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
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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25 Jan 2021
Health Payer Unveils Virtual Care Plan, Telehealth Care Access
The first virtual care plan on the Texas Exchange utilizes telehealth technology to promote care access to primary and preventative services. Continue Reading
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25 Jan 2021
How Top Payers Are Providing COVID-19 Vaccine Coverage, Support
While certain rules govern coronavirus vaccine coverage during the public health emergency, some payers are looking beyond the crisis. Continue Reading
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22 Jan 2021
2021 Payer Strategies Build on Telehealth, Gene Therapy Lessons
Payers will hone their telehealth and gene therapy strategies in 2021 and will also refine their forecasting capabilities. Continue Reading
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21 Jan 2021
MA Plans See 99% Member Satisfaction Among Non-White Members
While Medicare Advantage plans saw high member satisfaction, health plans can improve member education on enrollment processes and different types of Medicare coverage. Continue Reading
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21 Jan 2021
WI Submits Medicaid Demonstration Waiver, Health Savings Account Program
The Medicaid demonstration waiver, submitted to CMS in late December, seeks to leverage health savings accounts for childless Medicaid enrollees. Continue Reading
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20 Jan 2021
UnitedHealthcare Q4 Earnings Report Shows Leveling Care Activity
The coronavirus pandemic did impact UnitedHealthcare in the fourth quarter of 2020, particularly in regards to employer-sponsored health plan membership and outpatient activity. Continue Reading
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19 Jan 2021
Payer Diversity Program Contributes $375M to Economy, Creates Jobs
Along with the supplier diversity program, Independence Health Group uses other strategies to increase workforce diversity, healthcare access, and healthcare equity. Continue Reading
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18 Jan 2021
4 Positive Trends That Continue to Define Medicare Advantage Plans
Medicare Advantage plans have diverse member populations, low member spending, high quality of care, and high enrollment growth. Continue Reading
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15 Jan 2021
UnitedHealthcare Expands Virtual Care Policy to Boost Primary Care
The payer will expand its existing virtual care service as an alternative to in-person care, extending the policy into new states in 2021. Continue Reading
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13 Jan 2021
AHIP Blasts Pharmaceutical Industry as Drug Prices Increase
The payer organization called on the incoming administration to prioritize shielding Americans from drug price increases. Continue Reading
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08 Jan 2021
Payer Expands Member Engagement Program, Digital Outreach to ACA Members
The ACA member rewards program will feature digital outreach to promote member engagement and allow the payer to ensure members have access to care. Continue Reading
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07 Jan 2021
ACHP: Access to CDC COVID-19 Vaccine Data Key to Member Engagement
The payer organization argued that claims and billing data is slow and incomplete, hindering effective member engagement for vaccine distribution. Continue Reading
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06 Jan 2021
UnitedHealth Group Plans to Acquire Change Healthcare in 2021
UnitedHealth Group’s diversified health services company, Optum, and Change Healthcare will combine to simplify healthcare data exchange, lower spending, and streamline payment. Continue Reading
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05 Jan 2021
How 3 Major Payers Extended Temporary COVID-19 Benefits into 2021
While many elements are consistent, some major payers differ on how many COVID-19 benefits they are extending and for how long. Continue Reading
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04 Jan 2021
Joint Venture To Lower Employee Healthcare Costs, Haven, Disbands
The partnership between Amazon, JPMorgan Chase, and Berkshire Hathaway to address rising employee sponsored healthcare costs is shutting down. Continue Reading
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04 Jan 2021
Centene Plans to Acquire Major Behavioral Healthcare Platform
Centene executives say that the acquisition of Magellan Health would help the payer integrate its behavioral healthcare and physical healthcare services, among other potential benefits. Continue Reading
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30 Dec 2020
Drug Wholesale Prices Impact Payer Spending, Out-of-pocket Costs
