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Pharmacy Benefit Managers Help Reduce Payer Drug Spending

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Pharmacy benefit managers (PBMs) are instrumental in helping payers provide appropriate access to prescriptions, expand access, and rein in drug spending, according to a recent report from the Pharmaceutical Care Management Association (PCMA)....

House Passes AHCA To Repeal and Replace ACA By 1 Vote Margin

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The House has successfully passed the American Health Care Act (AHCA) to repeal-and-replace the ACA.  This was the House GOP’s second attempt to pass the bill, after the first vote was abruptly cancelled by Speaker Paul Ryan in...

Aetna Posts Q1 Loss After ACA Withdrawal, Merger Collapse

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After a tumultuous 2016, Aetna announced a first-quarter 2017 net loss of $381 million, a significant  reversal from a $737 million profit a year ago. Aetna blamed the loss on costs associated with its attempted merger with Humana,...

AHIP Sees 28% Increase in Medigap Enrollment Among Seniors

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AHIP has released data showing that enrollment in the Medicare Supplement, Medigap, has seen a steady increase from 2014 to December 2015.   The data represents statistics from 11.8 million enrollees with policies from 305 separate...

Chronic Care Management Fund Aids Underinsured Patients

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The HealthWell Foundation has launched the Movement Disorders Fund to provide financial support for those patients unable to pay insurance premiums or copays for necessary chronic care management. The fund is available to qualifying Medicare...

Aetna to Offer New HMO Option for Delaware State Employees

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Health insurer Aetna was recently awarded a three-year contract as a provider of Delaware’s health plan offerings for its employees and pensioners.  Aetna has chosen a coordinated care approach partnering with local innovators to move...

Tufts Health Plan Sees Opportunities as New RI Medicaid Option

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Rhode Island will add Tufts Health Plan (THP) as its first new Medicaid option in seven years, according to the Rhode Island Executive Office of Health & Human Services (EOHHS).  The new program, RITogether, will allow Medicaid...

Court Upholds Antitrust Ruling Against Anthem-Cigna Merger

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On Friday, a federal DC district appeals court upheld a February 2017 decision which blocked the acquisition of Cigna by health insurance giant Anthem.  Antitrust concerns led 11 states and the District of Columbia to join the US Justice...

Patient-Centered Medical Home Benefits Payers, Providers, Patients

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Blue Cross-Blue Shield of Michigan has one of the nation’s most successful patient-centered medical home (PCMH) networks.  The model has improved patient outcomes, lowered payer costs and increased provider satisfaction and revenue. ...

Medicaid Service Equals or Surpasses Private Health Payers

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A new report by the Commonwealth Fund found that Medicaid provides equal or better quality health coverage to private health insurance plans.  The Commonwealth Fund’s 2016 Biennial Health Insurance Survey measured statistics related...

Provider-Owned Health Plans Adopt Interoperability Standards

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Three provider-owned health plans have recently completed multiple phases and been awarded CAQH CORE certification.  This achievement places the provider-owned health plans at a level that supersedes present regulatory requirements...

PA Seeks Increased Payer Coverage of Emergency Air Ambulances

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Emergency air ambulances save lives, but they can also leave patients in a mountain of debt.  Pennsylvania Insurance Commissioner Teresa Miller would like payers to shoulder more of the costs of these critical services, and has accordingly...

Health Insurance Actuaries Propose Ways to Stabilize Market

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A stable health insurance marketplace is good for payers and consumers. Speculation over potential payer mergers, repeal or modification of the ACA, and the future of high-risk and low income subsidy payments have left premium rates and coverage...

Independence Blue Cross, UPenn Partner to Enhance Care Delivery

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A five-year partnership between Independence Blue Cross and the University of Pennsylvania Health Systems (UPHS) should help strengthen multiple aspects of care delivery for beneficiaries in the state. Both organizations are under contract to...

Aetna Will Exit Iowa ACA Health Insurance Exchange in 2018

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Aetna has announced that it will stop participating in the Iowa health insurance exchange in 2018, citing financial losses and market instability as primary reasons to exit.   "Earlier today we informed the appropriate federal and state...

House Committee Passes Bill with Healthcare Merger Implications

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The House Judiciary Committee has voted 16-10 in favor of a bill that would revise and standardize part of the process of reviewing mergers for potential antitrust violations.   The Standard Merger and Acquisition Reviews Through Equal Rules...

CMS: Payers May See 2.95% Rise in Medicare Advantage Revenue

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CMS announced updates to the Medicare Advantage (MA) program and Part D Prescription Drug Program, including an expected 0.45 percent increase in revenues for payers and the potential for up to 2.95 percent in revenue growth. “Medicare...

Wellmark BCBS Latest to Exit ACA Health Insurance Exchanges

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Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, will not renew or sell individual plans on the Affordable Care Act health insurance exchanges effective Jan 1, 2018. The decision follows three-year losses of approximately...

Prescription Drugs Account for 22% of Payer Premium Spending

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Prescription drug costs consume the largest proportion of dollars spent on healthcare premiums, with 22 cents out of every dollar going to medication costs, says AHIP in a new data brief. Eighty percent of every dollar is spent on medical expenses,...

CMS Extends Pediatric Alternative Payment Model Comment Period

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CMS will continue to take public comment on its pediatric alternative payment model (APM) initiatives until April 7, 2017.   In March, CMS issued a request for information (RFI) related to establishing an APM specifically focused on the...

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