Medicare, Medicaid and CHIP
Government programs ensure access to healthcare for vulnerable populations. Medicare covers people 65 and older and younger individuals with specific disabilities. Medicaid and the Children's Health Insurance Program (CHIP) are joint federal-state initiatives offering health coverage to low-income families, children, pregnant women, the elderly and people with disabilities.
Top Stories
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News
26 Nov 2024
CMS suggests public payer weight loss drug coverage changes
Amid suggestions around prior authorizations and AI use, CMS introduces a policy that would expand weight loss drug coverage in Medicare Advantage, Medicaid and Part D plans. Continue Reading
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25 Nov 2024
Top 5 Medicare Advantage payers by footprint in 2025
The five Medicare Advantage payers with the largest footprint in 2025 made their case to beneficiaries by positioning themselves on affordability, quality and access to care. Continue Reading
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News
14 Jul 2023
UHC Reports 13% Revenue Growth in Q2 2023 Due to Rising Enrollment
UnitedHealth Group executives highlighted key hurdles for payers in 2023 including provider shortages and drug costs. Continue Reading
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13 Jul 2023
Cigna Healthcare Boosts Treatment Access with New Biosimilar Coverage
By covering the Humira biosimilars, Cigna Healthcare aims to promote competition that will generate lower prescription drug costs. Continue Reading
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Feature
12 Jul 2023
How Payers Can Identify Providers for High-Performing Networks
Prioritizing data collection, technology, and provider engagement can help payers identify providers to include in high-performing networks. Continue Reading
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News
10 Jul 2023
Humana Foundation Supports Initiative to End Veteran Suicide
The initiative will direct philanthropic grants to nonprofit organizations working to end veteran suicide, including $6 million from the Humana Foundation. Continue Reading
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Feature
29 Jun 2023
How Plans Can Improve Race and Ethnicity Data Collection for HEDIS
Empowering payer staff and prioritizing self-reported data are critical to race and ethnicity data collection. Continue Reading
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News
26 Jun 2023
Members with Anxiety, Depression Face Higher Out-of-Pocket Spending
Out-of-pocket spending is almost twice as high for individuals with anxiety, depression or both. Continue Reading
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News
26 Jun 2023
BCBSA Will Invest $10M to Address Youth Mental Health Crisis
The funding will support Boys & Girls Clubs of America as they offer trauma-informed training and virtual therapy to address the youth mental health crisis. Continue Reading
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News
22 Jun 2023
Blue Cross MN Commercial Plans Will Cover Peer Support Specialists
Peer support specialists use their own lived experiences with mental health challenges to support people in similar situations. Continue Reading
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Feature
21 Jun 2023
How to Personalize Chronic Disease Management through Concierge Care
Elevance Health changed its approach to chronic disease management with a digital-first concierge program. Continue Reading
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19 Jun 2023
KFF: Over Half of Insured Adults Face Problems with Health Insurance
Adults who reported having poor or fair mental health experienced more problems with health insurance. Continue Reading
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News
09 Jun 2023
SCAN, CareOregon Grants Help Eliminate $110M in Medical Debt
The grants will help abolish medical debt for almost 70,000 people across Arizona, California, Nevada, Oregon, and Texas. Continue Reading
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News
08 Jun 2023
BCBSTX Provider Network Expansion Improves Behavioral Healthcare Access
The expanded provider network will facilitate behavioral healthcare access for fully insured BCBSTX group plan members in Texas and Illinois. Continue Reading
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News
08 Jun 2023
5 Chronic Diseases Plague High Spending Group Health Plan Members
The five common chronic diseases include heart disease, respiratory conditions, musculoskeletal conditions, and more. Continue Reading
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News
07 Jun 2023
Coverage Rates Equalize For LGBT Community, But Disparities Remain
Coverage rates for the LGBT community have improved, but LGBT individuals are still more likely to forego care due to cost. Continue Reading
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News
07 Jun 2023
Blue Cross MA Expands Mental Health Resources, Provider Network
Blue Cross has added more mental healthcare groups to its provider network, improving member access to mental health resources. Continue Reading
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News