A report in JAMA shows drug wholesale list prices doubled from 2010-2016, which led to increases in payer spending and out-of-pocket costs for patients. Continue Reading
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23 Dec 2020
How Non-Profit Medicare Advantage Plans Can Improve Growth
As for-profit Medicare Advantage health plans pull ahead in enrollment growth, non-profit Medicare Advantage health plans can improve their competitiveness. Continue Reading
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17 Dec 2020
Private Payer Spending Hits $1.2T in 2019 As Spending Growth Slows
Healthcare spending in the US reached $3.8 trillion overall in the year before the coronavirus pandemic gripped the nation. Continue Reading
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17 Dec 2020
Payer Gross Margins, Medical Loss Ratios Point to a Profitable 2020
Gross margins and medical loss ratios indicated that payers continued to make a profit through the third quarter of 2020. Continue Reading
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16 Dec 2020
Payers Will Improve Virtual Care, Forecasting, Growth in 2021
After the coronavirus pandemic decimated the healthcare system in 2020, payers have the chance to rebuild and rethink their strategies around virtual care in 2021. Continue Reading
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15 Dec 2020
CareFirst Announces COVID-19 Vaccine Coverage for All Members
Shortly after the FDA approved its first emergency use authorization for a coronavirus vaccine, the payer stated it would offer coronavirus vaccine coverage. Continue Reading
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15 Dec 2020
Experts Share 5 Pivotal Payer Industry Trends To Watch in 2021
Emerging from a tumultuous year, leaders from across the industry named these five payer industry trends that payers should focus on in 2021. Continue Reading
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14 Dec 2020
Humana Announces Value-Based Primary Care Services MA Model
Humana is the only payer to expand this value-based primary care services model to all 48 contiguous states and Washington, DC. Continue Reading
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14 Dec 2020
How COVID-19 Has Renewed Focus on Health Equity and Social Determinants of Health
While social determinants of health are by no means a new concept, the pandemic continues to highlight their impact on the ability of individuals to avoid infection Continue Reading
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10 Dec 2020
Highmark Expands Partnership to Personalize Substance Abuse Care
The health plan is expanding on an existing partnership to bolster its approach to substance abuse care. Continue Reading
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10 Dec 2020
Medicare Advantage Quality of Care Surpasses Traditional Medicare
While Medicare Advantage quality of care was excellent for high-need, high-cost individuals, the plans were not as strong in cost and utilization for certain beneficiary populations. Continue Reading
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09 Dec 2020
Prescription Coverage Draws Beneficiaries to Medicare Advantage
Nearly 30 percent of respondents cited prescription coverage as their reason for selecting a Medicare Advantage plan for 2021. Continue Reading
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09 Dec 2020
How Payers Use Clinics to Boost Vision Benefits, Access to Care
Aetna sponsored a three-day vision clinic in partnership with an international vision care nonprofit to expand access to care for Atlanta residents. Continue Reading
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08 Dec 2020
BCBS Payers Support Preventative Care, Access to Vaccinations
Across the country, BCBS payers are promoting vaccinations and immunizations by improving access to preventative care with a focus on at-risk communities. Continue Reading
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08 Dec 2020
How Medicaid Managed Care Organizations Can Improve Long-Term Care
A new AHIP report shows how Managed Care Organizations can streamline care and improve quality monitoring of Medicaid enrollees, including those in long-term care. Continue Reading
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07 Dec 2020
How Health IT Promotes Medicare Member Caregiver Wellbeing
Regence health plans announced a health IT partnership that promotes independent living by providing home healthcare for Medicare members and support for caregiver wellbeing. Continue Reading
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07 Dec 2020
BCBSIL Grant Promotes Preventative Care, Immunization Access
As part of an immunization initiative, BCBSIL has granted 12 organizations across Illinois up to $50,000 each to promote preventative care measures and immunization access. Continue Reading
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04 Dec 2020
