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How One Health Payer Partnership Reduced Hospitalizations

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Recently, the health payer Blue Cross and Blue Shield of Illinois (BCBSIL) announced in a press release that it will be extending its partnership with the American Lung Association of the Upper Midwest over the next two years. The specific partnership...

More Part D Beneficiaries Gain Access to Cost-Sharing Pharmacies

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Healthcare access among Medicare and Medicaid beneficiaries remains a top priority for the Centers for Medicare & Medicaid Services (CMS). In 2015, CMS listened to the concerns of many beneficiaries and discovered that many do not have efficient...

Payers Bear Monetary Losses in Health Insurance Exchanges

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Several medical insurance companies have experienced losses and financial troubles within the federal and state health insurance exchanges. UnitedHealth Group, for example, has considered pulling out of the health insurance exchanges starting...

CMS Released Proposed Rule for Accountable Care Organizations

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced a new proposed rule that would revise the formula used to analyze the performance of accountable care organizations participating in the Medicare Shared Savings Program....

AHA Claims Stark Law Harms Value-based Care Reimbursement

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The American Hospital Association (AHA) has encouraged Congress, specifically the House Committee on Ways and Means, to put an end to regulatory obstacles standing in the way of value-based care reimbursement. In a letter sent to Chairmen Brady,...

CMS Announced 121 New Accountable Care Organizations

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On Monday, the Centers for Medicare & Medicaid Services (CMS) revealed that there will be 121 new accountable care organizations joining the ranks of Medicare ACOs and the Shared Savings Program. A press release from the Department of Health...

America’s Health Insurance Plans Loses Aetna Membership

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The major health payer Aetna has recently withdrawn its membership from one of the nation’s largest insurance lobbying group America’s Health Insurance Plans (AHIP). The lobbying group is now under new leadership. Former administrator...

HHS Announces $157M for Accountable Health Communities Model

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Earlier this week, the Department of Health and Human Services (HHS) announced new funds available of as much as $157 million to develop an Accountable Health Communities Model, which will show whether testing beneficiaries on social needs and...

UPDATE: House Passes Bill to Repeal Obama’s Affordable Care Act

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The House of Representatives voted 240 to 181 in favor of the Budget Reconciliation bill, which would repeal large parts of the Patient Protection and Affordable Care Act as well as take away funding from Planned Parenthood for one year, The...

Is Employer Mandate in Affordable Care Act Constitutional?

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On Monday, the Association of American Physicians and Surgeons (AAPS) filed an amicus brief with the US Supreme Court that asks the justices to provide a writ of certiorari in a court case that claims the employer insurance mandate of the Patient...

The Senate Passes Bill to Repeal Chunks of Affordable Care Act

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On Thursday, the United States Senate voted 52 to 47 in passing a legislation that would gut major provisions within the Patient Protection and Affordable Care Act. This is the first time the Senate has approved such a bill and has the opportunity...

Medical Loss Ratio Provision Led to $2.4 Billion in Rebates

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A new report shows that consumers have received more than $2.4 billion in premium rebates since 2011 because of the passage of the Patient Protection and Affordable Care Act. The Medical Loss Ratio provision under the Affordable Care Act gives...

Soaring US Healthcare Spending Due to Technology, Drug Costs

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Before the Patient Protection and Affordable Care Act came into play, the United States was spending much more money on healthcare than many other first world countries. Despite high levels of US healthcare spending, our nation experiences worse...

Aetna’s Humana Acquisition Bringing Strong Opposition

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The complications between the free market of the health insurance industry tied with increasingly complex federal mandates over the last several years is coming to a head with the Humana acquisition by the insurer Aetna. According to a press...

CMS Releases Doctor Lookup Pilot on Health Insurance Exchange

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The health insurance exchange has a new feature that should bring more interest from consumers. The Centers for Medicare & Medicaid Services (CMS) announced yesterday that Healthcare.gov, the website that offers coverage plans on the health...

ACO Model Boosts Care Coordination for Kidney Failure Patients

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The healthcare industry is determined to strengthen patient care and improve quality through better care coordination among medical teams and across hospitals, rehabilitation centers, and clinics. Care coordination has been the name of the game...

Major Iowa Insurer Joins Obamacare Health Insurance Exchange

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The Patient Protection and Affordable Care Act under the Obama administration, which is colloquially known as Obamacare, set up a health insurance exchange platform that enables consumers to pick and choose which type of healthcare coverage is...

Accountable Care Organizations Cut Costs by $411 Million

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The medical industry has been focused on improving coordinated care across the spectrum of healthcare delivery. With ongoing healthcare reforms taking place around the country and the federal government taking a stronger role in improving patient...

$67M ACA Funds to Help Affordable Health Insurance Enrollees

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The Centers for Medicare & Medicaid Services (CMS) announced yesterday an abundant $67 million in Affordable Care Act (ACA) grant awards to aid outreach initiatives and help those individuals confused about health coverage and financial assistance...

Insurance Coverage Grows as Consumers Explore Payer Options

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Attitudes toward healthcare coverage and healthcare reform have been reshaped in recent years. New avenues of healthcare coverage have come to light, and they are opening more options for how consumers may receive their coverage. Between the...

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