06 Jun 2023
NY Health Plan Helps Members Navigate Health Insurance Renewals
Healthfirst members can receive personalized outreach via email, text, and phone about health insurance renewals. Continue Reading
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06 Jun 2023
Medicare Advantage Risk Adjustment Model Accuracy May Vary By Race
The Medicare Advantage risk adjustment model consistently underestimated American Indian/Alaska Native beneficiaries’ costs. Continue Reading
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News
02 Jun 2023
Type 2 Diabetes Patients Benefit from Capital Blue Cross Program
New research showed that type 2 diabetes patients experienced weight loss and lower A1c levels resulting from Capital Blue Cross assistance. Continue Reading
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News
01 Jun 2023
AHIP: Most Consumers Are Satisfied with Employer-Provided Coverage
A survey from AHIP found that 63 percent of consumers felt satisfied with their current employer-provided coverage. Continue Reading
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News
31 May 2023
Loss of ACA Preventive Care Mandate Could Impact 10M Enrollees
The long-term impacts may be higher as the US Preventive Services Task Force updates preventive care recommendations. Continue Reading
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News
30 May 2023
Aetna Awards $250K in Social Determinants of Health Grants in MI
The Aetna grants will provide support to 10 community-based organizations in Michigan, enabling them to fund social determinants of health and health equity initiatives for low-income patients. Continue Reading
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News
25 May 2023
Healthcare Organizations Oppose UHC’s GI Prior Authorization Program
The payer’s GI endoscopy prior authorization program will exacerbate care disparities and increase provider burden, the organizations wrote. Continue Reading
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News
22 May 2023
Aetna Injects $7.3M into Virginia FQHCs for Improved Cancer Outcomes
The value-based care incentive payments will go toward 22 FQHCs to fund methods promoting better cancer outcomes, such as greater preventive screening access. Continue Reading
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News
18 May 2023
KFF: Payers Will Issue $1.1B in Medical Loss Ratio Rebates in 2023
Payers in the individual market are expected to issue the highest medical loss ratio rebates of $500 million in 2023. Continue Reading
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News
16 May 2023
Blue Cross MA Expands Primary Care Network Amid Provider Shortages
The expanded primary care network will allow Blue Cross members to access virtual and in-person care, including mental health services and care navigation support. Continue Reading
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News
15 May 2023
CareSource Enters Value-Based Agreement to Improve Pediatric Health Outcomes
The value-based agreement with The Children’s Care Network will provide physicians with data and analytics to help them boost pediatric health outcomes in Georgia. Continue Reading
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News
15 May 2023
Humana Collabs with DME Companies to Advance Value-Based Home Healthcare
The collaboration aims to improve home healthcare quality for Medicare Advantage members and simplify the process of ordering and receiving durable medical equipment for providers. Continue Reading
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News
11 May 2023
Anthem Blue Cross Grants $400K to Boost Maternal Health Outcomes
The funding will support a program that provides prenatal care and mental health services to improve maternal health outcomes for pregnant people impacted by domestic violence. Continue Reading
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News
11 May 2023
Payer Invests in Helping Young Adults Find Work After Foster Care
Finding work after foster care can be a critical step for young adults who have aged out of the foster care system and Blue Cross NC’s partnership seeks to connect them with opportunities. Continue Reading
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News
10 May 2023
22% of Employers Waver on Adhering to ACA Preventive Care Rules
As the Affordable Care Act’s preventive care services regulations come under scrutiny, nearly a quarter of employers are unsure whether they would uphold the rules if eliminated. Continue Reading
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09 May 2023
CA Health Plans Commit $114M to Address Homelessness, Health Equity
The funding will address health equity by securing housing units for unhoused individuals with rental vouchers and supporting those who require assistance with daily living activities. Continue Reading
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09 May 2023
Humana Seeks to Improve Medicare Advantage Specialty Needs Benefits
Medicare Advantage members in skilled nursing facilities and senior living homes have complex needs and Humana and Longevity Health Plan’s partnership seeks to address those needs. Continue Reading
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08 May 2023