3 Payers Rank Among the Top 25 Employers for COVID-19 Response
The companies were ranked based on policies such as sick leave adaptations and community relief donations to determine their coronavirus response. Continue Reading
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02 Dec 2020
How COVID-19 May Impact MA Risk Scores, Payments in 2022, 2023
Medicare Advantage risk scores might not see the effects of coronavirus-related deferred care until contract year 2023. Continue Reading
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30 Nov 2020
Payer Minimizes Member Healthcare Spending With Health Rewards
Ambetter has minimized healthcare spending for hundreds of thousands of members through a program that incentivizes member engagement with rewards. Continue Reading
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30 Nov 2020
Employer-Sponsored Health Costs Rise, Call For ACA Expansion
Continued increases to premium contributions and deductibles for employer-sponsored health plans could further burden struggling families. Continue Reading
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27 Nov 2020
How Copayment, Coinsurance Impact Member Healthcare Spending
As employers search for new ways to control and reduce healthcare spending, copayments and coinsurance may be useful tools for particular healthcare services. Continue Reading
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24 Nov 2020
ACA Marketplaces Gain Payers in 2021, Rural Areas Still Struggle
Although the Affordable Care Act marketplaces are increasing payer participants overall, rural counties still face challenges in drawing more payer competition. Continue Reading
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23 Nov 2020
ACHP: Solidify Telehealth Flexibilities, COVID-19 Test Funding
The Alliance of Community Health Plans urged Congress to consider making telehealth flexibilities more concrete and increasing federal burden for coronavirus testing coverage. Continue Reading
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20 Nov 2020
UPMC Partnership Expands Chronic Disease Medication Adherence
UPMC and Sempre Health have extended the medication adherence program to diabetes medicines, furthering their focus on chronic disease management. Continue Reading
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20 Nov 2020
How CMS Reinterpretations Paved Way for MA Supplemental Benefits
Calendar year 2021 will be an explosive year for Medicare Advantage supplemental benefits and Milliman researchers say that health plans have CMS to thank. Continue Reading
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19 Nov 2020
Employer-Sponsored Health Plans Call for Regulation, Transparency
Employers listed hospital and drug prices as major threats to employer sponsored health plan affordability and called for new regulations. Continue Reading
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19 Nov 2020
Payer to Fork Over $6.3M For Medicare Advantage Fraud Allegations
The Medicare Advantage fraud allegations were against Group Health Cooperative, which Kaiser Foundation Health Plan of Washington acquired. Continue Reading
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18 Nov 2020
Market Concentration Escalated in Small Group, Individual Markets
In the individual health insurance market, market concentration was higher for states with federally-facilitated exchanges, GAO found. Continue Reading
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17 Nov 2020
Out-of-Network COVID-19 Tests Are Susceptible to Price Gouging
Testing conducted out-of-network—particularly in stand-alone labs—could cost up to triple the average test price due to price gouging, AHIP says. Continue Reading
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13 Nov 2020
Centene Eyes Value-Based Care with AI Vendor Apixio Acquisition
Apixio’s artificial intelligence platform furthers Centene Corporations goal to bring innovation to healthcare and provide value-based care. Continue Reading
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12 Nov 2020
48% of Payers Concerned About Coronavirus Vaccine Effectiveness
While payers are concerned about the future coronavirus vaccine’s effectiveness, they expressed confidence in their ability to start reimbursing soon after the vaccine’s approval. Continue Reading
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11 Nov 2020
ProMedica Accused of Anti-Trust Actions, 50% Market Domination
ProMedica called lawsuit “frivolous” that alleged anti-trust activity resultant from McLaren’s acquisition of St. Luke’s. Continue Reading
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11 Nov 2020
Fewer MA Plans See High Medicare Advantage Star Ratings in 2021
If enrollment were to stay the same, fewer beneficiaries would end up in plans with higher Medicare Advantage Star Ratings compared to 2020. Continue Reading
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10 Nov 2020
