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Private Payers News

AMA: Health Insurance Merger Cuts Medicare Advantage Competition

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The American Medical Association (AMA) announced in a press release earlier this week their position against the health insurance merger between Aetna and Humana, particularly regarding its impact on the Medicare Advantage market. The AMA is...

Payers See High Financial Losses on Health Insurance Exchanges

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Healthcare payers have been facing significant financial losses on the health insurance exchanges in recent years. UnitedHealth Group lost $475 million in 2015 and was predicting a loss of $650 million in 2016, according to Kaiser Health News....

Payers Continue to Drop Out of the Health Insurance Exchanges

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Healthcare payers have seen significant obstacles when it comes to operating on the public health insurance exchanges with large, national insurance companies losing money through this marketplace. Below we outline some key insurers that have...

UnitedHealth Group Adopts Bundled Payment Models for Surgeries

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The commercial payer UnitedHealth Group has begun expanding its involvement in bundled payment models. Forbes reported that UnitedHealth will be implementing bundled payment models for spinal surgeries as well as hip and knee replacement operations...

Health Insurance Merger Lawsuit Considers Efficiencies Factor

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On Monday, November 21, the court trial filed by the Department of Justice against the health insurance merger between Anthem and Cigna began. The drive to stop the $48 billion health insurance merger started due to concerns over a negative impact...

Deductibles, Out-of-Pocket Healthcare Spending Rose 3% in 2015

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Healthcare spending within the private health insurance market has grown 4.6 percent in 2015, according to a press release from the Health Care Cost Institute (HCCI). This type of growth in spending is higher than in recent years. For instance,...

Humana Spent $93M in Quality Payments for Provider Network

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The national payer Humana announced in a company press release earlier this week that it has reimbursed more than $93.6 million to more than 4,000 provider groups countrywide participating in their Provider Quality Rewards Program. These particular...

Healthcare Insurance Literacy Vital for Higher Coverage Rate

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New research from the RAND Corporation shows that uninsured Americans who have better healthcare insurance literacy were more likely to purchase coverage when the Affordable Care Act’s health insurance exchanges opened in 2014, according...

Anthem-Cigna Health Insurance Merger Suit Starts on November 21

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The lawsuit against the Anthem-Cigna health insurance merger had its first pretrial conference this past Monday, according to The Coalition to Protect Patient Choice. Judge Amy Berman Jackson said that the two parties met to have a discussion...

Top 5 Ways Commercial Payers Could Boost Consumer Engagement

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Consumer engagement is an important factor that commercial healthcare payers may need to address in order to keep a loyal customer base throughout future open enrollment periods. Some health insurance companies have worked to address consumer...

Health Insurance Exchanges Require Engagement, Narrow Networks

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Since some private health payers are struggling with enrollment and the ability to make a profit on the health insurance exchanges, engaging consumers, reducing the administrative burden, and creating a narrow provider network will become an...

Humana’s Value-Based Care Platform Decreased Costs by 20%

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The health payer Humana released positive results within its Medicare Advantage program for the third year in a row, according to a company press release. The value-based care platform used at Humana indicated 19 percent higher HEDIS scores among...

How Payers Could Compete in Midst of Health Insurance Mergers

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Among the payers facing a Department of Justice lawsuit against their health insurance mergers, Aetna and Humana have requested sanctions due to the government allegedly delaying the release of documents the two insurers need. The Motion for...

Private Payers Falling Behind in MACRA Implementation, APMs

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Earlier this month, the Department of Health & Human Services (HHS) announced the release of the finalized ruling for the MACRA legislation. Along with gutting the flawed Sustainable Growth Rate formula, MACRA legislation brings forward Advanced...

Healthcare Payers Struggle with Price Transparency, Technology

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Health insurance companies are still struggling with improving price transparency in order to gain greater trust from their consumer base. One survey has shown low customer service satisfaction and a need for payers to inform consumers on their...

Private Payers Face Challenges on Health Insurance Exchanges

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The health insurance exchanges created after passage of the Affordable Care Act may not serve as a truly effective marketplace for commercial payers since some national insurers like Aetna and UnitedHealthcare have been dropping out of operating...

How Investing in Social Services Could Cut Healthcare Spending

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While healthcare spending is continually increasing, patient outcomes and overall health has not necessarily improved greatly, according to a report from Leavitt Partners and the Robert Wood Johnson Foundation. However, the study also...

How Provider-Sponsored Health Plans Can Compete for Consumers

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Provider organizations that take the leap to develop their own health plans compete in a highly competitive healthcare environment with established national, regional and local plans, and in some markets, new non-traditional entrants in the health...

Two Legal Arguments For and Against Health Insurance Mergers

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In 2015, the national insurer Anthem began proceedings to acquire Cigna while Aetna planned to merge with Humana. Very quickly, opposition lined up against the two planned health insurance mergers, with some arguing that bringing the top five...

How Healthcare Price Transparency Could Gain Consumer Loyalty

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The lack of price transparency remains a major concern of consumers that healthcare payers will need to address in the coming years. A HealthEdge survey shows that 88 percent of polled consumers are looking for better price transparency from...

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