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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06 Dec 2024
Lawmakers promote access to direct primary care in Medicaid
While Medicaid programs can use waivers to implement direct primary care, a law that is under consideration in the Senate would make it easier for states to take this approach. Continue Reading
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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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23 Nov 2021
Humana Expands Medicare Advantage Value-Based Contract in MN
The payer will expand its partnership with Allina Health to cover more members under Medicare Advantage value-based contracts. Continue Reading
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18 Nov 2021
An Overview of 2021 Prescription Drug Benefits: Tiers, Cost-Sharing
There was no singular right way for employers and payers to structure prescription drug benefits in 2021 as the nation continued to struggle with escalating drug prices. Continue Reading
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15 Nov 2021
What Member Engagement Means to Today’s Healthcare Consumers
Health plans have improved their digital member engagement efforts, but they have more opportunities to tailor their activities to improve care management. Continue Reading
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15 Nov 2021
The Status of High Deductible Health Plans with Savings Option
As deductibles continue to grow, large employers are leveraging high deductible health plans with savings option to manage cost-sharing. Continue Reading
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12 Nov 2021
Americans Ready To Choose Coverage During 2022 Open Enrollment
As the coronavirus pandemic continues to influence members’ decision making, Americans are feeling more prepared to select a health plan during 2022 open enrollment. Continue Reading
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11 Nov 2021
Teladoc, Trustmark Announce Virtual-First Health Plan
The partners stated that their virtual-first health plan will centralize around primary care services but would also include mental healthcare and chronic disease management capabilities. Continue Reading
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11 Nov 2021
Humana Announces Changes To Veteran Population Health Management
Humana will add the veteran community to the payer’s Bold Goal initiative in order to improve veteran population health management. Continue Reading
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10 Nov 2021
Payer Third Quarter Earnings Results Spotlight COVID-19 Impact
The impact of coronavirus remained clear across the payer third quarter earnings results for Humana, Anthem, and Aetna. Continue Reading
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09 Nov 2021
Humana Type 2 Diabetes Reversal Program Leverages RPM, Nutrition
Humana’s Type 2 diabetes reversal program will leverage remote patient monitoring and personalized nutrition strategies to improve member outcomes. Continue Reading
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08 Nov 2021
Step Therapy Protocols Vary By Health Plan, 55% Too Strict
Payers use step therapy protocols to lower costs, but some health plans implement step therapy protocols that go beyond clinical guidelines. Continue Reading
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08 Nov 2021
United Behavioral Health Sued for Restrictive Bundled Payment Policy
United Behavioral Health is being sued for allegedly denying claims for medically necessary treatment under its bundled payment policy. Continue Reading
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04 Nov 2021
Coronavirus Pandemic’s Impact on Insurer, Consumer Trends in 2021
Insurers and enrollees shifted behavioral patterns in response to the coronavirus pandemic in 2020 and the repercussions continue to have an impact in 2021. Continue Reading
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03 Nov 2021
COVID-19 May Push Americans To Change Plans For Open Enrollment
Apart from the pandemic, consumers found their own changing healthcare needs and healthcare costs to be compelling reasons for switching plans during open enrollment 2022. Continue Reading
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01 Nov 2021
How Payers Help Tackle Substance Use Disorders, Other Conditions
Payers have several opportunities to improve their coverage options for members who have substance use disorders with co-occurring conditions. Continue Reading
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01 Nov 2021
Aetna Will Offer Some Gene Therapies As Standard Medical Benefit
Aetna established a provider network for gene therapies which will be available to fully-insured and self-insured employers as a standard medical benefit in 2022. Continue Reading
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01 Nov 2021
Addressing Senior Physical, Mental Health With Group Exercise
COVID-19 has taken a toll on seniors’ well-being. The right fitness programs can help lift seniors’ well-being post-pandemic. Continue Reading
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01 Nov 2021
Leveraging Patient Access APIs to Optimize Risk Adjustment Efforts
The adoption of patient access APIs can enable claims data to move between payers and support improved risk adjustment. Continue Reading
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29 Oct 2021
More Employers Turn to Employer-Sponsored Primary Care Clinics
Employer-sponsored primary care clinics can address a variety of employer goals including improving patient access to care, quality of care, and patient satisfaction. Continue Reading
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26 Oct 2021
CVS Health to Offer Coverage for Moderna COVID-19 Booster Shot
Eligible individuals who have received a two-dose mRNA vaccine or a Johnson & Johnson vaccine can receive a Moderna COVID-19 booster shot at select CVS Health pharmacies at no cost. Continue Reading