Anthem Blue Cross Adds Providence to Value-Based Care Health Plan
First joint-venture between health system and health plan in the country set to enhance value-based care, streamline healthcare system experience. Continue Reading
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09 Nov 2020
BCBS of Louisiana Promotes Mental Health Services, Telehealth Appointments
Noting the unique stressors of 2020, BCBS of Louisiana fosters access to care using telehealth and virtual resources to support mental health. Continue Reading
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09 Nov 2020
Medicare Advantage Faces Sicker Population, Lower Payments in 2021
Medicare Advantage plans will need to brace themselves for anywhere from four to six percent lower payments and higher healthcare costs due to deferred care. Continue Reading
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09 Nov 2020
UnitedHealthcare Targets Children’s Eye Health, New Vision Benefits
As screen time increases with remote learning, UnitedHealthcare has expanded vision benefits for eligible dependents under the age of 19. Continue Reading
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06 Nov 2020
BCBSIL Pursues Health Equity With Pilot Program And Diversity Institute
The New Health Equity Hospital Quality Incentive Pilot Program will collectively provide $100 million in funding to participating hospitals. Continue Reading
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05 Nov 2020
BCBSA Settles Anti-Trust Litigation for $2.7B, Anthem Pays 22%
Blue Cross Blue Shield Association will distribute $2.7 billion to qualifying policyholders to end an anti-trust lawsuit. Continue Reading
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26 Oct 2020
Safeguarding Employees Through the Uncertainty of COVID-19
With workplaces welcoming back employees, employers and payers must ensure that work environments are safe and staff has timely and convenient access to care. Continue Reading
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23 Oct 2020
Top 5 Social Determinants of Health Domains for Payers to Address
To employ a comprehensive social determinants of health approach, payers can devise innovative solutions that tackle each of the five social determinants of health domains. Continue Reading
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21 Oct 2020
34% Medicare Advantage Plans Will Offer COVID-19 Benefits in 2021
Medicare Advantage plans are increasingly offering telehealth as a basic Medicare benefit, instead of a supplemental benefit, the study indicated. Continue Reading
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20 Oct 2020
Employer Sponsored 2020 Out-of-Pocket Costs Were Stable Pre-COVID
Premiums and deductibles for employer-sponsored health plans continued their upward trajectory in 2020, with average premiums for single and family coverage rising four percent each. Continue Reading
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19 Oct 2020
Surveys, Advanced Analytics Key for Member Experience, Star Ratings
Since Medicare Advantage Star Ratings are leaning more heavily on member experience in the coming years, payers will need to bolster their assessment tools. Continue Reading
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15 Oct 2020
Medicare Advantage Gross Margins Rise 41% Over 2019 Margins
Medicare Advantage average gross margins are the highest that they have ever been, increasing by on average $64 per member per month over June 2019 levels. Continue Reading
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15 Oct 2020
AMA: 56% Increase in Payer Market Consolidation In Past 5 Years
The American Medical Association found that payer market consolidation has been widespread across all markets and increasing. Continue Reading
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13 Oct 2020
Medicare Advantage HMOs Remain Popular in 2021 Open Enrollment
Medicare Advantage health maintenance organizations (HMOs) draw the largest percentage of Medicare enrollment, at 15.2 million enrollees. Continue Reading
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12 Oct 2020
21 Part D Plans Rank Tops in 2021 Medicare Advantage Star Ratings
The 2021 Medicare Advantage Star Ratings add to the positive narrative around the Medicare Advantage program as quality of care increases and accessibility continues to be strong. Continue Reading
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12 Oct 2020
Integrated Mental Health Strategies: A Right-Sized Approach to 2021
Promoting mental health strategies is a “win-win” proposition for members and a business’s bottom line, especially during a public health crisis. Continue Reading
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07 Oct 2020
Open Enrollment 2020 Marks Shift Toward Virtual Member Engagement
Due to social distancing restrictions, broker and member engagement during 2020 Medicare open enrollment will look very different than previous years. Continue Reading
