Payer Issues

Piedmont Healthcare, Cigna reach value-based agreement

Atlanta-based Piedmont Healthcare and Cigna extended their contract multiple years under a new value-based agreement. By Morgan Haefner - 10/24/18

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Aetna's historic Medicare Advantage expansion: 3 things to know

Aetna will offer Medicare Advantage plans in an additional 358 counties and six states for the 2019 coverage year, the insurer said Oct. 22. By Morgan Haefner - 10/24/18
Why states are choosing to run their own ACA exchanges: 3 notes

Some states are opting to create and run their own eligibility and enrollment platforms for ACA-compliant individual plans instead of using the federally run marketplace, according to a Georgetown University Health Policy Institute blog post. By Morgan Haefner - 10/24/18

UnitedHealth, Aetna among 8 health plans vying to manage North Carolina Medicaid

In 2019, North Carolina will bring on private health plans to manage its Medicaid program, according to StarNews Online. By Morgan Haefner - 10/24/18
1 in 6 ER claims face denial if Anthem's policy becomes norm, study finds

Anthem's policy to retrospectively deny coverage for emergency care it deems nonemergent could land 1 in 6 patients with denied claims if widely adopted, according to a study published in JAMA Network. By Morgan Haefner - 10/24/18
NJ community hospital settles with BCBS after alleging it was pushed out of market

Ridgewood, N.J.-based Valley Hospital settled with Horizon Blue Cross and Blue Shield of New Jersey the day before a trial was set to begin on allegations that the insurer pushed smaller community hospitals out of the market, according to NJ.com. By Leo Vartorella - 10/24/18
Microsoft to debut employee health plan with Eastside Health Network, Premera Blue Cross

Microsoft will offer a new custom health plan option, dubbed the the Health Connect Plan, for some of its Washington state employees beginning in 2019. By Jessica Kim Cohen - 10/24/18

2019 Medicare Part A and B deductibles, premiums: 3 things to know

CMS released premium and deductible information for 2019 Medicare Part A and B plans. By Morgan Haefner - 10/23/18
Centene sees revenue jump 36% in Q3

Health insurer Centene saw its revenue increase in the third quarter of fiscal year 2018 as its managed Medicaid business grew. By Morgan Haefner - 10/23/18
Trump administration's new insurance guidelines for states, employers: 10 things to know

The Trump administration issued new guidelines and proposals aimed at giving states and employers more flexibility to waive ACA regulations. By Morgan Haefner and Kelly Gooch - 10/23/18
Most common type of state Medicaid breach? Misdirected letters, faxes

State Medicaid agencies are more likely to experience a breach affecting a single individual, rather than a large-scale incident affecting numerous patients, according to a report from the Office of Inspector General at HHS. By Jessica Kim Cohen - 10/23/18

15 insurers to enter MA market in 2019

The number of Medicare Advantage plans across the U.S. varies drastically, with as many as 50 plans available in some counties, according to an October data note from the Kaiser Family Foundation. By Morgan Haefner - 10/22/18
Oscar wants to use telemedicine for complex conditions: 3 notes

Health insurance startup Oscar Health intends to cover telemedicine services for members with complex care needs, according to Politico. By Morgan Haefner - 10/22/18
Humana expands MA footprint to New Jersey

Humana will enter New Jersey's Medicare Advantage market for the first time in 2019, the insurer said Oct. 19. By Morgan Haefner - 10/22/18
Idaho hospital's ER physicians ink retroactive agreement with BCBS

Pocatello, Idaho-based Portneuf Medical Center emergency room physicians are back in network with Blue Cross of Idaho, according to the Idaho State Journal. By Morgan Haefner - 10/22/18
Do private Medicaid plans boost quality, cost savings? Evidence is shaky, report says

Private health insurers now manage Medicaid programs in 38 states, according to Kaiser Health News. However, studies and government reports have failed to prove this model improves care quality or generates greater cost efficiencies. By Morgan Haefner - 10/22/18
Virginia to roll out Medicaid expansion Nov. 1

Virginia is preparing for Medicaid expansion, state Gov. Ralph Northam announced Oct. 18. By Kelly Gooch - 10/19/18
Aetna to pay $4.3M in attorney fees related to HIV privacy breach

Aetna agreed to pay $4.3 million to attorneys who represented plaintiffs of a class-action lawsuit concerning an inadvertent disclosure of their HIV status, according to Bloomberg Law. By Morgan Haefner - 10/19/18
BCBS of Louisiana to pick up 45K member health plan

Blue Cross and Blue Shield of Louisiana signed a definitive agreement Oct. 17 to acquire majority ownership of regional Vantage Health Plan for an undisclosed amount. By Morgan Haefner - 10/18/18
UnitedHealth paying $69B toward value-based agreements

UnitedHealth Group is spending $69 billion on value-based payments, up from $64 billion in 2017, according to Forbes contributor Bruce Japsen. By Morgan Haefner - 10/18/18

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