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Private Payers News

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

January 16, 2018 - Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in 2017. In 2016, opioid abuse was responsible for 42,000 deaths. Forty-percent of all deaths from an opioid overdose were from either a legally or illegally obtained...


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Humana Becomes Latest Payer to End AHIP Membership

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Humana is the latest commercial payer to end its membership in AHIP, the nation’s largest health insurance trade organization. “Humana has not actively participated in AHIP since early 2017,” a Humana spokesperson told HealthPayerIntelligence.com....

Healthcare Insurance Market Profits May Hold Steady in 2018

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Certain segments of the healthcare insurance market, including employer-sponsored insurance and Medicare Advantage (MA), will help to stabilize payer profitability in 2018, predicts a report by A.M. Best. The gains from these sectors are expected...

BCBS Ohio Plans for Upping Patient ED Visit Costs Raise Concerns

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BCBS of Ohio plans to charge beneficiaries the total cost of their emergency department visits  if a diagnosis suggests the visit wasn’t emergency-based, a policy which has been met with extensive concern from The American College...

Humana Enters Home Health Market With $800M Provider Purchase

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Humana signed a definitive agreement to acquire a 40 percent minority in the Kindred at Home division of Kindred Healthcare, the nation’s largest home health care provider.  The $800 million agreement follows several major announcements...

ACA Cost Concerns Offer Payers a Member Engagement Opportunity

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Consumers purchasing health insurance through the ACA exchanges are likely to actively seek out lower-cost options when enrolling or re-enrolling in individual health plans, says new data from GAO, giving payers a chance to practice their member...

Aetna to Waive Narcan Co-Pays, Combat Opioid Overprescribing

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Aetna will be the first national payer to waive Narcan co-pays for fully-insured members as part of a larger effort to address the nation’s opioid crisis, the payer announced in a press release. Narcan is considered a preferred branded...

Optum to Purchase DaVita Medical Group for $4.9B

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Optum, a subsidiary of UnitedHealth Group, has agreed to acquire DaVita Medical Group for $4.9 billion, expanding the health care services company’s footprint in the direct care delivery environment. The acquisition, expected to be finalized...

CVS Health to Buy Aetna for $69B, Altering Payer Landscape

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CVS Health is continuing its quest to become a major force in the growing world of consumer-centric healthcare by announcing that it will buy Aetna for $69 billion.  "This combination brings together the expertise of two great companies...

Integrated Medical, Pharmacy Benefits Help Costs, Member Engagement

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Integrating medical benefits with pharmacy benefits can help healthcare payers and employer sponsors lower spending, improve member engagement, raise satisfaction, increase care coordination, and manage population health – ticking all the...

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 its...

11 Healthcare Payers to Enhance Substance Use Treatment Access

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Executives from 11 healthcare payers have pledged to enhance substance use disorder (SUD) treatment access and offer provider incentives to more effectively address opioid misuse and other substance use issues. In a joint letter, payer executives...

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 several...

AMA: Payers Operate in Extremely High Concentrated Markets

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Payers have significant control of their respective healthcare markets as 69 percent of payers offering HMO, PPO, POS, and public health exchanges operate in very high concentrated markets, AMA found in a study of national insurance markets....

What are the Pros and Cons of Consumer Directed Health Plans?

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In recent years, payers have been extending their consumer-directed health plan (CDHP) offerings as a way to encourage health plan enrollment and save on healthcare costs. Many healthcare stakeholders see CDHPs as products that create mutual...

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 provide...

Employer Insurance Enrollment, Member Engagement Stagnated in 2016

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Growth in employer-sponsored insurance enrollment and certain measures of member engagement did not significantly increase in 2015 and 2016, according to the Medical Expenditure Panel Survey (MEPS) released by AHRQ. There was no significant change...

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 release....

Pediatric Data Reveals Private Payer, Medicaid Spending Gaps

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Private payers spend close to twice as much on pediatric services as Medicaid, according to a statistical brief from AHRQ, highlighting significant disparities in cost related to visit type and geographical region. Data from the 2015 Household...

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 offers...

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