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Private Payers News

Humana Adds Former ONC Chief Karen DeSalvo as Board Member

November 16, 2017 - Former National Coordinator for Health IT and Assistant HHS Secretary Karen DeSalvo, will join Humana’s board of directors, the payer announced in a press release. Humana believes that the addition of DeSalvo to the board will improve its value-based care competencies because of her impressive resume involving coordination with health IT systems. DeSalvo served as the Health Commissioner...


Articles

11 Healthcare Payers to Enhance Substance Use Treatment Access

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Executives from 11 healthcare payers have pledged to enhance substance use disorder (SUD) treatment access and offer provider incentives to more effectively address opioid misuse and other substance use issues. In a joint letter, payer executives...

Emergency Response Devices Add Value to Medicare Advantage Plan

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Anthem BlueCross BlueShield plans to add value onto consumer Medicare Advantage (MA) plans by offering personal emergency response systems (PERS) to beneficiaries, the payer announced in a series of press releases. MA beneficiaries in several...

AMA: Payers Operate in Extremely High Concentrated Markets

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Payers have significant control of their respective healthcare markets as 69 percent of payers offering HMO, PPO, POS, and public health exchanges operate in very high concentrated markets, AMA found in a study of national insurance markets....

What are the Pros and Cons of Consumer Directed Health Plans?

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In recent years, payers have been extending their consumer-directed health plan (CDHP) offerings as a way to encourage health plan enrollment and save on healthcare costs. Many healthcare stakeholders see CDHPs as products that create mutual...

Anthem Adds Home Meal Delivery to Medicare Advantage Plans

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Anthem is offering home meal delivery service to its post-discharge Medicare Advantage plan members in  in several states including Georgia, Kentucky, Missouri, and Wisconsin the payer announced. Anthem is partnering with GA foods to provide...

Employer Insurance Enrollment, Member Engagement Stagnated in 2016

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Growth in employer-sponsored insurance enrollment and certain measures of member engagement did not significantly increase in 2015 and 2016, according to the Medical Expenditure Panel Survey (MEPS) released by AHRQ. There was no significant change...

Blue Shield of CA to Offer Statewide Healthcare Provider Directory

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Blue Shield of California plans to develop a statewide healthcare provider directory, with the help of Integrated Healthcare Association (IHA), that gives members access to current information on providers, the payer announced in a press release....

Pediatric Data Reveals Private Payer, Medicaid Spending Gaps

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Private payers spend close to twice as much on pediatric services as Medicaid, according to a statistical brief from AHRQ, highlighting significant disparities in cost related to visit type and geographical region. Data from the 2015 Household...

NB and IA Offer New Individual Market Plan For Open Enrollment

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An new individual market plan created out of Medica and CHI Health will be available to consumers during the open enrollment period in Nebraska and Iowa, the health networks announced in a press release. The Medica with CHI Health plan offers...

Nevada Blue to Offer Supplemental Medicare Coverage to Members

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On October 1, Blue Cross Blue Shield (BCBS) of Nevada members can enroll in Medicare Supplemental Innovation Plans F, G, or N that provide preventative care services and extended benefits, the payer announced earlier this week. The plans will...

Anthem to Acquire FL Medicare Advantage Organization HealthSun

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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...

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...

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