Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Private Payers News

Cigna, CVS MinuteClinics Partner for Expanded Healthcare Access

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Cigna and CVS Health have partnered to launch Cigna Health Works for expanded healthcare access for the payers employer-based health plan members.  The launch is currently limited to certain markets only. Cigna Health Works will...

Centene Will Enter Health Insurance Exchanges in 3 New States

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Centene Corporation will expand its presence in a number of state health insurances exchanges in 2018, building on its successful 2017 marketplace results.  The payer is planning to enter...

Employer Health Plans See Spike In Out-of-Pocket Costs

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The National Center for Health Statistics study found a double-digit increase in the use of high-deductible employer health plans has generated increased economic strain for members. Beneficiaries reported struggling to pay medical bills...

High Costs, Little Return are Hurting Health Insurers under ACA

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High cost beneficiaries, risk adjustment methodologies, and insufficient capital are the top three issues facing health insurers today, according to MinuteMan CEO Tom Policelli.  As the national debate over the future of the ACA and...

Payers Leaving Affordable Care Act Insurance Exchanges in 2017

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Questions over the future of the Affordable Care Act (ACA) and its cost-sharing reduction (CSR) payments have prompted many payers to abandon ACA state health insurance exchanges in part or entirely in 2017.  Insurers cited the usual...

PA Payer Market Stable, but OH Loses ACA Exchange Participants

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Pennsylvania and Ohio are having very different experiences with their Affordable Care Act health insurance exchanges as they move into 2018. While Pennsylvania’s existing five payers will continue to offer exchange plans at roughly...

BCBS Georgia Plan to Charge for Unnecessary ER Visits Draws Ire

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Blue Cross of Georgia is facing criticism from the American College of Emergency Physicians (ACEP) for a policy directive that would charge members for emergency department visits that result in a non-emergency diagnosis. The policy,...

$18M Claimant Case Challenges Affordable Care Act Payers

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In April of 2017, Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, announced it would exit the 2018 health insurance exchanges.  The payer cited higher than expected claims costs, including Member X, who had...

AHIP: Congress Must Stabilize Payer Market, Consider Reforms

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With passage of the AHCA, the insurance industry group AHIP has sent its response to congress and presented its recommendations for what direction to go in with healthcare reform The payer industry organization submitted recommendations...

Harvard Pilgrim Enters Outcomes-Based Pharmaceutical Contracts

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Harvard Pilgrim Health Care has signed a three-year value-based care contract with drug maker AstraZeneca for two therapies used to treat acute coronary disease and type 2 diabetes. The arrangements will use patient outcomes as a measure...

NC Payer Raises Health Insurance Rates Due to CSR Lawsuit

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Blue Cross Blue Shield of North Carolina announced its 2018 individual premium rates will increase an average of 22.9 percent for coverage on and off the health insurance exchange in all 100 counties it serves.  The increase is a...

Care Coordination is Tops for Health Insurance Satisfaction

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Coordination of care among healthcare providers is the single most important criteria influencing member satisfaction with their health insurance plan, according to the J.D. Power 2017 Member Health Plan study.   Members...

BCBS of Kansas City Will Leave ACA Health Insurance Exchange

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The exit of Blue KC from the ACA health insurance exchange in 2018 will affect a 32-county service area in Kansas and Missouri, and leave both urban and rural counties without any marketplace exchange insurers. The payer blamed losses...

Employers Seek Clarity, Stability in Health Insurance Market

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The nation’s largest employers are taking a second look at what type of health insurance they buy, and why.  The American Health Policy Institute (AHPI) surveyed over 400 large companies and found issues of transparency,...

Kaiser Permanente Will Stay in ACA Health Insurance Exchange

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Kaiser Permanente will continue to offer coverage options through the ACA health insurance exchanges during 2018, the payer and provider announced this week. “Kaiser Permanente will continue to offer coverage—including access...

KY Medicaid Awarded for Exceeding Quality, Patient Care

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Kentucky’s Anthem Blue Cross and Blue Shield Kentucky Medicaid has received an award from the National Committee for Quality Assurance (NCQA) for its Medicaid managed care plan.  The award recognizes the plan’s service...

Two-Thirds of Physicians Disapprove of American Health Care Act

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Two-thirds of physicians in a new Merritt Hawkins survey reported having a negative impression of the American Health Care Act (AHCA).  This includes 58 percent of physicians who have a “strongly” negative take on...

Anthem Terminates Cigna Merger, but Refuses to Pay Out $1.8B

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After a court ruling in Delaware, Anthem has notified Cigna that their proposed $54 billion merger is off, but that doesn’t mean the two insurance companies are amicably parting ways. Anthem has stated that it will not pay Cigna a...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

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In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the...

Aetna Will Abandon All Health Insurance Exchanges for 2018

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Aetna is ending participation in the Delaware and Nebraska ACA health insurance exchanges, completing its retreat from the public marketplace.   The company also made announcements earlier this year that it would be leaving the...

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