Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Private Payers News

Pharmacy Benefit Managers Help Reduce Payer Drug Spending

by

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 Association (PCMA)....

Aetna Posts Q1 Loss After ACA Withdrawal, Merger Collapse

by

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 Humana,...

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

by

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 Initiative.  NAIC...

Aetna to Offer New HMO Option for Delaware State Employees

by

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 to move...

Tufts Health Plan Sees Opportunities as New RI Medicaid Option

by

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 Medicaid...

Court Upholds Antitrust Ruling Against Anthem-Cigna Merger

by

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 Justice...

Patient-Centered Medical Home Benefits Payers, Providers, Patients

by

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 revenue. ...

Medicaid Service Equals or Surpasses Private Health Payers

by

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 related...

Provider-Owned Health Plans Adopt Interoperability Standards

by

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 requirements...

Population Health Approach to Prenatal Care Cuts Payer Costs

by

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 situations,...

PA Seeks Increased Payer Coverage of Emergency Air Ambulances

by

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 accordingly...

UnitedHealth Grows by 11.8% Despite ACA Marketplace Withdrawal

by

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 were...

Payers, Providers Collaborate to Combat Opioid Abuse, Addiction

by

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 establish...

Top 5 Largest Health Insurance Payers in the United States

by

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 the ACA,...

Independence Blue Cross, UPenn Partner to Enhance Care Delivery

by

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 contract to...

Aetna Will Exit Iowa ACA Health Insurance Exchange in 2018

by

Aetna has announced that it will stop participating in the Iowa health insurance exchange in 2018, citing financial losses and market instability as primary reasons to exit.   "Earlier today we informed the appropriate federal and state...

Wellmark BCBS Latest to Exit ACA Health Insurance Exchanges

by

Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, will not renew or sell individual plans on the Affordable Care Act health insurance exchanges effective Jan 1, 2018. The decision follows three-year losses of approximately...

BCBS of Minn. Cites Risk Pools for $322.4M in 2016 Losses

by

Blue Cross Blue Shield (BCBS) of Minnesota reported a net operating loss of $322.4 million in their 2016 financial audit, citing unbalanced risk pools and rising premium pricing as a current and future detriment to profitability. At the end of...

Anthem Appeals Cigna Merger with Cost, Quality Arguments

by

Anthem has opened an appeal in the U.S District Court citing opportunities for increased consumer savings and quality of care weeks after the DOJ blocked its planned merger with Cigna. Anthem argued that the DoJ’s ruling neglected a possible...

Payers Face 9.6% Underwriting Loss on Health Insurance Exchange

by

Underwriting margins for payers selling individual plans on the health insurance exchange dropped from a 6 percent earned premium loss in 2014 to a 9.6 percent loss in 2015, Milliman recently reported. The financial losses stemmed from the Affordable...

Continue to site...