Private Payers News

Payer Gives Community-Based Social Determinants of Health Support

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Updated 6/30/21: Humana's Bold Goal strategy led to a 6.8 percent decrease in the number of unhealthy days for San Antonio members. A previous version listed 8.6 percent as the...

Humana Increases Access to NC Medicare Advantage Mental Healthcare Resources

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Humana has announced plans to open additional Humana Neighborhood Centers across North Carolina to improve the physical and mental health of its Medicare Advantage members. Humana Neighborhood Centers...

ACHP Recommends Federal Employee Plan Comparison Tool Updates

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The Alliance of Community Health Plans (ACHP) has proposed a number of recommendations to improve the Federal Employees Health Benefits (FEHB) program’s plan comparison tool in order to boost...

Aetna Partnership Aims to Increase, Improve Suicide Prevention

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Aetna has partnered with a behavioral health education platform to provide healthcare professionals with resources for suicide prevention. Aetna and CVS Health are aiming to reduce suicide attempts...

Alignment Expands Medicare Advantage for Seniors in 3 States

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Alignment Healthcare (Alignment) is extending its Medicare Advantage (MA) footprint in Arizona, North Carolina, and Nevada to provide coverage for more senior beneficiaries. Starting in 2022,...

Humana Plans to Acquire Value-Based Home Healthcare Partner

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Humana has announced its plan to acquire One Homecare Solutions (onehome) from WayPoint Capital Partners in order to expand value-based care in home healthcare services. The acquisition accompanies...

UHG Outlines Strategies to Improve Health System, Access to Care

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UnitedHealth Group’s 2020 Sustainability Report revealed several ways that payers are helping the healthcare system advance to improve health equity, access to care, and other key...

6 Expectations Employers Have for Provider Care Coordination

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Providers are not meeting employees’ needs in certain areas and employers expect more from their provider partners' care coordination strategies, employers expressed in a report compiled...

Florida Blue Partnership Increases Substance Abuse Care Access

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Updated 6/16/21: Dr. Dewan is an MD. A previous version of this article included PhD in his title.  Blue Cross and Blue Shield of Florida (Florida Blue) and New Directions Behavioral Health...

Centene Launches PSA Initiative to Boost COVID-19 Vaccine Rates

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Centene Corporation has launched a new initiative to increase COVID-19 vaccination rates among health plan members as well as all Americans. One half of the initiative will include a call campaign to...

UHC Temporarily Reverses Emergency Department Coverage Policy

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UnitedHealthcare (UHC) has announced it will delay its recent protocol change regarding emergency department (ED) claims and coverage, after receiving backlash from providers and health organizations...

Care Deferrals, Digital Tools Will Shape 2022 Medical Cost Trend

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The medical cost trend for 2022 may not be as high as expected, but it is still higher than the trend from the past few years with the exception of 2021, the PwC Health Research Institute found in...

Largest Share of Premium Dollar Goes Toward Prescription Drugs

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The majority of the average healthcare premium dollar goes toward prescription drugs and outpatient and inpatient hospital costs, according to AHIP’s most recent research. AHIP looked at 30...

UHC Changes Emergency Department Claims Evaluation Protocols

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Editor's Note: UHC has delayed implementation of this policy. Find out more here. UnitedHealthcare (UHC) announced in a network bulletin that it will be changing some of its methods around...

BCBSOK, OUHP Settle Dispute, Work Toward Long-Term Contract

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After months of negotiations, Blue Cross and Blue Shield of Oklahoma (BCBSOK) and OU Health Physicians (OUHP) settled their dispute and have agreed upon a contract that will keep the provider...

Humana Expands Value-Based Care Model to Cover More Seniors

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Humana’s CenterWell Senior Primary Care (CenterWell) is expanding its value-based care model to Original Medicare members to improve care quality and health outcomes, as well as lower the cost of...

Payer Partners with Nonprofit to Improve Prenatal Care Access

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The United Health Foundation has announced a partnership with the nonprofit organization CAMBA, Inc. to improve health outcomes and increase prenatal care access for women in Brooklyn. The United...

Commercial Plan Member Satisfaction Jumps 10 Percentage Points

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Member satisfaction has improved significantly among commercial health plans, JD Power’s 2021 commercial member health plan study found. “The past year has proven without a doubt that...

Health System Joins Blue Cross NC to Expand Value-Based Care

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Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Mission Health have signed an agreement that will expand the benefits of value-based care to members across Western North Carolina and...

UPMC Health Plan Virtual Assistant Aims to Improve Access to Care

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The University of Pittsburgh Medical Center (UPMC) Health Plan has launched a virtual tool to assist members with questions about benefits, coverage, services, and access to care. The health...