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25 Oct 2021
Members Find Private Payer Mental Healthcare Networks Inadequate
Even when payers integrate mental healthcare into primary care services, members said that mental healthcare networks paled in comparison to medical care networks. Continue Reading
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25 Oct 2021
Most Payers Are Unfamiliar with Prescription Digital Therapeutics
Prescription digital therapeutics are still young, but payers are starting to consider whether covering these solutions could lower costs. Continue Reading
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25 Oct 2021
Addressing Health Literacy to Improve Member Health, Outcomes
Health literacy is essential to empowering patients to take greater ownership over their healthcare experience and achieve improved outcomes. Continue Reading
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22 Oct 2021
UnitedHealthcare Targets Prenatal Care, Maternal Health Outcomes
UnitedHealthcare will help launch group prenatal care models at OB-GYN clinics in North Carolina to improve maternal health outcomes. Continue Reading
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21 Oct 2021
More Medicare Advantage Plans Offer SDOH Benefits With $0 Premium
In 2022, more beneficiaries will have access to Medicare Advantage plans with $0 premiums that offer supplemental benefits. Continue Reading
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20 Oct 2021
UnitedHealth Group Kicks Off Integrated Virtual-First Health Plan
The new virtual-first health plan will be available in nine cities and will aim to integrate virtual and in-person care needs. Continue Reading
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19 Oct 2021
Financially Burdened Seniors Struggle to Cover Healthcare Costs
In the past year, seniors reported having to delay treatment or postpone other expenses due to high healthcare costs. Continue Reading
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19 Oct 2021
Continuous Marketplace Coverage Led to Increased Prenatal Care Use
Pregnant people who received continuous Marketplace coverage before and during pregnancy were more likely to have high prenatal care use. Continue Reading
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18 Oct 2021
Walmart Increases Self-Funded Employer Access to Cost-Effective Care
Self-funded employer health plans will have access to Walmart’s collection of healthcare services following a partnership between the retail giant and a digital healthcare platform. Continue Reading
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18 Oct 2021
Humana Expands Medicare Advantage Plans, Benefits in Tennessee
Humana intends to introduce new Medicare Advantage plans for Tennesseans in 2022 that address dual-eligible benefits, veteran coverage, and food insecurity. Continue Reading
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18 Oct 2021
A Phased Approach to Next-Generation Member Engagement
A two-phased approach allows health plans to identify and target specific populations and then deploy and measure the effectiveness of their member engagement efforts. Continue Reading
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14 Oct 2021
UnitedHealthcare Shares Growth, COVID-19 Impacts, 2022 Forecast
The third quarter earnings report and call for UnitedHealthcare revealed the impact of the coronavirus pandemic, but ended on a hopeful note for 2022. Continue Reading
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12 Oct 2021
Employer Health Benefits Spending Will Normalize in 2022
After two unpredictable years of healthcare spending, employer health benefits spending will return to prepandemic levels in 2022, employers predicted. Continue Reading
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11 Oct 2021
51% of Employees Satisfied with Employer-Sponsored Health Benefits
Overall, employees reported being satisfied with their employer-sponsored health benefits, but they still expressed the need for more mental health benefits and lower costs. Continue Reading
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07 Oct 2021
Medicare Advantage COVID-19 Hospitalizations Were Lower Than FFS
Medicare Advantage coronavirus hospitalizations and mortality rates were lower than the rates in fee-for-service Medicare during most of 2020. Continue Reading
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04 Oct 2021
How Payers Use Chronic Disease Management Flexibilities in HSAs
The flexibilities for covering chronic disease management in health plans with health savings accounts have enabled payers to reduce cost-sharing for members. Continue Reading
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01 Oct 2021
Blue Cross NC Reduces Lab Service Costs, Unnecessary Testing
Lab service costs can be an expensive category of healthcare spending, but Blue Cross NC aimed to change that with its latest partnership. Continue Reading
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29 Sep 2021
Top 5 Largest Health Insurers in the US by National Market Share
UnitedHealth Group, Anthem, Aetna, and Cigna returned to the list of the top five largest health insurers and one newcomer joined the list. Continue Reading
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29 Sep 2021
Health Insurance Industry Consolidation Grew from 2014 to 2020
At the national level, UnitedHealth Group, Anthem, Aetna, and Cigna maintained their rankings as holding the highest market shares while health insurance industry consolidation grew. Continue Reading
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29 Sep 2021
How Data Aggregation, Sharing Improves Specialty Patient Outcomes
With data supplementation, specialty pharmacies can piece together a complete digital picture of the patient that improves medication adherence and patient outcomes. Continue Reading
