Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

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Data from Health Plans, PBMs Helps Lower Prescription Drug Costs

November 16, 2018 - The health information network Surescripts is using data from both payers and PBMs to give prescribers access to patient-specific and formulary-based benefit and cost information for nearly three-quarters of all covered lives in the country. At the point of care, there have been 30 million views of this data which is integrated within electronic health record technology via the...


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HealthCare.gov Breach Exposes Data of 75K Individuals

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Last month, a breach of HealthCare.gov took place that affected those applying for coverage under the Affordable Care Act, HHS reported last Friday. The intrusion led to inappropriate access to the personal information of about 75,000...

Cigna: Integrated Pharmacy, Medical Benefits Improve Overall Health

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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...

PA Expands Access to Medication Assisted Treatment for SUD

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Commercial payers and the Pennsylvania Department of Insurance (PDI) have agreed to increase access to medication-assisted treatments (MAT) and realign prior authorization processes for beneficiaries struggling with substance use disorders...

Medicare Deductibles, Premiums to Increase Slightly in 2019

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CMS has announced that Medicare Part A and Part B premiums and deductibles are expected to increase slightly for the 2019 plan year. Part B members will see small increases in both their premiums and their deductibles, while Part A...

CMS: ACA Premiums to Decline in 2019 for Silver Plan Consumers

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CMS has announced it expects the average ACA health plan premium to drop by 1.5 percent for healthy consumers that purchase low-cost silver tier plans. The agency stated that it is the first time since 2014 that premiums in any part of...

Private Insurance Spending Has Outpaced Public Spending Since 2016

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Private insurance spending has grown faster than Medicare and Medicaid spending since 2016, even though national enrollment has plateaued, says a new report from Altarum. The report suggests that higher per-enrollee spending, plus...

Aetna Sells Portion of Medicare Business to Fast-Track CVS-Aetna

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Aetna has sold its Medicare Part D prescription plan business of 2.2 million beneficiaries to WellCare in an attempt to increase the likelihood of the CVS-Aetna merger closing before year’s end. In SEC filings, Aetna explained that...

NCQA, Health Plans to Measure Patient-Reported Outcomes

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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 Person-Driven Outcome Measurement...

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

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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 opportunities related to value-based...

Anthem, Walmart Partner for Over-the-Counter Drug Allowance

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A new partnership between Anthem and Walmart will allow Medicare Advantage beneficiaries to purchase over-the-counter drugs and other drug store necessities with a plan allowance. Starting in January of 2019, Anthem beneficiaries will be...

CMS Provides $8.4M to Stabilize State Insurance Markets

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CMS has awarded $8.4 million to 31 states in an effort to stabilize state insurance markets and increase the number of affordable health plan options for beneficiaries. Recipients are allowed to use the ACA-funded State Flexibility Grant...

CMS Processes State Medicaid Requests, Approvals 23% Faster

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CMS has announced that an agency initiative to streamline state Medicaid approvals and state plan amendments (SPAs) has increased approval processing speed by 23 percent. In 2017, CMS sent a bulletin to state Medicaid programs informing...

Google Invests $375M in Oscar Health for Medicare Advantage

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Google’s parent company, Alphabet, has invested $375 million in Oscar Health to help the tech-focused payer enter into Medicare Advantage markets by 2020, according to multiple news outlets, including Reuters. Oscar Health said in...

CMS Proposed Rule Aims to Secure 2018 Risk Adjustment Payments

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CMS has proposed a new rule that aims to resolve legal issues over the risk adjustment program’s payment methodology.  The rule would ensure that payers will receive appropriate risk adjustment payments for plan year 2018. The...

Medicare Part D Premiums Expected to Decline in 2019

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CMS has announced that monthly Medicare Part D premiums are expected to fall from $33.59 in 2018 to $32.50 in 2019 as new policies to reduce Medicare’s drug costs take effect. Earlier in 2018, CMS issued a final rule that made...

Centene, Ascension Partner for Medicare Advantage Offering

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Centene and Ascension have partnered to offer a Medicare Advantage plan across multiple geographic markets in 2020.   Centene Chairman and CEO Michael F. Neidorff believes that the partnership will showcase effective strategies to...

CAQH CORE Urges Industry Collaboration on Prior Authorizations

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CAQH CORE is urging healthcare payers, providers, and other stakeholders to promote industry-wide collaboration on how to improve prior authorizations. Leading provider and payer organizations, including AHIP, AHA, the BlueCross...

CMS Proposes Site-Neutral Payments, Drug Price Negotiation

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CMS has proposed a rule that would expand the use of site-neutral payments and improve the drug price negotiation process with manufacturers in order to reduce Medicare’s overall spending. The new rule would allow Medicare to...

Highmark BCBS Saves $260M Using Value-Based Reimbursement

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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...

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