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06 Oct 2020
Payer-Provider Partners Tap Telehealth for Behavioral Health Access
The need for behavioral health services skyrocketed since the start of the COVID-19 pandemic. Payer-provider partnerships will be critical to maintaining these services throughout the pandemic and after. Continue Reading
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01 Oct 2020
MA Payers Focus on Cutting Out-of-Pocket Costs, Home Health in 2021
Three major Medicare Advantage payers emphasized lower out-of-pocket costs for home healthcare telehealth benefits, premiums, and prescriptions. Continue Reading
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22 Sep 2020
Employer-Sponsored Healthcare Coverage Fell by 3.3 M, 2M Uninsured
The report’s findings corroborate previous findings about the impact of Medicaid expansion and how employer-sponsored healthcare coverage losses are deepening racial disparities. Continue Reading
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21 Sep 2020
Payers Begin To Pay Individual, Small Group Rebates Amid COVID-19
BlueCross BlueShield of Tennessee and Cigna will pay out individual and small group rebates to 143,000 members. Continue Reading
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16 Sep 2020
MA Plan Uses Home Healthcare to Manage Multiple Chronic Diseases
Aetna’s program aims to help Medicare Advantage members with multiple chronic diseases through preventive care and at-home services. Continue Reading
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15 Sep 2020
Two Blues Partner with Providers to Launch New Health Plans
In New Jersey and Wisconsin, Blues are partnering with local providers on new health insurance ventures. Continue Reading
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14 Sep 2020
Humana Launches Two More Value-Based Program for Specialty Care
Models focused on heart and shoulder surgery join four other value-based programs for specialty care. Continue Reading
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14 Sep 2020
How an Innovative User Experience Streamlines Care Access, Cost
Effective virtual care technology is able to streamline access to high-quality care at a lower cost by focusing on user experience. Continue Reading
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02 Sep 2020
Payer Seeks to Democratize Social Determinants of Health Data
Blue Shield of California’s new partnership aims to make regional social determinants of health data available to all in order to assist healthcare reforms. Continue Reading
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01 Sep 2020
Neither Anthem, Cigna to Receive Damages in Merger Disputes
Anthem and Cigna’s merger dispute ends with the court deciding that neither of the major payers should receive any form of payment from the other for all their troubles. Continue Reading
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01 Sep 2020
New Aetna Health Plan Leverages CVS HealthHUBs, Narrow Networks
The narrow network health plan will incorporate lower cost sites of care and will offer premiums that Aetna projects will be 20 percent lower than its PPO competitors. Continue Reading
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27 Aug 2020
Verily Launches Tech-Focused Payer for Self-Funded Employers
The life sciences and healthcare company will join forces with a Switzerland-based insurer to launch the new product for self-funded employers. Continue Reading
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26 Aug 2020
Aetna Fined $500,000 for Denying Emergency Room Claims in CA
The payer denied 93 percent of the emergency room claims that California investigated, underscoring that surprise billing remains a relevant issue during the coronavirus pandemic. Continue Reading
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25 Aug 2020
Hits to Employer-Sponsored Insurance May Affect Healthcare Jobs
In an industry that relies heavily on employer-sponsored insurance to cover its income, unemployment and loss of insurance could become a serious economic feedback loop. Continue Reading
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24 Aug 2020
Dispelling the Most Common Myths About Virtual Care
Virtual care is changing patient access to care, but choosing the right modality goes a long way toward increasing utilization and satisfaction Continue Reading
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13 Aug 2020
Sentara Healthcare, Cone Health Announce Value-Based Care Merger
The integrated health systems’ value-based care merger continues a trend of slow but continued mergers and acquisitions in the first half of 2020 despite the pandemic. Continue Reading
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12 Aug 2020
AHIP Responds to Lawmaker Questions on Payer COVID-19 Profits