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28 Sep 2021
4 Employer Health Benefit Strategies That Lower Healthcare Costs
Advanced primary care, episode-based benefits, integrated health benefits, and association health plans are employer health benefit strategies that can help employers manage costs. Continue Reading
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27 Sep 2021
How Change Management Leads to Successful Member Engagement
Health plans implementing a digital platform for member engagement must consider the importance of effective change management. Continue Reading
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24 Sep 2021
UPMC Partners with Meal Delivery Service, Improves Health Outcomes
The pilot program utilized a meal delivery service that helped members tackle food insecurity and manage chronic conditions. Continue Reading
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20 Sep 2021
How Specialty Pharmacies Connect the Dots for Patient-Centered Care
Specialty pharmacists are able to coordinate services and address social determinants of health, leading to improved medication adherence and health outcomes. Continue Reading
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17 Sep 2021
NCQA Releases Health Plan Performance Ratings with COVID-19 Data
NCQA found that health plan performance for most eligible plans hovered around 3.5 stars overall on measures covering quality of care, patient experience, and health quality processes. Continue Reading
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15 Sep 2021
How Payers Can Cultivate Consumer-Centered Digital Innovation
Consumer-centered digital innovation is increasingly important for payer success, but what digital solutions do members want and how should payers implement them? Continue Reading
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14 Sep 2021
Digital Member Experience Services May Boost Plan Satisfaction
Payers may see increased enrollment and higher member satisfaction levels if they employ omnichannel digital member experience services. Continue Reading
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13 Sep 2021
Payer Extends Medicare Advantage Footprint to Reach 5M Seniors
SCAN Health Plan will offer its senior-first Medicare Advantage Plans in 17 markets across three states starting in 2022. Continue Reading
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13 Sep 2021
6 Reasons to Invest in Next-Generation Member Engagement
Health plans must meet the changing expectations of consumers to deliver a meaningful member experience through targeted member engagement. Continue Reading
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09 Sep 2021
Anthem Offers Virtual Care Platform To Facilitate Second Opinions
The virtual care platform will be provided in conjunction with The Clinic by Cleveland Clinic in order to connect members with high-quality care and secondary health assessments. Continue Reading
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08 Sep 2021
How COVID-19 Impacted Employer-Sponsored Health Plan Coverage
Employer-sponsored health plan coverage did not return to pre-pandemic levels even as the employment levels recovered in 2020. Continue Reading
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07 Sep 2021
Centene Will Group Medicare Offerings Under Wellcare Brand
In addition to consolidating its Medicare offerings, the payer will streamline its Wellcare branding in order to improve member engagement and experience. Continue Reading
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02 Sep 2021
New BCBSA Plan Product Prioritizes Labor Union Health Insurance
CareFirst and Highmark are introducing a health insurance product to the 2022 market that will focus on improving labor union health insurance. Continue Reading
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02 Sep 2021
6 Policies To Reduce Prescription Drug Prices, Boost Competition
As prescription drug spending climbs, ACHP is calling on policymakers to reduce high prescription drug prices and enhance market competition. Continue Reading
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30 Aug 2021
Cigna Expands Individual Health Insurance Market Participation
After the surge in 2021 marketplace enrollment due to the special enrollment period, payers are announcing plans to expand their reach in the individual health insurance market in 2022. Continue Reading
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30 Aug 2021
How Personalized Messaging Leads to Effective Member Engagement
Tailoring messaging to the unique and specific needs of individuals is essential for health plans to improve member engagement. Continue Reading
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25 Aug 2021
ACHP: Health Equity Success Requires Holistic, Integrated Approach
ACHP outlined a holistic approach for payers to achieve health equity by addressing care disparities on multiple interconnected levels including individual, community, and systemic. Continue Reading
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24 Aug 2021
Private Payers Renew Cost-Sharing For COVID-19 Hospitalizations
Nearly three out of four private payers are no longer waiving cost-sharing for COVID-19 hospitalizations and treatment. Continue Reading
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23 Aug 2021
How Payers Can Launch a Virtual-First Health Plan
Virtual-first health plans appear to be the natural next step in the evolution of virtual care, remote care, and telehealth technology. How can payers launch a successful plan? Continue Reading
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23 Aug 2021
How Specialty Pharmacies Address Social Determinants of Health
Specialty pharmacies are uniquely positioned to identify social determinants of health that could impact medication adherence and health outcomes. Continue Reading
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20 Aug 2021