UHC Grants $275K to Address Social Determinants of Health for Foster Kids
Local organizations will use the funding to advance social determinants of health initiatives for foster children, including kinship placements and support groups. Continue Reading
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News
04 May 2023
UnitedHealthcare Pays $91.2M After Underpaying Envision for Medical Care
The financial award compensates the medical group for UnitedHealthcare’s breach of contract after the payer reduced reimbursement to Envision clinicians in 2017 and 2018. Continue Reading
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News
02 May 2023
Higher Market Share Helps Payers in Negotiations, Premium Impact Unclear
Numerous factors impact payer-hospital price negotiations including market share, but the actual impact on premiums remains uncertain. Continue Reading
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News
28 Apr 2023
Payers Fall Short of Employer Expectations on Behavioral Healthcare
Employers seeking a strong commitment to behavioral healthcare access and quality of care from their payer partners expressed disappointment in a National Alliance survey. Continue Reading
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Feature
25 Apr 2023
3 Ways Payers Can Employ Machine Learning, Advanced Analytics
Machine learning and advanced analytics have various uses in the health insurance industry, including condensing medical records, hypertargeting, and supporting risk adjustment. Continue Reading
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News
24 Apr 2023
Anthem, Valley Health Resolve Lawsuit Over Past-Due Payments
Valley Health dropped its lawsuit against Anthem Blue Cross and Blue Shield, which claimed the payer owed the health system $11.4 million in past-due payments. Continue Reading
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21 Apr 2023
Humana Funds UNF Program Expansion to Address Food Insecurity
Food insecurity is a major social determinant of health barrier for many seniors, but a couple of colleges are seeking to address this issue. Continue Reading
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19 Apr 2023
Importance of Increased Activity to Lower Rates of Chronic Conditions
Importance of Increased Activity to Lower Rates of Chronic Conditions Continue Reading
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News
19 Apr 2023
Why Addressing Stress is the Foundation for Improved Health Outcomes
Why Addressing Stress is the Foundation for Improved Health Outcomes Continue Reading
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18 Apr 2023
83% of Consumers Are Interested in Health Savings Accounts for Non-HDHPs
Health savings accounts have helped consumers manage escalating healthcare costs, but if these accounts were acceptable through non-HDHP plans the uptake might be even higher. Continue Reading
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17 Apr 2023
Coverage Gaps, Uninsurance Tied to Unmet Vision Care Needs
Almost half of adults with year-round uninsurance and 27 percent of those who experienced coverage gaps reported unmet needs for vision care. Continue Reading
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14 Apr 2023
Humana Continues to Address Housing Stability with $40M Investment
The funding will address housing stability by acknowledging the limited number of low-cost rental units and creating affordable housing capacity in underserved communities. Continue Reading
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News
13 Apr 2023
Employees Turn to Health Savings Accounts to Manage Healthcare Costs
Gen-Zers are particularly receptive to health savings accounts, but many employees are seeing the value as healthcare costs continue to escalate. Continue Reading
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10 Apr 2023
Aetna Offers Virtual Care Tool for Gastrointestinal Chronic Diseases
The payer’s partner will enable members in certain plans to access gastrointestinal treatment and management support through its virtual care tool. Continue Reading
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News
10 Apr 2023
How Interventional Analytics Will Improve Nursing Care for MA Members
Interventional analytics has emerged as an essential technology to assist payers and nursing homes in making care decisions to improve outcomes for aging members. Continue Reading
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News
07 Apr 2023
How 2023 Medicare Advantage Enrollment Growth Has Shifted
Medicare Advantage enrollment growth in 2023 was associated with quality performance and was highest among for-profit health plans. Continue Reading
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05 Apr 2023
Out-of-Pocket Spending for Pediatric Hospitalizations Reached $3,000
Out-of-pocket spending for pediatric hospitalizations was higher for those covered by high-deductible health plans and exceeded $3,000 for one in seven hospitalizations. Continue Reading
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News
03 Apr 2023
Study Finds Racial Coverage Disparities Following Unemployment
Black and Hispanic adults likely faced racial coverage disparities following job losses due to structural and administrative barriers to Medicaid enrollment, according to the researchers. Continue Reading
