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Private Payers News

Assessing Providers for Participation in Value-Based Care Contracts

May 17, 2018 - Creating strong networks of high-quality healthcare providers can be a major challenge for any payer looking to expand its value-based care contract portfolio. Providers aren’t the only ones accepting risk when entering into pay-for-performance arrangements since payers are also putting revenue and reputation on the line.  In order to ensure that a contracting arrangement can deliver...


Articles

Cigna Files with SEC to Begin $67B Express Scripts Acquisition

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Cigna has submitted a filing to the Securities and Exchange Commission (SEC) to complete a $67 billion acquisition of the pharmacy benefit manager (PBM) Express Scripts. The payer filed the merger agreement under a temporary parent company called...

Harvard Pilgrim, Partners HealthCare Discuss Possible Merger

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Harvard Pilgrim and Partners HealthCare are engaging in discussion of a possible merger.  A deal would combine Massachusetts’s largest payer organization with the state’s largest provider group and may create a dominant healthcare...

Supplemental Insurance is a Value-Add Opportunity for Employers

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Employers may have a prime opportunity to add value to their health plan options by offering supplemental insurance, according to a recent AHIP survey. The survey found that 95 percent of employees are satisfied with supplemental plan benefits...

How Payers Can Effectively Scale Value-Based Care Networks

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Value-based care networks are a promising opportunity for payers that want to manage costs and improve outcomes of beneficiaries.  But effectively scaling collaborative, risk-based reimbursement networks for millions of beneficiaries requires...

Medicare Advantage, Premium Revenues Drive Q1 Payer Profits

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Healthcare payers experienced strong first quarter profits in 2018 because of sharp growth in Medicare Advantage (MA) enrollment and premium revenues, according to newly released earnings statements. The reports confirm the stability and profitability...

High-Deductible Health Plan, HSA Enrollment Reached 21M in 2017

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High-deductible health plan (HDHP) and health savings account (HSA) enrollment reached 21 million members in 2017, according to new research from AHIP.  These health plan options are expected to see continued growth in the near future. In...

Humana Expands Bundled Payment Model for Medicare Advantage

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Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations. The payer has teamed up with orthopedic specialists to expand its Total Joint Replacement...

Rumors Swirl of Possible Walmart Acquisition of Humana

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Walmart may be making a move to acquire Humana, one of the nation’s biggest health payers, according to The Wall Street Journal. Citing sources familiar with the matter – but without comment from Humana or Walmart – the Journal...

CVS, Aetna Merger May Face Antitrust, Consumer Protection Issues

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The American Antitrust Institute (AAI) has warned the Department of Justice (DoJ) that the proposed CVS and Aetna merger would violate consumer protections and damage competition in the healthcare industry. AAI believes that the merger of CVS...

Aetna Will Apply Pharmacy Rebates to Prescription Drugs in 2019

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Aetna has announced plans to automatically apply pharmacy rebates to eligible prescription drug benefits by 2019 in an effort to increase pricing transparency and control costs. Nearly three million Aetna members are likely to experience lower...

Policy, Market Changes May Harm Employer-Sponsored Insurance

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Significant changes to the employer-sponsored insurance market, such as increasing medical costs, policy changes, and improvements in other payer markets may cause employers to stop providing health insurance An analysis from the American Health...

Payment Cuts Drive Medicare Advantage Plans to Contain Costs

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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...

Cigna, Amazon Alexa Offer Voice Control Beneficiary Education

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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

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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

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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

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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

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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

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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

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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...

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