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Private Payers News

Humana, Aetna, Cigna Invest in Value-Based Care Payment Models

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Value-based care payment models are continuing to make headlines among major health insurance companies around the nation. Last month, Humana entered into a value-based care arrangement with the population health management company Fullwell,...

Blue Cross Health Plans Expand Value-Based Care Reimbursement

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Along with other national payers, Blue Cross Blue Shield health plans have been investing in expanding value-based care reimbursement. For example, New York-based Excellus Blue Cross Blue Shield has partnered with vendors to use analytics and...

How Blue Cross Health Plans Affect Anthem-Cigna Merger Lawsuit

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The Anthem-Cigna merger lawsuit has brought significant evidence to light ever since the case began on November 21, 2016. The Department of Justice has been able to illuminate that the health insurance merger would create major market concentration...

Humana Standardizes Healthcare Quality Measures for Physicians

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Last week, Humana announced in a company press release the development of a Clinical Quality Metrics Alignment (CQMA) program meant to simplify and regulate healthcare quality measures. The new strategy will be used specifically among doctors...

UnitedHealthcare Cut Costs through Value-Based Care Programs

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Last month, UnitedHealthcare released a report outlining the benefits of value-based care programs. The report called Collaborative and Coordinated: How Value-Based Care Programs are Driving Improvements in Quality and People’s Health began...

How 4 Healthcare Payers Fare in 2016’s Health Insurance Market

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The health insurance market has gone through significant changes in 2016. A number of payers have pulled back from the health insurance exchanges such as UnitedHealth and Humana. The Department of Justice has also filed lawsuits against the mergers...

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...

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