The Food and Drug Administration (FDA) and Federal Trade Commission (FTC) can streamline the biosimilar approval process and adopt other strategies to promote biosimilars and lower healthcare spending,...
Member engagement strategies need to make better use of advanced analytics, be more attuned to members’ journeys of care, and culminate in a tight, dedicated team with a broad range of...
A new report warns of rising premiums and out-of-pocket expenses for beneficiaries resulting from healthcare spending to combat the COVID-19 pandemic.
Covered California, the state’s health...
Health payers will be exposed to claims-based, economic, and operational challenges due to the COVID-19 pandemic, according to an AM Best report sent to HealthPayerIntelligence by email.
The report...
Since the beginning of the pandemic, healthcare stakeholders have guessed that overall and out-of-pocket healthcare spending for coronavirus treatment will be high. But now researchers from the...
Despite having generally the same level of disability as Medicare beneficiaries in a traditional fee-for-service model, Medicare Advantage beneficiaries have lower spending and lower cost burden, a...
Reactions to the finalized interoperability rule have fallen predictably along industry lines, as payers and providers spurn the new rules but technology companies warm up to them.
For more...
As several states look to launch a state-based health insurance marketplace (SBM), experts warn that policymakers should weigh the decision carefully and pursue a marketplace only as part of a...
Employer-sponsored health plans spent $5,892 per plan member in 2018, most of which went towards emergency department visits and other outpatient services, according to a report produced by the Health...
Surprise billing occurrences can become more likely when providers and payers are locked in a contract dispute, like UnitedHealthcare’s (UHC’s) dispute with MEDNAX that is set to end...
Update 02/21/2020: This article has been updated to reflect that Blue Cross Blue Shield of Rhode Island partnered with the Anchor Recovery Community Center (a program of The Providence Center) to...
The US has seen coverage gains over the past two decades, due in large part to the ACA. However, access to care has dropped nearly three percentage points in that same time frame because of high...
Medicare will now cover Next Generation Sequencing for beneficiaries with inherited ovarian or breast cancer in order to improve their precision medicine treatment options, CMS...
Two major payers were unable to seal their deals by the first day of the new year due to conflict over the appropriate cost of care.
UnitedHealthcare and Houston Methodist have ended their...
Blue Cross Blue Shield Michigan (Blue Cross) is initiating value-based contracts with seven major Michigan healthcare providers under their alternative payment model called the “Blueprint for...
The clash between healthcare expectations and the reality of the health system leads Americans wanting healthcare reform. This presents a roadblock when the political system is resistant to change the...
America’s Health Insurance Plans (AHIP) submitted a statement to the House Energy and Commerce Committee opposing current single-payer proposals in the United States.*
“Americans are...
Health payer spending in 2018 saw a 13.2 percent increase in net insurance costs, driven largely driven by the health insurance tax reinstatement, an analysis by the Centers for Medicare and Medicaid...
The average annual growth in premium and deductible costs for workers outpaced their median income growth from 2008 to 2018, a Commonwealth Fund study discovered.
“Over the last decade, employer...
The concept of payer philanthropy has been getting more attention lately as a novel means of solving social determinants of health (SDoH) issues, but it’s an approach that may not be the right...
