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Private Payers News

Can Payers Reduce Stress of Alternative Payment Models for Physicians?

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Alternative payment models (APMs) may be placing significant burdens and stress on physicians, requiring payers to make additional efforts to improve their communication and smooth the process of transitioning to value-based care,...

60% of Employers Fail to Address Healthcare Spending Waste

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Sixty percent of employers don’t capitalize on opportunities to address healthcare spending waste, even though they say wasteful spending is a key concern, according to a new survey from the National Alliance of Healthcare Purchaser...

CMS Grants NC 1115 Medicaid Waiver to Implement Managed Care System

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North Carolina has received a 1115 waiver from CMS allowing the state to implement a Medicaid managed care system administered through private payers. The state’s Department of Health and Human Services (DHHS) can now recruit...

Employer Wellness Programs Reduce Costs by Targeting Chronic Diseases

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In order to reduce overall spending, employers should focus on designing wellness programs that target chronic diseases and address other clinical factors impacting employee health, says a new research paper from Transamerica. The...

Physical Therapy, Chiropractic Back Care Cut Opioid Use, Costs

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Payers could improve outcomes, increase cost-effectiveness, and reduce opioid use for lower back pain by expanding non-pharmacological coverage such as physical therapy and chiropractic care, according to a new study published in JAMA...

Medicare Advantage Plans Proliferate in 2019, Raising Competition

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Medicare Advantage (MA) payer competition is increasing significantly for plan year 2019 as more than 400 new options hit an already-crowded market, says a new report from the Kaiser Family Foundation (KFF).   More than 2700...

BCBS of TN Defrauded $2M in $2B Telemedicine Insurance Scheme

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BlueCross BlueShield (BCBS) of Tennessee has been named a damaged party after it was defrauded $2 million as part of a larger $2 billion telemedicine insurance scheme, according to the Department of Justice (DOJ). The District Court for...

IL Payers File Pharma Lawsuit Over Opioid Prescription Costs, Safety

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A coalition of Illinois payers has sued prominent pharmaceutical companies in a lawsuit that argues the companies are responsible for a spike in opioid prescription costs and patient safety risks. The Intergovernmental Risk Management...

PA Expands Access to Medication Assisted Treatment for SUD

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Commercial payers and the Pennsylvania Department of Insurance (PDI) have agreed to increase access to medication-assisted treatments (MAT) and realign prior authorization processes for beneficiaries struggling with substance use disorders...

CVS-Aetna Merger Gets DOJ Nod as Aetna Sheds Medicare Part D

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The Department of Justice (DOJ) has announced that it will approve the proposed merger between CVS and Aetna as soon as Aetna completes the divestiture of its Medicare Part D business line.   Two weeks ago, Aetna initiated the sale...

Private Insurance Spending Has Outpaced Public Spending Since 2016

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Private insurance spending has grown faster than Medicare and Medicaid spending since 2016, even though national enrollment has plateaued, says a new report from Altarum. The report suggests that higher per-enrollee spending, plus...

NYCHH Triples Denials Recovery from UnitedHealthcare to $40.1M

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NYC Health + Hospitals (NYCHH) has more than tripled the amount the health system is seeking in claims recovery from UnitedHealthcare, from $11.1 million to $40.1 million after a comprehensive case-by-case review of high-profile...

Aetna Sells Portion of Medicare Business to Fast-Track CVS-Aetna

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Aetna has sold its Medicare Part D prescription plan business of 2.2 million beneficiaries to WellCare in an attempt to increase the likelihood of the CVS-Aetna merger closing before year’s end. In SEC filings, Aetna explained that...

Employers are Experimenting with Innovative Health Plan Designs

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Just under half of employers participating in a survey from the National Business Group on Health (NBGH) are actively experimenting with innovative health plan designs that aim to foster new approaches to care delivery. NBGH found that...

NCQA, Health Plans to Measure Patient-Reported Outcomes

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The National Committee for Quality Assurance (NCQA) has selected four health plans to test a new performance standard for collecting patient-reported outcomes measures, or PROMs. NCQA’s Person-Driven Outcome Measurement...

Consumers Struggle with Health Plan Finances, Healthcare Literacy

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The majority of consumers with employer-sponsored health plans lack the necessary financial health literacy to optimally manage their health plan finances, according to a new report from Alegeus. As high-deductible health plans (HDHPs)...

Cigna Launches $250M Venture Fund for Analytics, Digital Health

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Cigna will invest $250 million in the new Cigna Ventures fund, which will invest in healthcare startups specializing in analytics, digital health, retail, care management, and other business opportunities related to value-based...

FDA Recruits Payers to Submit Quality Feedback on Medical Devices

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FDA has launched a new quality assurance program that leverages feedback from commercial payers about medical device coverage requirements in order to expedite approvals. The Private Payor Program (PPP) is a voluntary program for medical...

Google Invests $375M in Oscar Health for Medicare Advantage

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Google’s parent company, Alphabet, has invested $375 million in Oscar Health to help the tech-focused payer enter into Medicare Advantage markets by 2020, according to multiple news outlets, including Reuters. Oscar Health said in...

Nearly 20% of Employees Have Inpatient Out-of-Network Claims

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Approximately twenty percent of employees with insurance had at least one out-of-network claim for inpatient care, according to a Peterson-Kaiser Tracker analysis. Employees with out-of-network provider bills may experience increased...

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