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31 Mar 2023
Anthem Announces Virtual-First Health Plan in MO for Commercial Members
Commercial members will gain access to a symptom checker, routine wellness care, and behavioral health services through the virtual-first health plan. Continue Reading
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30 Mar 2023
CVS Health Finalizes $8B Acquisition of Signify Health
The merged CVS Health and Signify Health organization will focus on improving care delivery, lowering costs, and boosting member engagement. Continue Reading
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30 Mar 2023
How One Payer Redesigned Wellness Program Rewards Around Choice, Tech
UnitedHealthcare redesigned its rewards for wellness program participation to incorporate a wider range of options for members and more advanced technologies. Continue Reading
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29 Mar 2023
UPMC Partnership Facilitates Access to Healthcare Services, Coverage
UPMC’s Medicaid managed care plan members can receive assistance with accessing healthcare services and coverage at laundromats across Pennsylvania. Continue Reading
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27 Mar 2023
How Overall, Out-of-Pocket Costs of Obesity Escalated in 10 Years
Out-of-pocket costs grew 37 percent for individuals diagnosed with obesity between 2011 and 2021. Continue Reading
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27 Mar 2023
UnitedHealth Group Commits $2M to Improve Health Equity for LGBTQ+ Youth
The funding will go to Rainbow Health, a nonprofit organization that addresses health equity by facilitating care access for LGBTQ+ youth and people facing care disparities in Minnesota. Continue Reading
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21 Mar 2023
60% of Privately Insured Patients Utilized Some ACA Preventive Care
A recent study shows that ACA preventive care utilization is satisfactory in 2018, but the ongoing Braidwood Management v. Becerra case could jeopardize this access. Continue Reading
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20 Mar 2023
How Payers Can Promote Member Health and Well-being with Wearables
Providing wearable technology to members allows payers to engage with them in new ways. By providing users with real-time feedback and personalized recommendations Continue Reading
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20 Mar 2023
81% of Entries Are Inaccurate in Provider Directories of 5 Large Payers
Comparing provider directories from Aetna, Elevance, Cigna, Humana, and UnitedHealth with Medicare data, a research letter found that many entries contained inaccuracies. Continue Reading
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17 Mar 2023
National Alliance Playbook Guides Employers on Biosimilar Adoption
Biosimilar adoption is challenging but employers can follow several steps to improve their integration of biosimilars into formularies and plan designs. Continue Reading
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15 Mar 2023
BCBSRI Recognizes Healthcare Sites Providing LGBTQ-Inclusive Care
The latest round of BCBSRI’s Safe Zone certifications went to children’s hospitals, physical therapy locations, and hospital clinics that offer LGBTQ-inclusive care. Continue Reading
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14 Mar 2023
Humana Shares Data on Economic Contributions in Florida
The payer organization found that its presence in the state had contributed a total of $48 billion to the Florida economy throughout 2022. Continue Reading
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13 Mar 2023
Health Insurance Impacts Racial Inequities in Cervical Cancer Diagnoses
Being uninsured or receiving health insurance through Medicaid accounted for more than half of racial inequities in advanced-stage cervical cancer diagnoses, researchers found. Continue Reading
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10 Mar 2023
CareOregon Initiative Boosts Access to Housing for Community Members
The recently purchased Red Lion Inn & Suites will be converted into housing units for community members with behavioral health needs and local healthcare workers, boosting access to housing. Continue Reading
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09 Mar 2023
Women Face High Out-of-Pocket Costs for Breast Cancer Treatment
Women with high deductible health plans or consumer driven health plans experienced higher out-of-pocket costs for breast cancer treatment than those with PPO or EPO plans. Continue Reading
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09 Mar 2023
CareFirst, Aledade Partnership to Help PCPs with Value-Based Care
The player plans to leverage tools and resources provided by Aledade to enhance the quality of care while reducing healthcare costs, supporting value-based care goals. Continue Reading
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07 Mar 2023
Humana Collab Expands Value-Based Care for Medicare Advantage Members
Through the 10-year agreement, Humana Medicare Advantage members will be able to receive value-based primary care from in-network physicians affiliated with Aledade, a public benefit corporation. Continue Reading
