Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Private Payers News

Medicaid Service Equals or Surpasses Private Health Payers

April 27, 2017 - A new report by the Commonwealth Fund found that Medicaid provides equal or better quality health coverage to private health insurance plans.  The Commonwealth Fund’s 2016 Biennial Health Insurance Survey measured statistics related to access to care, quality of care, and problems related to medical bills.   The study found Medicaid recipients rated ahead of private payers...


Articles

Provider-Owned Health Plans Adopt Interoperability Standards

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Three provider-owned health plans have recently completed the fourth phase of CAQH CORE certification.  This achievement places the provider-owned health plans at a level that supersedes present regulatory requirements for interoperability...

Population Health Approach to Prenatal Care Cuts Payer Costs

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Health insurance payers can improve patient outcomes and reduce spending by expanding the use of population health management models for expectant mothers.  Early intervention and preventive care can lower costs in high-risk birth situations,...

PA Seeks Increased Payer Coverage of Emergency Air Ambulances

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Emergency air ambulances save lives, but they can also leave patients in a mountain of debt.  Pennsylvania Insurance Commissioner Teresa Miller would like payers to shoulder more of the costs of these critical services, and has accordingly...

UnitedHealth Grows by 11.8% Despite ACA Marketplace Withdrawal

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Despite its very public near-total withdrawal from the Affordable Care Act marketplace in 2017, the nation’s largest healthcare payer recently reported substantial Q1 profit growth.     Revenues at UnitedHealth were...

Payers, Providers Collaborate to Combat Opioid Abuse, Addiction

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Insufficient control of opioid prescriptions is one of the key reasons why opioid abuse and addiction have risen dramatically over the past few years.    To mitigate the epidemic, payers have developed programs to directly establish...

Top 5 Largest Health Insurance Payers in the United States

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The Affordable Care Act has been a divisive policy for the public and politicians, but since 2010 it has been a financial boon for the top five giants of the health insurance payer industry.  The expanding customer base created by the ACA,...

Independence Blue Cross, UPenn Partner to Enhance Care Delivery

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A five-year partnership between Independence Blue Cross and the University of Pennsylvania Health Systems (UPHS) should help strengthen multiple aspects of care delivery for beneficiaries in the state. Both organizations are under contract to...

Aetna Will Exit Iowa ACA Health Insurance Exchange in 2018

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Aetna has announced that it will stop participating in the Iowa health insurance exchange in 2018, citing financial losses and market instability as primary reasons to exit.   "Earlier today we informed the appropriate federal and state...

Wellmark BCBS Latest to Exit ACA Health Insurance Exchanges

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Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, will not renew or sell individual plans on the Affordable Care Act health insurance exchanges effective Jan 1, 2018. The decision follows three-year losses of approximately...

BCBS of Minn. Cites Risk Pools for $322.4M in 2016 Losses

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Blue Cross Blue Shield (BCBS) of Minnesota reported a net operating loss of $322.4 million in their 2016 financial audit, citing unbalanced risk pools and rising premium pricing as a current and future detriment to profitability. At the end of...

Anthem Appeals Cigna Merger with Cost, Quality Arguments

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Anthem has opened an appeal in the U.S District Court citing opportunities for increased consumer savings and quality of care weeks after the DOJ blocked its planned merger with Cigna. Anthem argued that the DoJ’s ruling neglected a possible...

Payers Face 9.6% Underwriting Loss on Health Insurance Exchange

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Underwriting margins for payers selling individual plans on the health insurance exchange dropped from a 6 percent earned premium loss in 2014 to a 9.6 percent loss in 2015, Milliman recently reported. The financial losses stemmed from the Affordable...

AHA Urges D.C Appeals Court to “Uphold Cigna-Anthem Ruling”

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The American Hospital Association (AHA) released a public document urging the U.S Court of Appeals in Washington D.C, to affirm the block on the Cigna-Anthem merger. In an amicus barae, the AHA outlined various antitrust violations and inhibitions...

CBO Score Confirms Industry’s American Health Care Act Concerns

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After the Congressional Budget Office released their cost estimate on the American Health Care Act (AHCA) several healthcare industry leadership groups reaffirmed their concerns about the bill, which may leave approximately  14 million Americans...

Aetna, Cigna Join 300 Organizations in CAQH CORE Phase III

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A new press release confirmed that Aetna and Cigna are now certified under CAQH CORE Phase III Operating Rules. Their certification will provide the entire CAQH CORE collaboration interoperable access to two of the largest payers in the US. Under...

Market Monopoly Cause of Court Blocking Cigna-Anthem Merger

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The full opinion of United States District Court for the District of Columbia blocking Anthem’s acquisition of Cigna became publicly available earlier this week and provides details into the court’s decision. In the memorandum opinion,...

After Terminated Merger, Cigna Demands $13B from Anthem

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UPDATE: Anthem has secured a restraining order against Cigna preventing the final dissolusion of the merger.  The temporary order will be reviewed during a Delaware Chancery Court hearing on April 10. After a court ruling ended the...

Humana to Leave ACA Health Insurance Exchanges by 2018

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Humana will halt sales of individual health insurance plans through the Affordable Care Act’s exchanges by 2018, which will leave more than 150,000 Humana customers without a carrier.   Amid ongoing political uncertainty, Humana said...

Aetna, Humana Terminate Merger Deal After Court Defeat

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Aetna and Humana have scrapped their merger plans after the Department of Justice blocked the deal due to antitrust concerns.  Aetna will pay Humana a $1 billion termination fee, included as part of the original agreement. The DOJ lawsuit,...

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