Value-Based Contracting

CVS-Aetna Merger Gets DOJ Nod as Aetna Sheds Medicare Part D

by Thomas Beaton

The Department of Justice (DOJ) has announced that it will approve the proposed merger between CVS and Aetna as soon as Aetna completes the divestiture of its Medicare Part D business line.   Two...

Payers Partner with Trade Orgs to Roll Out Association Health Plans

by Thomas Beaton

Healthcare payers are beginning to launch partnerships with trade organizations and chambers of commerce to provide association health plans (AHPs) to small businesses and contractors. The roll out of...

Managed Care Payers Struggle to Staff Long Term Support Services

by Thomas Beaton

Managed care payers and state Medicaid agencies are finding it difficult to find personnel to administer long-term support services (LTSS) within home and community-based settings (HCBS), says a new...

Payers Can Leverage Telehealth for Chronic Disease Management

by Thomas Beaton

Telehealth offers a cost-effective way to improve member satisfaction with benefits and support meaningful chronic disease management, according to a new report from AHIP and the Coalition to Transform...

Cigna’s Digital Diabetes Prevention Program Cuts Costs, Ups Outcomes

by Thomas Beaton

With more than one out of every three Americans living with prediabetes, payers are actively seeking out innovative strategies for preventing progression of the costly and life-changing disease....

How Managed Care Payers Can Improve Substance Use Treatment

by Thomas Beaton

Managed care payers can use data analytics, case management strategies, and patient engagement tools to address the needs of high-risk individuals with substance use disorders (SUDs), states a new...

Consumer Engagement Tools Prep Members for Open Enrollment

by Thomas Beaton

Mobile apps, enrollment platforms, and search engines help the majority of consumers prepare for open enrollment and make informed healthcare choices, says a new survey from...

Employers are Experimenting with Innovative Health Plan Designs

by Thomas Beaton

Just under half of employers participating in a survey from the National Business Group on Health (NBGH) are actively experimenting with innovative health plan designs that aim to foster new approaches...

NCQA, Health Plans to Measure Patient-Reported Outcomes

by Thomas Beaton

The National Committee for Quality Assurance (NCQA) has selected four health plans to test a new performance standard for collecting patient-reported outcomes measures, or PROMs. NCQA’s...

Top Health Plans Excel in Preventive Care, Chronic Disease Management

by Thomas Beaton

Health plans that offered high-quality preventive care and comprehensive chronic disease management received top marks in the latest health plan rankings from the National Committee on Quality...

Narrow Network Alignment Could Drive Value-Based Payment Reform

by Thomas Beaton

Investment in high-performance narrow networks, creating new payment incentives, and leveraging digital innovation could help to increase adoption of value-based payment reform across the healthcare...

Risk Scoring, New Payment Models Can Reduce Medication Non-Adherence

by Thomas Beaton

Adopting new payment models, engaging in targeted risk scoring, and improving prior authorization processes may help payers address medication-non adherence among members with mental health concerns,...

Payers Play Crucial Role in Healthcare Quality Transparency

by Thomas Beaton

Payers will need to take the lead in being transparent about healthcare quality and costs in order to improve patient safety and reduce unnecessary spending, experts told the Senate HELP...

Medicare-Medicaid Dual Eligible Care Models Aim to Coordinate Care

by Thomas Beaton

Medicare and Medicaid dual-eligible care models provide extensive care coordination to ensure beneficiaries with multiple chronic conditions can access healthcare services, according to a new AHIP...

Reference Pricing Models for Prescription Drugs May Contain Costs

by Thomas Beaton

Reference pricing models for prescription drugs may help to contain spending and reduce high costs for beneficiaries, says a new report from the Commonwealth Fund. Currently, most payers use tiered...

Patient-Centered Medical Home Model Saved BCBS of MI $626M

by Thomas Beaton

BlueCross BlueShield of Michigan has reduced expected spending by $626 million over a nine-year period through a patient-centered medical home (PCMH) model that emphasizes personalized care. The payer...

Employers Could See High Financial Returns for Mental Healthcare

by Thomas Beaton

More comprehensive coverage for mental healthcare could bring a financial return of four dollars for every one dollar spent by employers, says a report from the National Alliance of Healthcare...

Poor Healthcare Literacy Leads to $4.8B in Administrative Costs

by Thomas Beaton

Widespread rates of poor consumer literacy within the healthcare industry creates administrative burdens for payers and contributes to an additional $4.8 billion in health plan costs, according to a...

Cigna Launches $250M Venture Fund for Analytics, Digital Health

by Thomas Beaton

Cigna will invest $250 million in the new Cigna Ventures fund, which will invest in healthcare startups specializing in analytics, digital health, retail, care management, and other business...

FDA Recruits Payers to Submit Quality Feedback on Medical Devices

by Thomas Beaton

FDA has launched a new quality assurance program that leverages feedback from commercial payers about medical device coverage requirements in order to expedite approvals. The Private Payor Program...