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CVS Caremark Provides Real-Time Benefits Data to Pharmacies

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CVS Caremark, the pharmacy benefit manager (PBM) of CVS Health, will provide pharmacies and prescribers with real-time benefits data on patients as a way to reduce payer and patient drug costs, the organization announced in a press release....

Health Plan Partnership Aims to Boost Care for Native Americans

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A merger between Tribal First (a subsidiary of Alliant Specialty Insurance Services) and American Indian Health Services (AIHS) will combine two national leaders in providing quality care to Native Americans, the organizations announced in ...

ACA Individual Mandate Repeal Could Cut Insured Number By 13M

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As a potential repeal of the ACA’s individual mandate faces the US Senate, the Congressional Budget Office (CBO) and Joint Tax Committee (JTC) found that a repeal would cut the number of insured individuals by four million in 2019. In...CBO and JTC also found that nongroup insurance markets would remain relatively stable following a repeal of the mandate, but premiums in these markets would likely increase by 10 percent per year between 2018 and 2027. The findings are base...CBO and JCT previously estimated that a repeal of the individual mandate would decrease the nation’s insured rate by 16 million, and concluded their report by saying the estimates could fluctuate in the coming months. However, both or...

Humana Adds Former ONC Chief Karen DeSalvo as Board Member

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Former National Coordinator for Health IT and Assistant HHS Secretary Karen DeSalvo, will join Humana’s board of directors, the payer announced in a press release. Humana believes that the addition of DeSalvo to the board will improve...

Value-Based Care Outperforms Fee-for-Service Health Plans

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Health plans that include value-based care (VBC) principles are more cost-effective than fee-for-service (FFS) options and are starting to produce better patient outcomes, Humana asserts in a new report. The total healthcare costs associate...

Maine Referendum Expands Medicaid Despite Governor Opposition

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The state of Maine has become the first state to expand Medicaid through a ballot vote that overrides Governor Paul R. LePage’s (ME-R) previous decisions to block the expansion, according to national news outlets. On Tuesday, Maine re...

Emergency Response Devices Add Value to Medicare Advantage Plan

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Anthem BlueCross BlueShield plans to add value onto consumer Medicare Advantage (MA) plans by offering personal emergency response systems (PERS) to beneficiaries, the payer announced in a series of press releases. MA beneficiaries in sever...

ACA Open Enrollment Rate Expected to Drop Up to 13% in 2018

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Analysts expect up to a 13 percent drop in open enrollment on the ACA marketplace exchange in 2018,  according to Standard and Poor’s Global (S&P Global). Only 10.1 million to 11.4 million individuals are expected in enroll i...

AHIP Launches Initiative To Combat Nationwide Opioid Crisis

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AHIP launched the Safe, Transparent Opioid Prescribing (STOP) Initiative to support health plans’ widespread adoption of clinical guidelines for pain care and opioid prescribing, and combat the national opioid crisis, the organization...

Mercy Health, Centene Form Medicaid Accountable Care Organization

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Mercy Health of Arkansas and the Centene Corporation have received approval to operate an accountable care organization within the state focusing on Medicaid beneficiaries, the organizations announced in a press release. Centene subsidiarie...

CBO: Alexander-Murray Healthcare Bill Could Save $3.8B

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The Bipartisan Health Care Stabilization Act of 2017, also known as the Alexander-Murray compromise bill, would save the federal government $3.8 billion without drastically changing the number of individuals with health insurance, the Congr...Continuing to fund the CSRs is expected to reduce federal spending by $1.5 billion from 2018 to 2027 in the form of rebates from state governments and private payers. However, the CBO’s estimate determined that funding the CSRs again ...

Iowa Withdraws 1332 Waiver for Insurance Market Stabilization

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Iowa Insurance Commissioner Doug Ommen has withdrawn his state’s application for a 1332 waiver to stabilize its insurance markets in 2018.   The proposed stopgap measure  included a single, standardized plan available to eve...

Anthem Adds Home Meal Delivery to Medicare Advantage Plans

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Anthem is offering home meal delivery service to its post-discharge Medicare Advantage plan members in  in several states including Georgia, Kentucky, Missouri, and Wisconsin the payer announced. Anthem is partnering with GA foods to p...

Bipartisan Senate Compromise May Reinstate CSRs, Alter 1332 Waivers

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Senators Lamar Alexander (R-TX) and Patty Murray (D-WH)  have floated a bipartisan deal to reinstate the ACA’s cost-sharing reductions (CSRs) and boost individual enrollment outreach in exchange for alterations to the state 1332 ...

Executive Order Eases ACA Rules on Association Health Plans

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An executive order signed by President Trump will lighten rules on association health plans (AHPs), which could allow groups of businesses to provide lower cost insurance without essential health benefits (EHBs), as reported by multiple new...

CMS Releases 2018 Medicare Advantage Star Ratings for Health Plans

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CMS has updated the 2018 Medicare Advantage star ratings on health plans, allowing consumers to explore options that will best suit their individual needs.   The star ratings are based on several consumer engagement and care quality cr...

Senate to Vote on Funding CHIP for Five Additional Years

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A bipartisan bill to continue CHIP funding for five more years and transition to a state-federal partnership will move to a Senate vote after being approved by the Senate Finance Committee.   The “Keep Kids’ Insurance Depen...

HHS Nixes Proposed Rule for Health Plan Compliance Documents

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HHS has withdrawn a proposal for a rule that would have required controlling health plans (CHPs) to submit additional information and documentation demonstrating compliance with HHS operating rules, the agency posted in the Federal Register...

Blue Shield of CA to Offer Statewide Healthcare Provider Directory

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Blue Shield of California plans to develop a statewide healthcare provider directory, with the help of Integrated Healthcare Association (IHA), that gives members access to current information on providers, the payer announced in a press re...

NB and IA Offer New Individual Market Plan For Open Enrollment

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An new individual market plan created out of Medica and CHI Health will be available to consumers during the open enrollment period in Nebraska and Iowa, the health networks announced in a press release. The Medica with CHI Health plan offe...

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