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Highmark BCBS Saves $260M Using Value-Based Reimbursement

July 2, 2018 - 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 outcomes. Highmark’s True Performance Program measures primary care providers (PCPs) on their ability to deliver the right care at the right time within the most appropriate...


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CMS Approves Okla. Value-Based Drug Purchasing for Medicaid

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CMS has approved the nation’s first value-based drug purchasing agreement for Medicaid by allowing Oklahoma’s state program to negotiate supplemental prescription drug rebates based on treatment outcomes. CMS allows state Medicaid...

Senators: Stop $89B in Medicare, Medicaid Improper Payments

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The US Senate Budget Committee has penned a letter to HHS Secretary Alex Azar urging the department to address approximately $89 billion in improper payments within Medicare and Medicaid. The Senators referenced a recent GAO report suggested...

Humana, Walgreens Offer Primary Care Clinics for Medicare Members

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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 subsidiary...

AHIP, BCBSA, AMA Join to Improve Public, Private Payer Ecosystem

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The Partnership for America’s Health Care Future (PAHCF), a newly formed coalition, consisting of leading healthcare provider societies and payer organizations, has committed to strengthening the nation’s private and public payer...

Amazon, Berkshire Hathaway, JP Morgan to Name Healthcare CEO

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The new Amazon, Berkshire Hathaway, and JP Morgan & Chase healthcare company will have its inaugural CEO in the next two weeks, Berkshire Hathaway’s CEO Warren Buffett told CNBC in an interview. Buffett was joined by Jamie...

WellCare Buys Meridian for $2.5B to Grow Medicaid Footprint

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WellCare has entered into a definitive agreement to purchase Meridian Health Plan of Michigan, Meridian Health Plan of Illinois, and MeridianRx in order to increase revenues and expand its footprint in the Medicaid and Medicare Advantage markets....

NYCHH Seeks $11.5M from UnitedHealthcare for Denied Claims

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A New-York based health system has initiated arbitration with UnitedHealthcare in order to collect $11.5 million in denied reimbursement from claims. NYC Health + Hospitals, a public healthcare network that serves New York City’s five boroughs,...

Cigna Files with SEC to Begin $67B Express Scripts Acquisition

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Cigna has submitted a filing to the Securities and Exchange Commission (SEC) to complete a $67 billion acquisition of the pharmacy benefit manager (PBM) Express Scripts. The payer filed the merger agreement under a temporary parent company called...

CMS Highlights Drug Price Transparency Data Dashboards

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CMS has released redesigned drug price dashboards to provide information about manufacturer drug costs and advance the agency’s goals of promoting consumer price transparency. Patients, providers, and researchers are able to explore data...

CMS Increases Payments for Durable Medical Equipment

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CMS has issued an interim final rule that raises Medicare payments for durable medical equipment (DME) to ensure Medicare beneficiaries have access to critical medical devices. The rule will raise DME payments to Medicare providers from June...

Former CMS Employee Found Guilty in Insider Trading Scheme

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A former CMS employee leaked high-level information related to the agency’s rulemaking decisions and changes in provider reimbursement as part of an insider trading scheme, according to a guilty verdict in the Southern District of New York...

CMS Releases Medicare Advantage Encounter Data to the Public

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CMS has planned to release Medicare Advantage encounter data so that researchers and consumers have the ability to make informed opinions about the cost and healthcare outcomes of the MA program. The agency will allow researchers to access 2015...

HHS Appoints James Parker to Address Health Insurance Costs

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HHS Secretary Alex Azar has appointed James Parker as Senior Advisor to the Secretary of the Office of Health Reform to address healthcare challenges related to health insurance costs and health plan availability. Parker previously served as...

Humana Expands Bundled Payment Model for Medicare Advantage

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Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations. The payer has teamed up with orthopedic specialists to expand its Total Joint Replacement...

Maryland Creates State Reinsurance Program to Control Premiums

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Maryland governor Larry Hogan has signed legislation to create a state reinsurance program aimed at stabilizing health plan premium increases. The reinsurance program will use state and federal reinsurance funding to pay catastrophic claims for...

BCBS Association: Use Alternative Pain Therapies Before Opioids

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The BlueCross BlueShield Association (BCBSA) has announced a new professional standard that removes opioid prescriptions as a primary pain treatment in a majority of clinical situations. The payer’s National Council of Physician and Pharmacist...

Proposed Rule Deregulates Medicaid Managed Care, Fee-for-Service

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CMS has proposed a new rule that deregulates certain aspects of Medicaid managed care and Medicaid fee-for-service (FFS) programs in order to reduce regulatory burdens at the state level. The rule would exempt managed care programs from certain...

BCBS of MI Launches Bundled Payments for Hip, Knee Replacements

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BlueCross BlueShield of Michigan has launched a pilot program that will use bundled payments for knee and hip replacements in order to manage costs and improve member outcomes. BCBS data estimates that knee and hip replacements can cost between...

Tavenner Steps Down from AHIP, Hands Leadership to Matt Eyles

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The AHIP Board of Directors has appointed Matt Eyles as the organization’s new President and CEO to replace Marilyn Tavenner after she retires on June 1st, 2018.    Eyles was elected unanimously as Tavenner’s successor. ...

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