Payer Issues

UnitedHealth will advance its bundled payment initiatives: 3 things to know

UnitedHealth Group plans to increasingly work with physicians, health systems and the government to boost Medicare bundled payment programs. By Morgan Haefner - 2/23/18
38 New York hospitals get $24.2M in quality payments from Excellus BCBS

Excellus BlueCross BlueShield paid 38 hospitals in upstate New York $24.2 million in quality improvement payments in 2017. By Morgan Haefner - 2/23/18
Could freestanding birth centers and bundled payments slow spiraling costs for maternal care – and decrease C-Sections?

The steady rise in C-sections from 21 percent of births in 1996 to 32 percent today is a major quality and cost problem. By Malini Nijagal, MD, MPH, University of California, San Francisco, Bhargav Raman, MD, Carrum Health, Jeff Durkin, Healthcare Data Engineer & Sach Jain, CEO, Carrum Health - 2/22/18

Humana takes $148M hit from workforce cuts in 2017

Humana recorded charges of $148 million for a voluntary early retirement program and involuntary layoffs it initiated in 2017, according to financial documents filed with the Securities and Exchange Commission. By Morgan Haefner - 2/22/18
Ohio lawmakers consider banning tax breaks, state contracts from Anthem over ED policy: 4 things to know

Three Ohio legislators want to draft a bill barring insurers like Anthem who cover emergency department visits on a discretionary basis from state contracts and tax incentives, The Columbus Dispatch reports. By Morgan Haefner - 2/22/18
BCBS of Oklahoma error lands members with out-of-network notices

Blue Cross and Blue Shield of Oklahoma erroneously notified some members they would need to find new physicians or pay out-of-network rates, the Stillwater News Press reports. By Morgan Haefner - 2/20/18
Viewpoint: Medicare Advantage claims data should be made public

While claims-level data for traditional Medicare has been available for several decades, the same light has not been shed on Medicare Advantage data, according to an opinion article published by JAMA. By Morgan Haefner - 2/20/18

Anthem: It's not medically necessary for anesthesiologists to assist most cataract surgeries

Anthem will no longer cover monitored anesthesia care or general anesthesia for cataract surgery in most cases, according to a clinical guideline published Feb. 1. By Morgan Haefner - 2/20/18
HHS proposes executive order loosening regulations on short-term plans

In response to an October executive order by President Donald Trump, HHS proposed regulatory changes Tuesday that would extend the availability of short-term insurance plans. By Leo Vartorella - 2/20/18
New Mexico denies allegations of bias in awarding Medicaid contracts: 3 things to know

New Mexico officials rejected claims its selection of managed care insurers to run its Medicaid program was biased, the Santa Fe New Mexican reports. By Morgan Haefner - 2/19/18
2 OSF hospitals back in network with BCBS

Two hospitals recently acquired by Peoria, Ill.-based OSF HealthCare from Chicago-based Presence are back in network with Blue Cross Blue Shield of Illinois as of Feb. 16, The News-Gazette reports. By Morgan Haefner - 2/19/18

Anthem acquires America's 1st Choice: 5 things to know

Anthem completed its acquisition of America's 1st Choice, a privately held for-profit Medicare Advantage plan in Florida. By Morgan Haefner - 2/19/18
3 more states investigating Aetna after former medical director's comments

Colorado, Washington and Connecticut have joined California in investigating Aetna after one of the health insurer's former medical directors admitted under oath he never reviewed patients' medical records when deciding whether to approve or deny claims, according to CNN. By Ayla Ellison - 2/19/18
The state of value-based payments: 5 things to know from 117 financial executives

The Healthcare Financial Management Association asked 117 senior financial executives how hospitals, physicians and payers are feeling about using value-based payment models. By Morgan Haefner - 2/16/18
Anthem updates 'always pay' conditions under ER policy: 5 things to know

Anthem increased the number of "always pay" exceptions under its controversial discretionary emergency care policy. By Morgan Haefner - 2/16/18
Why Walgreens now appears less likely to acquire Humana or WellCare

Stock analysts have speculated that CVS Health's $69 billion deal to buy Aetna may push Walgreens Boots Alliance to purchase Humana or WellCare Health Plans, but those deals now appear less likely, according to TheStreet. By Ayla Ellison - 2/15/18
Aetna: Former medical director misrepresented our denial process

Aetna says comments a former medical director made under oath, which implied he never reviewed patients' medical records when deciding claim approvals or denials, are "a gross misrepresentation of how the process actually works." By Morgan Haefner - 2/15/18
BCBS of Minnesota CEO to step down: 3 things to know

Michael Guyette, president and CEO of Blue Cross and Blue Shield of Minnesota, will leave the insurer in March. By Morgan Haefner - 2/15/18
BCBS of Idaho to sell 5 plans bypassing ACA rules: 6 things to know

Blue Cross and Blue Shield of Idaho submitted a request to state insurance regulators Tuesday to sell five plans that do not comply with ACA requirements, as informed by the executive order signed by Idaho Gov. Butch Otter (R) in January, according to the Idaho Statesman. By Leo Vartorella - 2/14/18
Georgia hospital group sues Anthem over new ER and imaging policies

Atlanta-based Piedmont Hospital and five sister facilities have sued Blue Cross Blue Shield of Georgia and its parent company, Anthem, according to The Atlanta Journal-Constitution. By Ayla Ellison - 2/14/18

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