Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Private Payers News

Amazon, Berkshire Hathaway, JP Morgan to Name Healthcare CEO

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The new Amazon, Berkshire Hathaway, and JP Morgan & Chase healthcare company will have its inaugural CEO in the next two weeks, Berkshire Hathaway’s CEO Warren Buffett told CNBC in an interview. Buffett was joined by...

Early Health Insurance Premium Proposals Indicate Hikes for 2019

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Significant increases to health insurance premiums are on the horizon for beneficiaries in multiple states as payers begin to share their 2019 rate plans.   A challenging regulatory landscape, complicated by policy changes that have...

WellCare Buys Meridian for $2.5B to Grow Medicaid Footprint

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WellCare has entered into a definitive agreement to purchase Meridian Health Plan of Michigan, Meridian Health Plan of Illinois, and MeridianRx in order to increase revenues and expand its footprint in the Medicaid and Medicare Advantage...

Short-Term Wellness Interventions Improve Employee Well-Being

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Short-term wellness interventions can improve employee well-being and may help employers reduce their overall costs while maintaining employee health and productivity, according to a new study published in the American Journal of Health...

Pros and Cons of High Cost Sharing for Employer Health Plans

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Employer-sponsored health plans that include high cost sharing expectations can help control spending for plan sponsors, but could create longer-term health risks for employee beneficiaries.   Striking the right balance between...

How Payers Identify, Succeed in Health Plan Market Opportunities

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Healthcare payers that wish to be known as innovators need to continually be on the lookout for emerging health plan market opportunities that offer strong profit potential. Payers need to monitor specific market indicators and implement...

Assessing Providers for Participation in Value-Based Care Contracts

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Creating strong networks of high-quality healthcare providers can be a major challenge for any payer looking to expand its value-based care contract portfolio. Providers aren’t the only ones accepting risk when entering into...

Cigna Files with SEC to Begin $67B Express Scripts Acquisition

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Cigna has submitted a filing to the Securities and Exchange Commission (SEC) to complete a $67 billion acquisition of the pharmacy benefit manager (PBM) Express Scripts. The payer filed the merger agreement under a temporary parent...

Harvard Pilgrim, Partners HealthCare Discuss Possible Merger

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Harvard Pilgrim and Partners HealthCare are engaging in discussion of a possible merger.  A deal would combine Massachusetts’s largest payer organization with the state’s largest provider group and may create a dominant...

Supplemental Insurance is a Value-Add Opportunity for Employers

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Employers may have a prime opportunity to add value to their health plan options by offering supplemental insurance, according to a recent AHIP survey. The survey found that 95 percent of employees are satisfied with supplemental plan...

How Payers Can Effectively Scale Value-Based Care Networks

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Value-based care networks are a promising opportunity for payers that want to manage costs and improve outcomes of beneficiaries.  But effectively scaling collaborative, risk-based reimbursement networks for millions of beneficiaries...

Medicare Advantage, Premium Revenues Drive Q1 Payer Profits

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Healthcare payers experienced strong first quarter profits in 2018 because of sharp growth in Medicare Advantage (MA) enrollment and premium revenues, according to newly released earnings statements. The reports confirm the stability and...

High-Deductible Health Plan, HSA Enrollment Reached 21M in 2017

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High-deductible health plan (HDHP) and health savings account (HSA) enrollment reached 21 million members in 2017, according to new research from AHIP.  These health plan options are expected to see continued growth in the near...

Humana Expands Bundled Payment Model for Medicare Advantage

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Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations. The payer has teamed up with orthopedic specialists to expand its Total Joint...

Rumors Swirl of Possible Walmart Acquisition of Humana

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Walmart may be making a move to acquire Humana, one of the nation’s biggest health payers, according to The Wall Street Journal. Citing sources familiar with the matter – but without comment from Humana or Walmart – the...

CVS, Aetna Merger May Face Antitrust, Consumer Protection Issues

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The American Antitrust Institute (AAI) has warned the Department of Justice (DoJ) that the proposed CVS and Aetna merger would violate consumer protections and damage competition in the healthcare industry. AAI believes that the merger of...

Aetna Will Apply Pharmacy Rebates to Prescription Drugs in 2019

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Aetna has announced plans to automatically apply pharmacy rebates to eligible prescription drug benefits by 2019 in an effort to increase pricing transparency and control costs. Nearly three million Aetna members are likely to experience...

Policy, Market Changes May Harm Employer-Sponsored Insurance

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Significant changes to the employer-sponsored insurance market, such as increasing medical costs, policy changes, and improvements in other payer markets may cause employers to stop providing health insurance An analysis from the American...

Payment Cuts Drive Medicare Advantage Plans to Contain Costs

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Medicare Advantage (MA) plans contained beneficiary costs and remained profitable despite reductions to federal MA payments from 2009 to 2014, according to new research from the Commonwealth Fund. The report found that as Medicare reduced...

Cigna, Amazon Alexa Offer Voice Control Beneficiary Education

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Cigna is entering the voice control product space with an Amazon Alexa feature called “Answers by Cigna” that educates beneficiaries about complex health insurance terminology and customizes health benefits...

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