Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

NCQA Updates, Adds HEDIS Performance Measures for Plan Year 2019

by Thomas Beaton

The National Committee for Quality Assurance (NCQA) has released updates to its HEDIS performance measures for plan year 2019. The refresh includes several new measures to guide population health management initiatives, as well....

Highmark BCBS Saves $260M Using Value-Based Reimbursement

by Thomas Beaton

Highmark BlueCross BlueShield has saved $260 million in avoidable care costs by using value-based reimbursement and provider performance standards to hold healthcare organizations accountable for improving beneficiary...

Aetna Takes Amerigroup Spot in Kansas Managed Medicaid Contract

by Thomas Beaton

Aetna has received a Managed Medicaid contract from the state of Kansas for plan year 2019 and will replace Amerigroup as one of the state’s three managed care payers. The state received six bids from commercial payers and...

Partners HealthCare to Self-Insure 100K Employees

by Thomas Beaton

Partners HealthCare has announced it will self-insure 100,000 of its employees, transitioning coverage from BlueCross BlueShield of Massachusetts to its own Neighborhood Health Plan, according to The Boston Globe. “Neighborhood...

How to Drive Enrollment in the ACA Health Plan Marketplaces

by Thomas Beaton

Payers and states wishing to increase enrollment in the ACA health plan marketplaces should  create targeted advertisements, benchmark silver-tier plans as their primary exchange plan, and help consumers navigate health plan...

Customer Satisfaction with Medicare Advantage Health Plans Remain Low

by Thomas Beaton

Medicare Advantage (MA) plans are not meeting their customer satisfaction goals, and tend to leave consumers feeling less-than-pleased with the way health plans communicate and the availability of financial information, according to a new...

Humana, Walgreens Offer Primary Care Clinics for Medicare Members

by Thomas Beaton

Humana and Walgreens have announced the launch of two primary care clinics, designed to meet the needs of Medicare beneficiaries, that will operate within Walgreens locations in the Kansas City area. The collaboration, led by a Humana...

Beneficiaries Want More Holistic Health, Wellness Benefit Options

by Thomas Beaton

Health plan beneficiaries are increasing their demand for holistic health and wellness benefits, which can help payers deliver value and improve outcomes, according to a new report from Aetna. The Health Ambitions Study found that...

Amazon, Berkshire, JPMorgan Name Atul Gawande Healthcare CEO

by Thomas Beaton

Amazon, Berkshire Hathaway, and JPMorgan Chase have named Atul Gawande, a surgeon at Brigham & Women’s Hospital, as the CEO of their joint healthcare company. The company will be headquartered in Boston, Massachusetts. Gawande...

Customer Service is Primary Driver of Health Plan Satisfaction

by Thomas Beaton

Health plan members are seeking high-quality customer service experiences from their insurers, and will use positive interactions to make decisions about continued loyalty, according to a new Forrester analysis emailed to members of the...

Department of Labor Finalizes Association Health Plan Expansion

by Thomas Beaton

The Department of Labor (DOL) has issued a final rule that expands consumer availability of association health plans (AHPs) starting on September 1, 2018. The rule comes months after President Trump and the DOL proposed executive changes...

US Court: Payers Are Responsible for Risk Corridor Program Costs

by Thomas Beaton

Federal judges in the US Federal Circuit Court of Appeals have issued an opinion stating that healthcare payers, and not HHS, are responsible for the costs of the ACA’s risk corridor program. Chief Judge Sharon Prost filed the...

BlueCross BlueShield Nets $2.3B in Savings from 2017 Tax Cuts

by Thomas Beaton

BlueCross BlueShield companies saw  a total tax savings of $2.3 billion after passage of last year’s Tax Cuts and Jobs Act (TCJA), according to a new creditor’s briefing from AM Best. BCBS companies reported a mix of...

Automated Claims Administration Could Bring Billions in Savings

by Thomas Beaton

Automated claims administration could bring around $11 billion in savings to health plans and providers if the technology is implemented more broadly, according to the latest CAQH Index. Payers should encourage providers to adopt...

Quality Analytics, Risk Adjustment Tools Prep Payers for Success

by Thomas Beaton

Quality analytics and risk adjustment technologies are effective solutions for payers when these tools can structure claims and clinical information into actionable models, identify multiple risk indicators, and foster provider...

Humana, Roche Diagnostics Face $45M Federal Kickback Lawsuit

by Thomas Beaton

Humana and Roche Diagnostics will face a $45 million federal kickback lawsuit after a whistleblower filed a False Claims Act violation, which alleges Roche tried to entice Humana financially to secure access to the payer’s business...

Private Payers Deny Hepatitis C Drug Coverage to 52% of Members

by Thomas Beaton

Private payers denied Hepatitis C drug coverage to 52.4 percent of commercially insured beneficiaries from 2014 to 2017, according to new research from the Perelman School of Medicine at the University of Pennsylvania. Hepatitis C drug...

BCBS of TX Delays Non-Emergency ED Claims Review Policy

by Thomas Beaton

BlueCross BlueShield of Texas has delayed implementation of a claims review policy that would require HMO members to pay the total cost of an emergency department visit if the encounter is later deemed to be a non-emergency, according to a...

Early Health Insurance Premium Proposals Indicate Hikes for 2019

by Thomas Beaton

Significant increases to health insurance premiums are on the horizon for beneficiaries in multiple states as payers begin to share their 2019 rate plans.   A challenging regulatory landscape, complicated by policy changes that have...

Virginia Legislature Approves Medicaid Expansion

by Thomas Beaton

The Virginia General Assembly has passed Medicaid expansion as part of a two-year budget bill that could provide coverage to 400,000 newly eligible residents. The action would make Virginia the 33rd state in the US to expand Medicaid...

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