News

University Hospitals, Anthem start ACO for Medicare Advantage patients

To better coordinate care and reduce healthcare costs by improving communication between providers and insurers, Cleveland, Ohio-based University Hospitals and Anthem Blue Cross and Blue Shield have launched an accountable care organization that will serve patients in the insurer's Medicare Advantage plan, Crain's Cleveland Business reports.

Medi-Cal coverage of undocumented children needs work, advocates say

California's Medi-Cal expansion will cover the children of undocumented immigrants, but healthcare advocates in the state say that the coverage should guarantee that children can see doctors and that undocumented adults, too, have a right to healthcare.

The limitations of reference pricing

The California Public Employees Retirement System's (CalPERS) knee-and-hip experiment-- which saved $5.5 million in two years by capping hip and knee replacement procedures--understands how consumers' knowledge of the price of care affects insurer and provider-focused initiatives

Aetna-Humana merger could coax Anthem, Cigna to make a deal

The merger announced Friday between Aetna and Humana will not only have major implications for the insurers and their members, but it also may change the game for two other insurance giants locked in contentious takeover talks.

How Maryland's all-payer system transforms traditional payment models

For the past 18 months, Maryland has been implementing an all-payer system that shifts away from the fee-for-service reimbursement model and instead focuses on capped payments and rewards to providers who deliver quality healthcare at lower costs.

Challenges, benefits abound with Aetna-Humana deal

Now that Aetna and Humana became the first two major health insurers to merge, many questions remain about how the two companies will combine their operations and what the deal will mean for the health insurance industry.

States set cost limits for pricey prescription drugs

In an effort to limit consumer spending on specialty drugs, several states have capped the out-of-pocket payments of patients in private health plans. 

The argument for an all-payer system

One way to tackle the stubborn problem of skyrocketing, variable and opaque healthcare costs is to move to an all-payer system, according to an opinion piece published by The Hill.

State auditors slam Blue Shield of California

The California Franchise Tax Board shed some light on why the state revoked Blue Shield of California's tax-exempt status in a biting report it sent to the insurer in June, the L.A. Times reports.

Indiana's Medicaid program paves way for other states

Indiana's experimental Medicaid program, Healthy Indiana Plan, may pique the interests of Republican governors nationwide who remain on the fence about expanding the program.

To engage payers, HIEs must better meet their needs

To fully engage payers in robust and sustainable health data exchange, health information exchanges need to better align their value proposition with payers', according to research published at the Journal of the American Medical Informatics Association.

Aetna acquires Humana for $37B

Aetna will acquire Humana in a $37 billion deal, the companies announced Friday morning, becoming the first mega-insurers to pull the trigger amid months of merger rumors.

 

Medicare Part D plans cover majority of drugs used by dual-eligible consumers

Medicare Part D covers the bulk of medications commonly used by both Medicare and Medicaid beneficiaries, according to a new report from the Office of the Inspector General (OIG).

Public advocates, Kaiser Permanente wage war of words over mental health services

A war of words--and advertisements--is taking place in California over long-simmering allegations that Kaiser Permanente has failed to provide adequate treatment and insurance coverage for patients who need mental health services. A Kaiser spokesperson told FierceHealthcare that the Courage Campaigns' claims are just the latest efforts in an ongoing union smear campaign.

Publisher's Note

FierceHealthPayer will not publish Friday, July 3 in observance of the Fourth of July. We will return Monday with a brand new issue--enjoy your holiday weekend!...

Risk-sharing payments could affect future insurer mergers

Data on risk adjustment and reinsurance payments to insurers could play into future acquisitions, including any proposed deal for Humana.

The ACA's impact on insurer consolidation

With the uncertainty of King v. Burwell in the health insurance industry's rear-view mirror, the time might be right to strike acquisition deals. Economists, however, aren't sure whether payers will gain efficiencies.

4 keys to Covered California's exchange success

Since the first ACA open enrollment period, Covered California has enrolled 1.3 million residents, and 77 percent of individual enrollees pay less than $150 on monthly premiums. Yesterday, the state exchange's executive Director, Peter Lee, outlined four keys to its success. 

Health insurance execs and others react to King v. Burwell ruling

Major insurance companies and execs reacted to last week's Supreme Court ruling in King v. Burwell with a decidedly sunny vibe.

ACA risk adjustment program forces Mass. insurers to pay millions

Massachusetts' state Connector Authority notified 16 health insurance companies this week of changes affecting them as a result of the new payments and charges under the Affordable Care Act's risk adjustment program.