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06 Mar 2023
Blue Shield of CA Expands Access to Mental Healthcare Resources
Blue Shield of California members have gained access to mental healthcare resources, including assessments and topic centers, via an online platform. Continue Reading
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06 Mar 2023
BCBSM Funds Community-Based Orgs to Improve Senior Wellbeing
The $670,000 grant will support four community-based organizations that offer social and educational programs to improve the wellbeing of senior populations. Continue Reading
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03 Mar 2023
NCQA Recognizes WI UnitedHealthcare Plan for Health Equity Efforts
UnitedHealthcare Community Plan of Wisconsin has helped improve health equity by collaborating with community-based organizations across the state that support underserved populations. Continue Reading
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03 Mar 2023
Top Threats, Priorities in Employer-Sponsored Health Plan Benefits
Employers shared interventions that strengthen employer-sponsored health plan benefits in response to threats such as high-cost claims and medical inflation. Continue Reading
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News
01 Mar 2023
CareSource, Walmart Partner to Address Racial Health Disparities
The partnership aims to address maternal and racial health disparities, providing CareSource members access to social needs assessments, community resources, and health literacy education. Continue Reading
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28 Feb 2023
Blue Cross MN Partnership Expands Value-Based Care for Rural Members
Blue Cross Medicare Advantage members in 24 rural Minnesota counties will receive care under a full-risk value-based arrangement. Continue Reading
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27 Feb 2023
Humana Will Leave Employer Group Insurance Business to Focus on Public Plans
After exiting the employer group insurance business, Humana will prioritize the long-term growth of its Medicare Advantage, Medicare, and Medicaid health plans. Continue Reading
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24 Feb 2023
Why Employers Prefer Employer-Sponsored Health Plans Over Exchanges
Employers voiced a preference for employer-sponsored health plans over exchange coverage and expressed the conviction that, ultimately, employees share that view. Continue Reading
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22 Feb 2023
2022 Key Enrollment Trends For High Deductible Health Plans
Pre-deductible chronic disease prevention coverage was a big factor in high deductible health plan enrollees’ decision-making, along with factors like prescription drug coverage. Continue Reading
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21 Feb 2023
BCBST Report Reveals Racial Care Disparities Among TN Residents
Black Tennesseans were two and half times more likely to have a pregnancy-related death and two times as likely to die from diabetes than White women, highlighting racial care disparities in multiple areas. Continue Reading
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17 Feb 2023
Best Vendors for Healthcare Payer Services, Software Needs
Healthcare payers seeking a vendor for care management, risk adjustment, and other complex processes may find a high-performing partner in the Best in KLAS report results. Continue Reading
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17 Feb 2023
Indiana Payer Partners with Provider Org to Boost Primary Care Access
In addition to receiving exclusive primary care access, fully insured members of Physicians Health Plan of Northern Indiana will have access to an integrated care team, chronic condition management, and provider-dispensed medication. Continue Reading
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15 Feb 2023
Employer-Sponsored Health Plans Pay More for Drugs than Medicare
Five of the most used physician-administered drugs cost over 200 percent higher for employer-sponsored health plans than for Medicare. Continue Reading
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14 Feb 2023
New Humana Community Partnerships to Strengthen Health Equity
The payer has announced a new health equity strategy that centers around forming community partnerships to tackle healthcare barriers and social determinants of health, such as food insecurity. Continue Reading
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13 Feb 2023
Out-of-pocket Costs for Opioid Use Disorder Treatment Varied by Payer
In 2020, the mean out-of-pocket cost for opioid use disorder medication paid for by self-pay patients was $8.44 compared to $0.10 for prescriptions paid for by Medicaid. Continue Reading
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10 Feb 2023
Centene Managed Care Plans Will Pay Medi-Cal $215M for Overcharges
Centene saved its managed care plans $2.70 per prescription drug claim through its pharmacy benefit manager contracts, but did not pass on these discounts to Medi-Cal, according to the settlement. Continue Reading
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09 Feb 2023
