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Commercial Payer Prices Outpace Medicare, Medicare Advantage

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Commercial payers charge significantly higher prices for common clinical services than Medicare fee-for-service (FFS) and Medicare Advantage plans, according to a new report from the Congressional Budget Office (CBO). Commercial insurers charged...

Consumers Voice Opinions on Effective Healthcare Marketing

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Spending for healthcare marketing was $9.7 billion in 2015 alone, a double-digit increase from the previous year.  In all forms of media across the nation, there is no shortage of healthcare messaging being sent towards the public.  ...

Senate Has Released Bill to Revise ACA Repeal Legislation

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The Senate has released the working draft of the Better Care Reconciliation Act of 2017, revising the recently House-passed AHCA.   Both bills aim to repeal and replace the Affordable Care Act (ACA), which was passed in 2010. The AHCA...

Healthcare Spending Growing at Slower Than Expected Rate

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Expenditures on healthcare grew at a historically low rate between 2009 and 2013, according to a recent report, defying the conventional wisdom that healthcare spending has skyrocketed.  A Robert Wood Johnson Foundation report looked at...

Anthem BCBS Expands Value-Based Care Options with Premier Health

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Anthem Blue Cross Blue Shield has partnered with Ohio-based Premier Health to expand its value-based care offerings to its employer-based, individual and Medicare Advantage members. The agreement aligns Premier’s population health model...

AHIP: Congress Must Stabilize Payer Market, Consider Reforms

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With passage of the AHCA, the insurance industry group AHIP has sent its response to congress and presented its recommendations for what direction to go in with healthcare reform The payer industry organization submitted recommendations in four...

DOJ Sues UnitedHealth over Alleged $1B Medicare Fraud

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The Department of Justice is suing UnitedHealth  for alleged Medicare Advantage fraud in a civil case.  The complaint, filed in the Western District court, is “for monies unlawfully obtained or retained from the insurers Medicare...

CMS to Shutter Small Business Health Options Program Website

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As of 2018, HealthCare.gov will no longer host the Small Business Health Options Program (SHOP) Marketplace.   Usage of the healthcare insurance exchange by insurance producers and overall enrollment through SHOP never met anticipated...

Two-Thirds of Physicians Disapprove of American Health Care Act

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Two-thirds of physicians in a new Merritt Hawkins survey reported having a negative impression of the American Health Care Act (AHCA).  This includes 58 percent of physicians who have a “strongly” negative take on the newly...

Anthem Terminates Cigna Merger, but Refuses to Pay Out $1.8B

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After a court ruling in Delaware, Anthem has notified Cigna that their proposed $54 billion merger is off, but that doesn’t mean the two insurance companies are amicably parting ways. Anthem has stated that it will not pay Cigna a $1.85...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

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In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the nation’s patients. ...

Maine Medicaid Waiver Would Increase Patient Responsibility

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Maine will apply for a Section 1115 Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS) to be granted flexibility to circumvent federal regulations and impose reforms on its Medicaid program. The state’s proposed changes...

Aetna Will Abandon All Health Insurance Exchanges for 2018

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Aetna is ending participation in the Delaware and Nebraska ACA health insurance exchanges, completing its retreat from the public marketplace.   The company also made announcements earlier this year that it would be leaving the Virginia...

Humana Expands Orthopedic Bundled Payment Program to NC, VA

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Humana will bring its value-based orthopedic bundled payment program to 11 orthopedic specialty groups in North Carolina and Virginia.  The move follows a recent expansion into Kentucky and Indiana in 2017, and Ohio and Tennessee in...

BCBS Moves into Vacant TN Health Insurance Exchange

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Blue Cross-Blue Shield (BCBS) has announced its plans to offer coverage options on Tennessee’s Affordable Care Act health insurance exchange in 2018.  The separate rating area consists of 16 counties in the greater Knoxville area....

Medicaid Waiver Adds More Beds For Drug Addiction Treatment

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To circumvent an obscure Medicaid requirement, seven more states applied to join California, Maryland, Massachusetts and New York to receive a Medicaid waiver to expand drug addiction treatment.   Current federal policy prohibits the...

MD Health Insurance Exchange Rates Up Double-Digits for 2018

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Patients in Maryland looking for insurance in 2018 may have bigger bills than they bargained for. The health insurance exchange rates for individual and group plans in the state have risen by up to 58 percent as payers try to cope with uncertainty,...

Are Health Insurance Subsidies Enough for Low-Income Patients?

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Despite financial penalties designed to prompt consumers to keep their health insurance, current efforts to subsidize care for low-income individuals may not be enough to incentivize patients, according to a recent study by economists at MIT...

Healthcare Orgs React to House Vote on American Health Care Act

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The House vote to pass the American Health Care Act (AHCA) has drawn responses from across the healthcare industry.    The bill was passed 217-213, and immediately created a firestorm of commentary.  The passage of the bill...

Anthem Pursues Cigna Merger Up to the Supreme Court

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Just seven days after a court upheld the initial ruling which blocked Anthem’s acquisition of Cigna, the nation’s second largest insurer is not giving up.   Anthem has confirmed that it is filing a writ of certiorari with...

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