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Private Payers News

Humana Expands Orthopedic Bundled Payment Program to NC, VA

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Humana will bring its value-based orthopedic bundled payment program to 11 orthopedic specialty groups in North Carolina and Virginia.  The move follows a recent expansion into Kentucky and Indiana in 2017, and Ohio and Tennessee...

BCBS Moves into Vacant TN Health Insurance Exchange

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Blue Cross-Blue Shield (BCBS) has announced its plans to offer coverage options on Tennessee’s Affordable Care Act health insurance exchange in 2018.  The separate rating area consists of 16 counties in the greater Knoxville...

Patient Incentives from Payers Encourage Preventive Care Visits

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To reduce payer claim costs, would you pay members to go see their doctor once a year?  That’s the premise for a wave of patient incentive programs currently being offered by health insurance companies. For healthcare insurance...

MD Health Insurance Exchange Rates Up Double-Digits for 2018

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Patients in Maryland looking for insurance in 2018 may have bigger bills than they bargained for. The health insurance exchange rates for individual and group plans in the state have risen by up to 58 percent as payers try to cope with...

Anthem Pursues Cigna Merger Up to the Supreme Court

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Just seven days after a court upheld the initial ruling which blocked Anthem’s acquisition of Cigna, the nation’s second largest insurer is not giving up.   Anthem has confirmed that it is filing a writ of...

Pharmacy Benefit Managers Help Reduce Payer Drug Spending

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Pharmacy benefit managers (PBMs) are instrumental in helping payers provide appropriate access to prescriptions, expand access, and rein in drug spending, according to a recent report from the Pharmaceutical Care Management...

Aetna Posts Q1 Loss After ACA Withdrawal, Merger Collapse

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After a tumultuous 2016, Aetna announced a first-quarter 2017 net loss of $381 million, a significant  reversal from a $737 million profit a year ago. Aetna blamed the loss on costs associated with its attempted merger with...

Payers Offer 10 Ways to Improve Cost, Quality of Long-Term Care

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The National Association of Insurance Commissioners (NAIC) issued ten long term care (LTC) federal policy recommendations to Congress.   The report was completed as part of the group’s Retirement Security...

Aetna to Offer New HMO Option for Delaware State Employees

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Health insurer Aetna was recently awarded a three-year contract as a provider of Delaware’s health plan offerings for its employees and pensioners.  Aetna has chosen a coordinated care approach partnering with local innovators...

Tufts Health Plan Sees Opportunities as New RI Medicaid Option

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Rhode Island will add Tufts Health Plan (THP) as its first new Medicaid option in seven years, according to the Rhode Island Executive Office of Health & Human Services (EOHHS).  The new program, RITogether, will allow...

Court Upholds Antitrust Ruling Against Anthem-Cigna Merger

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On Friday, a federal DC district appeals court upheld a February 2017 decision which blocked the acquisition of Cigna by health insurance giant Anthem.  Antitrust concerns led 11 states and the District of Columbia to join the US...

Patient-Centered Medical Home Benefits Payers, Providers, Patients

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Blue Cross-Blue Shield of Michigan has one of the nation’s most successful patient-centered medical home (PCMH) networks.  The model has improved patient outcomes, lowered payer costs and increased provider satisfaction and...

Medicaid Service Equals or Surpasses Private Health Payers

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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...

Provider-Owned Health Plans Adopt Interoperability Standards

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Three provider-owned health plans have recently completed multiple phases and been awarded CAQH CORE certification.  This achievement places the provider-owned health plans at a level that supersedes present regulatory...

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...

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...

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...

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...

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...

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...

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