High Deductible Health Plan Enrollment Hit Record High in 2021
High deductible health plan (HDHP) enrollment reached record levels in 2021, with some states seeing over 60 percent of their private-sector workers covered through an HDHP. Continue Reading
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09 Feb 2023
Humana Maintains Primary Care Access for Medicare Advantage Members
Humana Medicare Advantage members will continue to have access to ChenMed’s medical center brands, which provide primary care at more than 120 locations across 50 states. Continue Reading
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08 Feb 2023
Most Employers Will Enhance Services to Improve Employee Wellbeing
Most employers plan to enhance their current employee wellbeing programs by adding more services, while almost a quarter are considering switching to a new vendor partner. Continue Reading
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08 Feb 2023
Employers Emphasize Quality of Care When Assessing Health Plans
Employers remained dissatisfied with their health plans in 2022, but those who had higher health plan satisfaction indicated that their payer’s quality of care emphasis was a key driver. Continue Reading
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07 Feb 2023
ACHP Addresses Proposed Rule on Substance Use Disorder Patient Data
The CARES Act’s substance use disorder patient data requirements should be more aligned with HIPAA standards, ACHP and its co-signees argued. Continue Reading
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06 Feb 2023
How a Growing, Changing Medicare Population Will Impact Payers
As Medicare takes on an aging, sicker population, payers need to ensure they are meeting evolving member expectations and using data to drive their strategy for member satisfaction. Continue Reading
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03 Feb 2023
Health Savings Account Balances, Contributions Grew in 2021
The average health savings account balance and total contribution were higher for those that received funds from employers in 2021. Continue Reading
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02 Feb 2023
Aetna Funding Improves Healthcare Access for Domestic Violence Survivors
The funding will help domestic violence survivors and their children enroll in healthcare coverage through Medicaid, CHIP, or other health plans while maintaining confidentiality. Continue Reading
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30 Jan 2023
Cigna’s Integrated Health Plan Reduced Care Costs for Employers
When individuals with a diabetes diagnosis were enrolled in the integrated health plan, employers saved $2,500 per member per year. Continue Reading
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25 Jan 2023
Employer-Sponsored Health Plans Face High Costs for SUD Treatment
Alcohol- and opioid-related use disorders were the most prevalent substance use disorders and posed some of the highest per-enrollee costs for employer-sponsored health plans. Continue Reading
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25 Jan 2023
Elevance Health Will Acquire BCBSLA, Improve Care Access in LA
In addition to improving care access, the proposed acquisition will create a foundation that aims to support local communities, address complex care needs, and reduce health inequities. Continue Reading
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23 Jan 2023
Medicare Pays Medicare Advantage Plans 6% More Than FFS Medicare
Medicare Advantage plans have seen growing enrollment in recent years, but they have also seen persistent coding intensity problems that lead to excess payments. Continue Reading
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19 Jan 2023
Tufts Health Plan, Harvard Pilgrim Collab Boosts Access to LGBTQ+ Care
Fully insured commercial members will have access to integrated LGBTQ+ care, including gender-affirming physical and mental healthcare, behavioral health services, and social support groups. Continue Reading
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19 Jan 2023
Private Payers Reimbursed Telehealth, In-Person Care Equally in 2020
Private health plan claims show that the average telehealth claims were generally within ten percent above or below the in-person care cost at the beginning of the pandemic. Continue Reading
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17 Jan 2023
BCBSRI Grants $740K to Improve Health Equity, Access to Stable Housing
The funding will help improve access to stable housing for Rhode Islanders by supporting organizations that focus on building and renovating homes and increasing homebuyer education. Continue Reading
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11 Jan 2023
Deductibles, Copayments, OOP Max Trends Indicate Cost-Sharing Growth
Between 2013 and 2020, employees experienced higher cost-sharing for many medical services, although some shifts depended on plan type and union employment. Continue Reading
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10 Jan 2023
Provider Orgs Join Full-Risk Value-Based Care Contracts with BCBSM
BCBSM’s full-risk value-based care contracts aim to improve members’ healthcare experience by boosting care quality and reducing costs. Continue Reading