Wellness Program Success Hinges on Long-Term Participation
Members highly engaged in Humana’s long-term wellness program, Go365, spent on average $116 less per member per month in healthcare costs than low-engaged participants, a five-year study...Challenges of Investing in Social Determinants of Health
Despite widespread industry calls to prioritize community health benefits, investing in social determinants of health can be risky for health payers. Between questionable return on investment and...Payers Admonish OPPS Rule, Assert Damage to Competition
Payer organizations are voicing their opposition to CMS’s Medicare Outpatient Prospective Payment System (OPPS) rule, stating that publishing negotiations would prevent payers from obtaining...Sponsored Article
How a PBM Uses Patient Engagement to Improve Care Outcomes, Cost
As the pharmacy benefit management landscape consolidates around a few monolithic players, it’s become increasingly difficult for independent challengers to carve out space for themselves in a...Verma Supports Medicare Advantage, Decries Public Option
CMS Administrator Seema Verma declared Medicare Advantage the most successful result of Medicare and criticized the program’s other functions. Verma also offered harsh words about proposals for...Why Payers Should Care About the Cadillac Tax Repeal
The House of Representatives recently voted 419-6 to repeal the Cadillac tax, which would impact the payers and plans employers choose if the law is formally repealed. Under the authority of the...BCBSRI Program Aims to Lower Senior Adverse Drug Events by 20%
Adverse drug events in older Americans cost approximately $3.8 billion in 2018, but a new program from Blue Cross Blue Shield of Rhode Island (BCBSRI) is looking to reduce costs by 20 percent while...CMS Defines New Medicaid Integrity Guidelines
The Centers for Medicare & Medicaid Services (CMS) released renewed guidance on Medicaid eligibility determinations and spending integrity the organization announced. According to CMS, Medicaid...Primary Care Physicians Influence LVC Spending, Studies Show
Studies have found that primary care physicians (PCPs) play a role in increasing low-value care (LVC) expenditures, indicating that payers, policymakers, and healthcare organizations should...Texas Enacts Bill to Protect Consumers from Surprise Billing
On June 14, Texas joined the ranks of a score of states with consumer protections against surprise billing (or balance billing) with the signing of Senate Bill 1264. Effective this September, the bulk...AHIP Warns Congress of High Costs Tied to Provider Consolidation
Mergers and acquisitions are commonplace in healthcare, but leading payers in the United States claim provider consolidation is costing consumers. In testimony submitted to the Senate Subcommittee on...Cigna, Other Payers Stop Public Health Option in Connecticut
Connecticut State Comptroller Kevin Lembo confirmed midweek that proposed legislation to establish a public option in the state is dead following resistance from major payers. One payer, in...HELP Draft Legislation Targets Major Changes in Healthcare Spending
Before members of Congress retired for the long weekend, leaders of the Senate Committee on Health, Education, Labor and Pensions (HELP) unveiled draft legislation for the Lower Health Care Costs Act...Addressing Price Variation Key for Cutting Healthcare Costs
Reducing the costs of certain diagnostic tests could result in cost savings totaling at $18 billion annually, according to a report from UnitedHealth Group. Currently, the healthcare industry is...Proposed Public Health Option in Connecticut Proves Divisive
A proposed bill to allow Connecticut small businesses and their employees to buy into the state’s public health plan has advanced favorably through the state legislature, but not without...Using Medically-Tailored Meals to Boost Chronic Disease Care
Chronic diseases are both costly and prevalent, with the healthcare industry shelling out billions each year to manage and treat these conditions. Although illnesses like diabetes, heart disease, and...Sponsored Article
