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Private Payers News

Anthem to Acquire FL Medicare Advantage Organization HealthSun

September 21, 2017 - Anthem entered into an agreement to acquire Florida-based HealthSun, a payer and integrated health system that provides care and coverage to 40,000 Medicare Advantage beneficiaries, the payer announced in a press release.   Leaders at Anthem see the acquisition of HealthSun as a prime opportunity to further expand their care networks, since HealthSun is one of the fastest growing health...


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More Payers, More Providers Increase Price Negotiation Power

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Payers that operate within healthcare markets with a high concentration of payers and providers prices can negotiate the price of services up to 19 percent lower than those operating in low-concentration payer-provider markets, found a new study...

Pharmacy Benefit Manager Accountability is Key for Employers

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As prescription drug costs continue to rise employers should ensure that they have strong pharmacy benefit manager (PBM) accountability measures in place to maximize cost-savings and plan efficiency, according to a report from the Midwest Business...

MS Medicaid Recovers $8.6M in Fraud, Improper Payments

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The Mississippi Division of Medicaid (DOM) recovered $8.6 million dollars from claims that were either directly fraudulent or improperly filed, the DOM announced in a press release. Through collaboration between Medicaid Fraud Control Units (MFCUs)...

BCBS Minnesota Launches Prediabetes Prevention Campaign

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Blue Cross Blue Shield (BCBS) of Minnesota is launching a prediabetes prevention campaign to lessen the rate of diabetes in local communities, the payer announced in a press release. Titled “Reverse It,” the campaign focuses on helping individuals...

Employers Expect 2018 Benefit Costs to Rise $14K Per Employee

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Large employers will have to rely on healthcare delivery innovations and cost management strategies as employers face a 5 percent rise in the cost of providing employee healthcare benefits, according to a National Business Group on Health (NBGH)...

Anthem to Withdraw from ACA Individual Market Exchanges in NV

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Anthem BlueCross BlueShield (BCBS) will completely withdraw from Nevada’s ACA exchange for individual health plans in 2018, the health payer announced on Monday. The payer’s decision follows discussion with state leaders and regulators....

Anthem Blue Cross Engages in Medicare Advantage Risk-Sharing

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Anthem Blue Cross and America's Health Plan (AHP) have announced a risk sharing partnership aimed at improving services for Medicare Advantage beneficiaries in California. AHP and Anthem view the partnership as a gateway for promoting value-based...

Amerigroup Creates Risk-Based Partnerships for Medicare Advantage

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Amerigroup has announced two risk-based partnerships between health systems in Houston and El Paso that aim to enhance quality of care and increase provider access for Medicare Advantage (MA) beneficiaries. Renaissance Physicians Organization...

KPMG: Cybersecurity Breaches on the Rise for Healthcare Payers

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Healthcare payers are increasingly becoming targets of cybersecurity breaches, both malicious and accidental, according to a new survey from KPMG.  Cybersecurity incidents resulting in compromised data and HIPAA violations affected 47 percent...

UnitedHealthcare of WI Grants $100K to Community Disability Groups

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UnitedHealthcare Community Plan of Wisconsin awarded four non-profit community health organizations a total of $100,000 to enhance healthcare access and resources for individuals with disabilities. Lt. Gov. Rebecca Kleefisch of Wisconsin joined...

GAO: CMS Erroneously Paid $16B to Medicare Advantage Orgs

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CMS incorrectly paid $16 billion to Medicare Advantage organizations (MAOs) as a result of insufficient oversight and mismanagement of data, says the Government Accountability Office (GAO) in a new report. Almost 10 percent of all MA payments...

Humana Foundation Awards $735K To Improve Community Health

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The Humana Foundation announced awards totaling $735,000 to help South Florida nonprofits to help improve community health. As part of the payer’s philanthropic pursuits, the grants are being awarded during their 2017 donation cycle to...

BCBS of Louisiana Offers Online Consumer Price Comparison Portal

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In an effort to improve transparency and customer engagement, Blue Cross Blue Shield (BCBS) of Louisiana launched an online consumer price comparison portal. The portal, called SmartShopper, allows any BCBS  customer in Louisiana to compare...

Member Engagement for Payers Should Focus on Simplicity

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For payers, an effective member engagement strategy can lead to better member health, lower claims cost, and improved product loyalty.  To achieve these goals, payers should start by identifying pain points and implementing processes that...

Narrow Insurance Networks Can Limit Options for Cancer Care

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Cancer patients may have limited access to top-tier healthcare options if enrolled in narrow insurance networks, according to a study from the Perelman School of Medicine at the University of Pennsylvania.  Policymakers and payers have a...

Kaiser Permanente Health Plan Falls Short on Behavioral Health

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Kaiser Permanente’s health plan does not adequately ensure that patients can access behavioral health services in a timely and effective manner, says the California Department of Managed Health Care after a routine survey.  The report...

Healthcare Payers See Promise in Private Exchange Successes

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Private exchanges have grown in significance as a means for payers to get their products before employers, and their growth has resulted in increasing the number of health plan options for employees and beneficiaries. Additionally, the expanded...

Employees Like Wellness Programs, But Don’t Use Them Much

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As employers and payers move towards a more engaged preventive health environment, the use of workplace wellness programs have increased across the nation, according to results from a UnitedHealthcare Consumer Sentiment Survey. Today, nearly...

4 Ways Payers Can Stay Competitive with Medicare Advantage Plans

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With an aging population and soaring healthcare costs, the public interest in Medicare Advantage (MA) plans has been steadily increasing.   As the marketplace becomes crowded with plan options and insurers, payers must understand how...

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