Court of Appeals denied a request to reopen a case that could provide over $12 billion in risk corridor payments to payers. Moda Health Plan, BlueCross BlueShield of North Carolina, and Land of...

Employer-Sponsored Medicare Advantage Enrollment Up 12% for 2019

by Thomas Beaton

Employer-sponsored Medicare Advantage (MA) enrollment for plan year 2019 increased by 12 percent, representing a bump of more than 443,000 individual members, according to a new analysis by Mark Farrah Associates. Individual Medicare...

Commercial, Managed Care Insurance Sectors Profits Boom in Q3

by Thomas Beaton

Commercial and managed care payers experienced significant third quarter profits, reductions in healthcare spending, and enrollment growth, according to the latest financial statements from insurance companies. Medicare Advantage (MA),...

Cigna: Integrated Pharmacy, Medical Benefits Improve Overall Health

by Thomas Beaton

Integrating pharmacy benefits with medical benefits can help to improve overall health and reduce employer costs, according to a new study released by Cigna. Individuals with connected medical, behavioral and pharmacy health benefits...

Proposed Rule Alters HRAs to Allow Direct Reimbursement to Employees

by Thomas Beaton

The Departments of Labor, Treasury, and HHS have proposed a new rule that would allow employers to directly reimburse employees’ care costs through health reimbursement arrangements (HRAs) as an alternative to traditional insurance...

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