The House Committee on Energy and Commerce will conduct an investigation into coronavirus testing coverage as well as how payer COVID-19 profits are being returned to the consumer. Continue Reading
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11 Aug 2020
Dawn of the Virtual Medicare Advantage Plan from Alignment Health
The virtual Medicare Advantage plan incentivizes employing virtual care combined with personal interaction from concierge care and service. Continue Reading
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04 Aug 2020
WellCare Offers SDOH Support for Seniors Through End of 2020
WellCare’s new partnership highlights both the continued need for social determinants of health support and the varied timelines of payer coronavirus-related programs. Continue Reading
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04 Aug 2020
Oscar Health Product Gives Members Free Virtual Care, Telehealth
The free virtual care and telehealth services—among other services—aim to lower healthcare spending for Oscar Health members. Continue Reading
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03 Aug 2020
Humana Tackles CKD Through Home Healthcare, Care Coordination
The payer has further expanded its chronic kidney disease management program to extend home healthcare and care coordination to Medicare Advantage members. Continue Reading
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27 Jul 2020
High Deductible Health Plan Enrollees Need Better HSA Education
With so many high deductible health plan enrollees not using their health savings accounts, employers and health plans can do a better job of member education. Continue Reading
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27 Jul 2020
COVID-19 May Impact Employer-Sponsored Plans Less Than Expected
Researchers found that the negative effects to employer-sponsored plans may be lower than expected and predicted the churn within and between markets in the health payer industry. Continue Reading
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23 Jul 2020
Payers Turn to In-Home Screening Kits for Chronic Preventive Care
Since some chronic preventive care services can only be done physically and not via telehealth, payers are designing kits for members to test themselves. Continue Reading
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23 Jul 2020
Payers Split on Factoring COVID-19 into 2021 Premium Rates
The 63 filings that have been made public shed some light on payers’ justifications for whether to consider coronavirus when setting 2021 premium rates. Continue Reading
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22 Jul 2020
Payer Helps Employers Recognize, Address Workforce Mental Health
Independent Health’s partnership aims to help employers identify workforce mental health conditions and navigate subsequent, sensitive conversations. Continue Reading
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22 Jul 2020
Molina Healthcare to Acquire Passport Health Plan Medicaid Plans
The acquisition is taking place in the aftermath of a heated Medicaid managed care contract dispute in which Passport Health Plan lost its managed care contract. Continue Reading
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16 Jul 2020
UnitedHealth Group’s Q2 Report Reveals Payer Progress, Priorities
The report starts providing answers to some of the questions payers faced at the end of the first quarter and outlines payer progress and priorities going forward through COVID-19. Continue Reading
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15 Jul 2020
Payer Fuses Value-Based Care, Support Payments for Small Practices
Blue Cross Blue Shield of Massachusetts is launching a new payment model for small practices that combines value-based care and support payments. Continue Reading
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14 Jul 2020
Walmart Forays Into Medicare with Walmart Insurance Services LLC
The retailer has been tight-lipped about the move but may be interested in selling Medicare plans through its new insurance arm, Walmart Insurance Services LLC. Continue Reading
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13 Jul 2020
Private Payer COVID-19 Reimbursement Rates Are Twice Medicare Rates
Even with the 20 percent boost in Medicare payments from the CARES Act, payers pay 1.8 to 2.1 times the Medicare rate for services related to coronavirus treatment. Continue Reading
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03 Jul 2020
Humana Ups COVID-19 Testing With At-Home, Drive-Thru Testing
The health payer will provide at-home or drive-thru COVID-19 testing for members who are displaying symptoms of or at-risk for the disease. Continue Reading
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02 Jul 2020
Vision Care Plans Generate High Member Satisfaction, Low Costs
Overall, 72 percent of patients reported that they were satisfied with their vision care plans, citing discounts and savings. Continue Reading