Innovation Meets Insurance: 5 More Disruptive Payers | FierceHealthPayer

FierceHealthPayer has recognized five more payers that recognized the growing trends this year and made leaps and bounds to revolutionize both their businesses and the industry. Click here to read the article.

Humana Once Again Named Top Payer in athenahealth® PayerView® Rankings

LOUISVILLE, Ky.–(BUSINESS WIRE)–For the second year in a row, Humana Inc. (NYSE: HUM) was ranked as the number one company for its ease of doing business with providers. Humana ranked number one in overall performance among 148 U.S. health insurers based on a review of 2013 claims-payment data conducted by athenahealth, Inc. (NASDAQ: ATHN). Continue reading

Fallon Health Partners With Cognizant to Become the First Massachusetts Health Insurer to Provide Quotes for Merged Market Plans Under Affordable Care Act

TEANECK, N.J., Feb. 25, 2014 /PRNewswire/ — Cognizant (NASDAQ: CTSH) today announced that it has enabled Fallon Health, a Massachusetts-based not-for-profit health care services organization, to become the first Massachusetts health insurer to provide quotes for merged market plans mandated by the Affordable Care Act (ACA). Continue reading

PwC’s Health Research Institute Identifies the Top 10 Health Industry Issues for 2014

NEW YORK, /PRNewswire/ — Implementation of the Affordable Care Act (ACA) is only one of the factors forcing a rapid reshaping of the $2.8 trillion U.S. healthcare industry in 2014 according to PwC’s Health Research Institute (HRI). In its annual report on the Top Health Industry Issues for 2014, PwC’s HRI identifies the top 10 issues facing the U.S. health sector this year, including the need to adjust to empowered consumers, rapid innovation, and increasing competition from non-traditional players. The report includes the results of a survey of 1,000 U.S. consumers and interviews with health industry leaders that provide insights into the emerging new health economy.

The report notes that much of the health industry has accepted that reform is here to stay – and forward-looking executives are making decisions based on a post-ACA landscape that has altered the provision of insurance and the delivery of care. Continue reading

New Research Shows ACA Exchanges Will Compete with Private Insurers; None are Easy

CHANGE SCIENCES HEALTH INSURANCE INFOGRAPHICNEW YORK, /PRNewswire/ — Web researchers Change Sciences Group released new data this week comparing the insurance shopping experience on public health exchange web sites, including the new HealthCare.gov site, with the shopping experience on private health insurance sites. According to the research, the new HealthCare.gov site (released on November 30) offers an insurance shopping experience which is now on par with leading private insurer web sites such as Aetna, eHealth and Kaiser Permanente. Continue reading

Cigna ACO Showing Higher Quality, Lower Costs in First Year

CONCORD, N.H. & BLOOMFIELD, Conn., December 11, 2013 – Cigna today is reporting on the first-year results from its collaborative accountable care initiative with Granite Healthcare Network (GHN), a partnership among five independent charitable health care organizations in New Hampshire.

According to a Cigna release, the program is making strides toward achieving its goals of improved healthaffordability and patient experience.They also say the initiative has helped GHN deliver a higher level of care in New Hampshire while controlling total medical costs for its 30,000 patients who are covered by a Cigna health plan.

Cigna noted that when the program started last year, it evaluated how well GHN followed nationally recognized evidence based medicine guidelines (a measure of quality) and Continue reading

Will ACOs Usher in a New Era of HMO-Style Managed Care?

Amber May has published an article on BenefitsPro.com that recalls a time in the 1990s when HMOs were the biggest thing in health care. She points out that the most obvious benefit of an HMO system is the coordination of care the organizations facilitate and how, since 1995, the National Health Insurance Law in Israel made participation in one of the four Israeli HMOs compulsory for all Israeli citizens.

May points out that once again the United States is experimenting with managed care. She notes that the Patient Protection and Affordable Care Act (PPACA) is attempting to address the lack of care coordination that’s developed in the American health care system by creating provisions for accountable care organizations (ACOS), coordinated groups of health care providers that provide care for specific populations of patients and are accountable for the quality, cost and outcomes of that care.

She notes that through PPACA, ACOs are tied to Medicare and speculates that a universal managed care system similar to Israel’s may be a long way off for the U.S. – To learn more see benefitspro.com.

Towers Watson Acquires Liazon to Expand Private Benefit Exchange Offerings

A press release issued today by Towers Watson, the global professional services company, announced that it has acquired Liazon Corporation, one of the leaders in developing and delivering private benefit exchanges for active employees.

The release noted that this acquisition, which follows the purchase of Extend Health in June 2012, solidifies Towers Watson’s strength in the private exchange market through its OneExchange solution. Going forward, Towers Watson said it will continue to enhance Liazon’s private exchange solution and serve the needs of Liazon’s broker, consultant and carrier partners, some of which offer the Liazon product under their own brands.

According to the release, Liazon’s online benefit marketplaces are currently distributed through over 400 insurance brokers, including nine of the top 10 national firms, under either the Bright Choices® brand or as a third-party proprietary exchange.

Towers Watson said it plans to continue these relationships based upon their current terms and use the Liazon name in the market with its broker partners. Towers Watson indicated that it will also continue to offer its OneExchange solution, which primarily serves larger employers. The OneExchange and Liazon solutions together will help organizations of all sizes deliver self- and fully insured benefits to both employees as well as pre- and post-65 retirees in new and cost-effective ways, Towers Watson said.

 

 

Medical Home Common Theme in ACA State Grant Programs

We have been tracking some of the health plan innovations that are being funding as part of the Affordable Care Act. (ACA). Stateline, the daily news service of the Pew Charitable Trusts, has published an article that looks into the progress states are making in their efforts to grapple with the relatively high cost and low quality of U.S. health care.

Stateline notes that out of the $1.8 trillion the ACA is projected to cost over the next decade, $10 billion is dedicated to innovation programs. Susan Dentzer of the Robert Wood Johnson Foundation, a nonprofit group that promotes improvements in the U.S. health care system told Stateline, “The idea is to take governors up on their claim that states are the laboratories of democracy where meaningful innovations can occur.”

So far, Stateline reports, Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont have applied for funds under the under an ACA program called the State Innovation Models Initiative, and this year, they began testing new health care financing models. Another 19 states are in various stages of developing similar experiments. Continue reading

CMS to Providers Looking to Support ACA Premiums: Not so Fast!

On November 4, 2013, the Department of Health & Human Services, Centers for Medicare & Medicaid Services issued a Q&A warning hospitals, other healthcare providers, and other commercial entities that it had “significant concerns” about those entities  supporting premium payments and cost-sharing obligations with respect to qualified health plans purchased by patients in the Marketplaces.

The guidance stated that HHS has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces. HHS said it discourages this practice and encourages issuers to reject such third party payments. The agency said it intends to monitor this practice and to take appropriate action, if necessary. – See the Q&A at cms.gov.