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Private Payers News

After Buying Aetna, CVS Health Commits $100M to Address SDOHs

January 16, 2019 - With its $69 billion acquisition of Aetna in the books, the newly expanded CVS Health is now investing heavily in developing and deploying new models to address community wellness and the social determinants of health (SDOH). The company’s new Building Healthier Communities will benefit from a five-year, $100 million investment from CVS Health, the CVS Health Foundation, and the...


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Anthem Medicare Advantage Members Can Use OTC Allowance at CVS

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Anthem Blue Cross (Anthem) Medicare Advantage members in California will now be allowed to purchase over-the-counter products at CVS Pharmacy stores using their health plan allowance. The partnership, launched on January 1, is intended to...

Patient-Centered Methods Help Health Plans Boost Cancer Care

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Employers and payers should ensure their health plans use patient-centered methods and provider performance measurement strategies to reduce costs and improve cancer care, a report from the National Alliance of Healthcare Purchaser...

60% of Medicare Advantage Members Feel Little Motivation from Plans

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Medicare Advantage (MA) plans are not doing enough to motivate their members to improve their personal health, according to a new survey from HealthMine. Sixty percent of members participating in the poll said that their MA plans do not...

AHIP Urges “Careful Planning” of Health Reimbursement Arrangements

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AHIP is cautioning federal regulators to move slowly and carefully when expanding the availability of health reimbursement arrangements (HRAs) as a more prominent means of paying for healthcare services. In response to a request for...

CVS Health to Begin Important Work of Integrating Aetna

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On the eve of Christmas, Judge Richard Leon of the United States District Court for the District of Columbia decided against halting the integration of the two companies in a merger valued at $69 billion. “Based on CVS’s...

Cigna Announces Closing of $67B Purchase of Express Scripts

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Cigna is officially the new owner of Express Scripts after announcing on December 20 that the $67 billion acquisition has closed. Cigna calls the acquisition a “blueprint to transform the healthcare system,” indicating that...

Prescription Drug Prices Rise Again After Brief Pause

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Several dozen pharmaceutical companies are planning to raise their prices again in 2019 after temporarily holding off on increases as a result of federal pressure. Reuters reports that nearly thirty drug makers, including Novartis, Bayer,...

Does Medicare Advantage Bidding Hold the Key to Reducing Costs?

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In light of future research on Medicare Advantage spending compared to Medicare fee-for-service, a trio of researchers writing on the Health Affairs blog see the promise in competitive bidding to drive down healthcare...

Risk Scores at Center of Sutter-DoJ Medicare Advantage Dispute

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A complaint against Sutter Health and Palo Alto Medical Foundation over appropriate risk scores has drawn the attention of the Department of Justice. The federal agency officially announced its intervention into a lawsuit that alleges...

BlueCross BlueShield Strikes Deal to Improve Health Data Exchange

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In an agreement that will support physicians and upgrade health outcomes for its members, BlueCross BlueShield of Western New York has announced a partnership with HEALTHeLINK. It will enable local participating physicians to access...

PwC: Digital Experiences, High Costs Will Challenge Payers in 2019

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Healthcare payers that hope to succeed in 2019’s competitive business environment will need to meet the strong demand for more consumer-centered digital experiences that help members control their spending and understand how to...

AHIP, Payer Groups Agree to Focus on Nixing Surprise Billing

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Nine of the nation’s most influential payer organizations, including AHIP and the Blue Cross Blue Shield Association (BCBSA), have released a new set of guiding principles aimed at eliminating surprise billing. Unexpected medical...

Health Payers Targeting Improved Consumer Experiences in 2019

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Improving the consumer experience is top of mind for health payers heading into the new year, according to a multi-industry survey of senior leaders by North Highland. “The concepts of culture and change are often at the foundation...

Narrow Network Health Plans Continue to Dominate ACA Exchanges

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New analysis of available health plans on ACA exchanges in 2019 shows that narrow networks remain a dominant force. Avalere researchers found that more restrictive networks own nearly three-quarters of all health plans on health insurance...

Kaiser Awards $6M to Support Mental, Behavioral Health Services

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Kaiser is making a five-year, $6-million investment in community health, the health system and payer announced earlier this week. Kaiser Permanente Southern California’s Community Mental Health and Wellness will $6 million to 16...

Private Medicare Advantage Plans Receive Marketing Boost from DC

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While officials claim to not be pivoting patients to private plans, the subject lines of recent emails appear to suggest differently, according to a report by Robert Pear in The New York Times. With the open enrollment period for the plan...

Aetna Joins Healthcare Blockchain Alliance, Pilot Project

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Not long after closing its deal to be acquired by CVS Health, health payer Aetna has signed on to pilot the use of blockchain technology as part of the Synaptic Health Alliance. In a statement with new fellow participants Ascension, the...

Employers Working to Drive Down Rising Health Insurance Costs

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The realization that consumers using less care but paying more to receive services and treatment is leading employers to rethink their approaches to providing health coverage to their employees, according to a recent report in The Wall...

AMA Study Finds Lack of Health Payer Competition Across US

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Decreased competition in health insurance is likely to do more harm than good, new AMA study concludes. The America Medical Association released its most recent study of health payer competition, and the results fail to indicate the...

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