MO Medicaid Home Healthcare Program Received Improper Payments
The state claimed more than it should have in federal Medicaid reimbursement for its Medicaid home healthcare program and did not keep adequate documentation. Continue Reading
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19 Aug 2021
Payer Virtual Care Management Platform Prioritizes Holistic Care
The payer’s virtual care management platform will improve patient-provider communication and offer members a convenient and holistic approach to care management. Continue Reading
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18 Aug 2021
Medicare Advantage Healthcare Spending Exceeds Original Medicare
Policymakers may soon have to address inequities between Medicare Advantage healthcare spending and Medicare spending. Continue Reading
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18 Aug 2021
Pros, Cons of Small Employers Joining Association Health Plans
Association health plans attract small businesses and self-employed individuals who want lower costs and more leverage in the marketplace, but are the benefits worth the detracting factors? Continue Reading
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17 Aug 2021
2021 Healthcare Spending, Hospital Admissions Lower Than Expected
Lower 2021 healthcare spending may be a result of patients forgoing treatment, instead of simply rescheduling services that the pandemic delayed in 2020. Continue Reading
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16 Aug 2021
UHC Will Pay Penalty on Mental, Behavioral Reimbursement Parity
UnitedHealthcare will pay $15.6 million in penalties and payments to beneficiaries and it will correct its policies that restricted mental and behavioral reimbursement parity. Continue Reading
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12 Aug 2021
Aetna Increases Member Primary Care Access With New Virtual Plan
CVS Health and Aetna have expanded their virtual care options with the launch of the new virtual primary care program which seeks to improve primary care access for members. Continue Reading
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11 Aug 2021
Payer Expands Value-Based Care Footprint for Clinical Procedures
Regence BlueShield is expanding its value-based care program by adding more covered services and welcoming Washington state’s largest healthcare purchaser. Continue Reading
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10 Aug 2021
The Fundamentals of Medicare Advantage Star Rating Methodology
The Medicare Advantage Star Rating methodology involves various components in order to measure Medicare Advantage health plan performance. Continue Reading
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10 Aug 2021
Centene Promotes Employee COVID-19 Vaccination, Remote Work
The Delta variant not only stalled the return to the workplace, but also caused the payer to redouble its efforts support employee coronavirus vaccination. Continue Reading
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09 Aug 2021
SCAN Health Plan Reports Decline in COVID-19 Vaccine Disparities
The payer stated that various efforts at building trust with members led to a decrease in coronavirus vaccine disparities, including both racial and economic disparities. Continue Reading
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05 Aug 2021
Tracking Social Determinants of Health Data in Medicare Advantage
Medicare Advantage plans have to draw social determinants of health data from a number of sources, both internal and external. Continue Reading
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04 Aug 2021
Top Trends In Small Business Health Insurance During COVID-19
Instead of dropping coverage due to economic pressures, small business health insurance remained stable during the pandemic. Continue Reading
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03 Aug 2021
Payer Financially Supports Diversity in Mental Healthcare Workforce
Blue Shield of California is financially supporting an internship program that encourages underrepresented young adults to join the mental healthcare workforce. Continue Reading
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03 Aug 2021
DOJ Intervenes in Whistleblower Cases Alleging Medicare Fraud
Six cases in Colorado and California alleged that Kaiser Permanente committed Medicare fraud in its Medicare Advantage risk adjustment processes. Continue Reading
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30 Jul 2021
2022 Marketplace Rate Filings Show Few Pandemic-Related Increases
A collection of marketplace rate filings for 2022 showed that most payers do not expect the coronavirus pandemic to have an upward impact on premiums. Continue Reading
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29 Jul 2021
What Employees Want in Their Employer-Sponsored Health Benefits
Employers and employees agree that healthcare costs are out of control, but they differ on the role of employer-sponsored health benefits. Continue Reading
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29 Jul 2021
UHC Funds Community-Based Social Determinants of Health Efforts
The payer is awarding more than $11 million to community-based organizations across 18 states to improve access to care and address social determinants of health barriers. Continue Reading
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28 Jul 2021
Cigna + Oscar Extends Virtual Primary Care Plan 2022 Footprint
The payer has announced the expansion of Oscar Virtual Primary Care into two additional states for members of select Cigna + Oscar health plans. Continue Reading
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28 Jul 2021
How Health Plans Successfully Implement a Digital Strategy
Effectively putting into place a digital strategy allows health plans to rethink outreach, engagement, and care management. Continue Reading
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23 Jul 2021
Arkansas Blue Cross Grants $5M to Improve Behavioral Healthcare
