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Private Payers News

Payment Cuts Drive Medicare Advantage Plans to Contain Costs

March 19, 2018 - Medicare Advantage (MA) plans contained beneficiary costs and remained profitable despite reductions to federal MA payments from 2009 to 2014, according to new research from the Commonwealth Fund. The report found that as Medicare reduced Medicare Advantage payments from 114 percent to 100 percent of costs per enrollee, MA plans internally worked to reduce per-beneficiary costs in an effort...


Cigna, Amazon Alexa Offer Voice Control Beneficiary Education


Cigna is entering the voice control product space with an Amazon Alexa feature called “Answers by Cigna” that educates beneficiaries about complex health insurance terminology and customizes health benefits information. Answers by...

UnitedHealthcare Finds Value-Based Care Closed 50M Gaps in Care


Value-based care helped close 50 million gaps in care between 2013 and 2017 while reducing care costs, lowering ED utilization, and increasing provider care quality, according to a new report from UnitedHealthcare (UHC). UHC examined data from...

Cigna to Acquire Express Scripts for $67B to Expand Consumer Value


Cigna is purchasing pharmacy benefit manager (PBM) Express Scripts Holding Company for $67 billion to improve consumer value, enhance care coordination models, and create long-term financial opportunities. Cigna stated in a press release...

UnitedHealthcare Integrates Apple Watch Into Wellness Incentives


UnitedHealthcare is integrating the Apple Watch into beneficiary wellness incentives, where members can earn the device and financial rewards by participating in a walking program aimed at improving overall member health. The payer will announce...

Centene to Acquire Medicaid, Medicare Advantage Provider Group


Centene signed an agreement to acquire Florida-based Community Medical Holdings Corp (CMG), a community medical group, to expand Centene’s Medicaid, Medicare Advantage (MA), and marketplace health plan businesses. Centene stated in a press...

HCSC Invests $1.5B to Develop Insurance Affordability Solutions


HCSC is investing $1.5 billion to develop health insurance affordability solutions including employee wellness programs, ways to address social determinants of health, and collaborative care. Dubbed Affordability Cures, the initiative uses a...

UnitedHealth Offers Data Analytics to CMS Bundled Payment Program


UnitedHealth Group will help support a new Medicare bundled payment program by offering data and analytics services to participating providers. The payer announced in a press release that it will contribute data and analytics, technology, and...

Payer Housing Partnership Addresses Social Determinants of Health


Health Partners Plans (HPP) and two community programs in Philadelphia announced a partnership to address housing-related social determinants of health by connecting homeless individuals to healthcare services, free clinics, free meals, and social...

Ongoing Payer Consolidation Leads to Consumer Premium Hikes


The four largest payers in the US have continued to get bigger over the past few years, said Leemore S. Dafny, a professor of the Bruce V. Rauner Professor of Business Administration at Harvard Business School, during a House Energy and Commerce...

CA to Investigate Aetna after Insurance Claim Review Admission


The California Insurance Commission has opened an investigation into Aetna’s medical practices after a former medical director for the company testified in court that he did not review patient records before approving or denying care. According...

71% of Workers Satisfied with Employer-Sponsored Health Plans


Over 70 percent of employees are generally satisfied with their employer-sponsored health plans, but are concerned with rising health plan costs, an AHIP study found. Employer sponsored health plans have provided fair premium and deductible financing...

Merger Impacts, Medicaid Growth Drove 2017 Earnings for Payers


Aetna experienced a 4 percent drop in year-to-year earnings because of fallout from its proposed Humana merger, while other payers increased revenues by taking advantage of growing Medicaid, Medicare, and ACA-compliant business opportunities....

Humana Expands Long-Term Social Health Determinant Investments


Humana, and its philanthropic arm the Humana Foundation, announced changes to their grant making processes that provide long-term investments into community programs that address the social determinants of health (SDOH). The new investment strategy...

Aetna Agrees to $17M Settlement in HIV Privacy Data Breach


Aetna has agreed to pay $17,161,200 in a settlement involving allegations that the payer exposed private HIV information for more than 12,000 beneficiaries. The final terms of the settlement require Aetna to break up the total settlement amount...

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse


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...

Humana Becomes Latest Payer to End AHIP Membership


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

Healthcare Insurance Market Profits May Hold Steady in 2018


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


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


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...


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