Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Private Payers News

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...

Health Payers Contend for Share of SMB Health Insurance Market

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Changing government regulations and demands for benefits in the small to medium business market is likely to lead to consolidation and place a growing emphasis on creating innovative health plans, according to a recent Edifecs...

CVS Closes $69B Acquisition of Aetna, Altering Consumer Landscape

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CVS Health has announced that its $69 billion takeover of Aetna has been completed.  The acquisition promises to radically transform the healthcare industry by creating new care delivery options for consumers. “Today marks...

Humana Tops List for Member Satisfaction, Net Promoter Score

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Customer service has been a perennial pain point for the health insurance industry, but a renewed focus on personalized experiences, member satisfaction, and consumer engagement appears to be paying off for some of the nation’s...

AHIP Eyes Solutions to Assist Consumers Shopping for Health Plans

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American Health Insurance Plans (AHIP) recently issued a dozen solutions aimed at assisting families with an income over 400 percent of the federal poverty level afford comprehensive coverage covering their pre-existing conditions. Last...

Addressing Healthcare Literacy Key to Health Plans Reducing Costs

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The inability of consumers to successfully navigate the healthcare system, which costs employers and health plans billions in administrative costs. In a recent article in the Harvard Business Review, members of Accenture’s...

FTC Clamps Down on Allegedly Fraudulent Health Plans

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A federal judge temporarily closed a Florida-based firm accused of fraudulently collecting over $100 million from Americans. Simple Health allegedly collected more than $100 million by preying on consumers shopping for health insurance by...

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