The payer’s charitable foundation is awarding grants to several programs in Arkansas that provide behavioral healthcare services to individuals of all ages. Continue Reading
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21 Jul 2021
Employer-Sponsored Health Plans Spent $814B on 2019 Benefits
Employer-sponsored health plans’ healthcare spending shows that healthcare coverage tax exemptions for employers are worthwhile, according to the American Benefits Council. Continue Reading
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19 Jul 2021
Anthem, Kroger Health Partner To Offer Medicare Advantage Plans
Members in four regions of the US will have access to the payer and retail health company’s new Medicare Advantage plan. Continue Reading
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16 Jul 2021
Payer Moves to Increase Member Access to Acute Home Healthcare
Regence BlueShield’s new partnership will offer members access to quality acute home healthcare services. Continue Reading
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15 Jul 2021
Community First Expands into TX Affordable Care Act Marketplace
Community First, with the help of a technology company, is expanding its health plans to reach more members by entering the Affordable Care Act marketplace. Continue Reading
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13 Jul 2021
How Employer Health Benefits Are Changing Due to Coronavirus
As employers transition their workforces back into in-person or hybrid workplace models, employer health benefits will have to evolve to accommodate mental health needs. Continue Reading
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12 Jul 2021
Leveraging Real-Time Healthcare Data to Drive More Efficient Medical Management
Payers and health plans can leverage data science capabilities to develop effective, artificial intelligence-powered data models to provide holistic care Continue Reading
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09 Jul 2021
How Proficiency in Speaking English Impacts Healthcare Spending
Healthcare spending is lower for Hispanic individuals who are not proficient in English, which may indicate the need for better language services among payers. Continue Reading
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08 Jul 2021
Aetna Prior Authorization Policy Takes Effect, Providers Protest
Aetna’s cataract surgery prior authorization policy went into effect on July 1, 2021 over ophthalmologists’ objections. Continue Reading
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07 Jul 2021
Payer COVID-19 Vaccine Outreach Program Vaccinates 2M Seniors
The vaccine outreach program, which AHIP and BCBSA launched in March, focused on providing vaccine access to seniors in underserved populations. Continue Reading
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01 Jul 2021
Medicare Supplemental Coverage Tied to Fewer Cost-Related Hurdles
Recent data shows that 15 percent of traditional Medicare beneficiaries who have Medicare supplemental coverage experience issues regarding healthcare spending. Continue Reading
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30 Jun 2021
Behavioral Healthcare Parity Is Low Among Regional, State Plans
Payers of all types did not perform perfectly on behavioral healthcare parity, but regional and state health plans demonstrated low compliance and high out-of-network utilization. Continue Reading
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30 Jun 2021
Payer Gives Community-Based Social Determinants of Health Support
Working with a community-based organization network, the payer will offer Medicare Advantage members easier access to community-based social determinants of health support. Continue Reading
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29 Jun 2021
Humana Increases Access to NC Medicare Advantage Mental Healthcare Resources
The payer will expand its Medicare Advantage mental healthcare resources for members in North Carolina by opening additional Neighborhood Centers. Continue Reading
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24 Jun 2021
ACHP Recommends Federal Employee Plan Comparison Tool Updates
The brief argued that the changes to the plan comparison tool would improve consumers’ plan shopping experience. Continue Reading
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22 Jun 2021
Aetna Partnership Aims to Increase, Improve Suicide Prevention
The payer, with the help of a behavioral health platform, will work to educate and train providers and clinicians to be better equipped at suicide prevention. Continue Reading
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21 Jun 2021
Alignment Expands Medicare Advantage for Seniors in 3 States
The payer will debut its Medicare Advantage plans in select Arizona counties and expand coverage to additional counties in North Carolina and Nevada. Continue Reading
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21 Jun 2021
How Payers Can Use Remote Patient Monitoring to Advance Care
Payers can assist members to adopt and reap the benefits of robust remote patient monitoring technologies. Continue Reading
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16 Jun 2021
Humana Plans to Acquire Value-Based Home Healthcare Partner
The payer has plans to expand its value-based home healthcare services with the help of One Homecare Solutions. Continue Reading
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15 Jun 2021
UHG Outlines Strategies to Improve Health System, Access to Care
Payers can support progress in the healthcare system by promoting access to care, improving patient experience, and advancing health equity. Continue Reading
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15 Jun 2021
6 Expectations Employers Have for Provider Care Coordination
Employers are looking for greater price transparency, reduced overtreatment, improved patient experience, and overall better care coordination from their provider partners. Continue Reading