Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Private Payers News

Medicare Advantage Part B Plans Can Use Drug Step Therapy

by

CMS is allowing Medicare Advantage (MA) health plans to implement step therapy protocols in order to decrease prescription drug spending. On January 1, 2019, MA health plans can apply step therapy guidelines for physician-administered...

AMA: CVS-Aetna Merger Would Reduce PBM Competition, Raise Prices

by

The American Medical Association is urging the Department of Justice to squash the proposed merger between CVS Health and Aetna.  The combined entity would drastically reduce competition in many pharmacy benefit management (PBM)...

Only 22% of Medicare Advantage Customers Aware of Star Ratings

by

Only 22 percent of Medicare Advantage (MA) beneficiaries are familiar with how star ratings work and increasing consumer awareness about star ratings would help beneficiaries choose high quality plans, according to a new Healthmine...

Provider Market Concentration Outweighs Payer Concentration

by

Healthcare provider systems tend to be bigger, more consolidated, and have more market share than payers in the same metropolitan areas, leaving some payers with less power to negotiate pricing and other contracts, according to the...

Centene, Ascension Partner for Medicare Advantage Offering

by

Centene and Ascension have partnered to offer a Medicare Advantage plan across multiple geographic markets in 2020.   Centene Chairman and CEO Michael F. Neidorff believes that the partnership will showcase effective strategies to...

10% of Medicare Advantage Members Receive Chronic Care Reminders

by

Only 10 percent of Medicare Advantage (MA) and Medigap plan members receive chronic care management reminders,, according to a new survey from Healthmine. The CDC estimates that 70 percent of all Medicare beneficiaries have at least one...

About 90% of Large, Mid-Size Employers Offer Medical Benefits

by

Close to 90 percent of employees in large and mid-size private businesses are offered medical benefits, according to data released by the Bureau of Labor Statistics. Larger businesses tend to see higher participation in employer-sponsored...

How Do Medicare Advantage, Medicare Supplemental Insurance Differ?

by

Medicare Advantage (MA) and Medicare supplemental insurance, or Medigap, are both intended to enhance the value of traditional Medicare coverage for seniors and other eligible beneficiaries. Both offer payers a lucrative opportunity to...

Pros and Cons of Small Business Health Options Program Health Plans

by

Health plans offered through the Small Business Health Options Program (SHOP) exchanges allow payers to provide the nation’s smallest businesses with affordable plan options that offer critical health benefits. SHOP health plans...

Emergency Physician Group Sues Anthem for ED Payment Policies

by

The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) have filed a lawsuit against Anthem BCBS of Georgia contesting an emergency department payment policy that makes patients responsible for...

Medicare Advantage Savings, Outcomes Exceed Fee-For-Service

by

The Medicare Advantage (MA) program has surpassed Medicare fee-for-service (FFS) in developing positive member healthcare outcomes and reducing care costs, according to an analysis of both programs from Avalere Health. Medicare Advantage...

Health Plan Cost Sharing, Deductibles Outpace Members’ Wage Growth

by

Health plan cost sharing and deductible spending have outpaced employee wage growth in the last ten years, according to data released by the Peterson-Kaiser Health System Tracker. Employees’ total financial responsibility increased...

Partners HealthCare to Self-Insure 100K Employees

by

Partners HealthCare has announced it will self-insure 100,000 of its employees, transitioning coverage from BlueCross BlueShield of Massachusetts to its own Neighborhood Health Plan, according to The Boston Globe. “Neighborhood...

Customer Satisfaction with Medicare Advantage Health Plans Remain Low

by

Medicare Advantage (MA) plans are not meeting their customer satisfaction goals, and tend to leave consumers feeling less-than-pleased with the way health plans communicate and the availability of financial information, according to a new...

Humana, Walgreens Offer Primary Care Clinics for Medicare Members

by

Humana and Walgreens have announced the launch of two primary care clinics, designed to meet the needs of Medicare beneficiaries, that will operate within Walgreens locations in the Kansas City area. The collaboration, led by a Humana...

Amazon, Berkshire, JPMorgan Name Atul Gawande Healthcare CEO

by

Amazon, Berkshire Hathaway, and JPMorgan Chase have named Atul Gawande, a surgeon at Brigham & Women’s Hospital, as the CEO of their joint healthcare company. The company will be headquartered in Boston, Massachusetts. Gawande...

BlueCross BlueShield Nets $2.3B in Savings from 2017 Tax Cuts

by

BlueCross BlueShield companies saw  a total tax savings of $2.3 billion after passage of last year’s Tax Cuts and Jobs Act (TCJA), according to a new creditor’s briefing from AM Best. BCBS companies reported a mix of...

Humana, Roche Diagnostics Face $45M Federal Kickback Lawsuit

by

Humana and Roche Diagnostics will face a $45 million federal kickback lawsuit after a whistleblower filed a False Claims Act violation, which alleges Roche tried to entice Humana financially to secure access to the payer’s business...

Private Payers Deny Hepatitis C Drug Coverage to 52% of Members

by

Private payers denied Hepatitis C drug coverage to 52.4 percent of commercially insured beneficiaries from 2014 to 2017, according to new research from the Perelman School of Medicine at the University of Pennsylvania. Hepatitis C drug...

BCBS of TX Delays Non-Emergency ED Claims Review Policy

by

BlueCross BlueShield of Texas has delayed implementation of a claims review policy that would require HMO members to pay the total cost of an emergency department visit if the encounter is later deemed to be a non-emergency, according to a...

X

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...