Next Insurance Lands $250M Series D

Next Insurance, which aims to be the go-to insurance provider for any small business, has raised $250 million in a Series D round.

The company will use the new funding to expand the team, grow the brand by investing in marketing and customer acquisition, and most importantly, complete the product so that Next Insurance can be a “one-stop shop” for any kind of business’ insurance needs, Goldstein said. Read More: CrunchBase

Bright Health Raises $500M, Plans Expansion into Employer-Based Insurance

Insurance startup Bright Health raised another $500 million, as it plans to expand into new markets and offer small group plans. The company, which was co-founded in 2015 by former UnitedHealthcare CEO Bob Sheehy, offers individual market plans and Medicare Advantage plans. It uses a narrow-network model that involves partnering closely with one health system in each market.

The startup also is building out its presence in employer-sponsored health insurance. It plans to offer fully insured small business plans in Denver, Nashville, Memphis and Nebraska. It also plans to offer level-funded plans for companies with 20 to 100 employees and offer administrative services to large, self-insured employers. Read More: MedCityNews

Cigna Launches Evernorth To Accelerate Delivery Of Innovative And Flexible Health Service Solutions

Cigna Corporation (NYSE: CI) announces the launch of Evernorth, a new brand for its growing, high-performing health services portfolio. Evernorth will accelerate delivery of innovative and flexible solutions to meet the diverse needs of health plans, employers, and government organizations.

Evernorth provides a distinct and dedicated platform for the distribution of health solutions geared toward health plans, employers, and government organizations – inclusive of those without Cigna medical insurance. This enables Evernorth to partner deeply with, and provide unmatched and focused support to these groups, all guided by its unwavering commitment to make health care better. Read More: InsuranceNewsNet

A Health Plan Showing Up in New Ways Amid COVID-19

The idea that a crisis is an opportunity for improvement couldn’t be more true now that coronavirus disease 2019 (COVID-19) has made it easier to see the problems in the American health care system while also reminding us of some of its best parts. Most critically, it is further revealing inequities for all to see as some populations, particularly communities of color, are disproportionately burdened by systemic factors such as poverty, racism, lack of access to quality health care, and more.1 There is a dire need to demonstrate leadership in newer ways to transform and reenergize the structures and systems we depend on, from hospitals to health plans to governments that shape our health care system. Amid the current devastation wrought by the global pandemic, as a nonprofit health plan in California, we feel obligated to fight through the systemic deficiencies by engaging in innovative cross-sector partnerships, leveraging new technology to target key needs exposed by COVID-19, and addressing health inequities through technology-enabled community health workers (CHWs). Read More: AJMC

Humana Adds Two New Value-Based Payment Programs for Select Medicare Advantage Plans

Humana announced today the expansion of its value-based program portfolio by adding two new programs for members of select Humana Medicare Advantage plans.

The first is the coronary artery bypass grafting episode-based model for certain members undergoing heart bypass surgery. The model provides cardiothoracic clinicians with data and analytics as well as financial incentives for enhancing patient care, delivering a more coordinated care experience, and reducing unnecessary services readmissions and complications.

The other new program is Humana’s third orthopedic payment program and is for certain members undergoing total shoulder arthroplasty. This program also provides clinicians with data and analytics, and offers payments when better health outcomes are achieved and when lower-costing surgery sites, such as at ambulatory surgical centers, are selected. Read More: HealthCareFinance

How Highmark Health Embraces Disruption and Builds for the Future

The only constant is change, and today’s companies are grappling with change on a massive scale. Even during less eventful times, companies invest significant resources to manage their change initiatives with no guarantee of success.

When change processes do stick, they can succeed beyond leaders’ expectations, going deep enough to transform the organization’s very DNA. Some companies see that as a grim surprise. Some see it as a cultural triumph.

Highmark Health is among the latter. One of the largest integrated delivery and financing systems in the U.S., Highmark Health serves 40 million customers across Pennsylvania, Delaware, and West Virginia from its Pittsburgh home office, and is affiliated with the Allegheny Health Network’s (AHN) nine hospitals and more than 200 primary- and specialty-care practices. Read More: Gallup

The Value of Connected Behavioral, Medical and Pharmacy Benefits

For the fourth year in a row, Cigna’s Value of Integration study demonstrates that connecting medical, pharmacy and behavioral benefits increases customer engagement, supports the whole person and reduces total medical costs. The results leveraged methodology developed with KPMG in 2018, in a match-case control study that examined approximately 2.2 million customers over a 2-year period.  The study compared those who have Cigna integrated medical, pharmacy, and comprehensive behavioral vs. those who have Cigna medical and basic behavioral coverage.

The study also revealed that when benefits are triple-integrated with Cigna, the focus on body and mind results in a 32% lower mental health readmissions*, 18% fewer out-of-network behavioral claims*, 5% higher utilization of high-performing, in-network providers* and a 4% reduction in out-of-network claims. * This translates to savings for both the individual and their employer.  Read More: Cigna

Reference-Based Pricing is Getting Renewed Attention

Reference-based pricing is a market disruptor. It is a viable alternative to carrier-sponsored health plans where providers are paid on a Medicare Plus basis. For the first time, transparency allows consumers to price medical services prior to care being rendered. It also introduces provider accountability. Patients can access quality metrics and performance outcomes before scheduling appointments. This is in sharp contrast to traditional health plans where patients are billed after care is rendered and required to pay as presented. Employers are motivated to consider RBP plan alternatives since carrier plan assurances, over several decades have not contained cost nor managed care.

Using a cost-up pricing approach, RBP optimizes provider payments for medical services based on publicly available cost, pricing and quality data. It establishes fair pricing for medical services by geography to ensure equitable provider payments by market. In stark contrast to PPO health plans. RBP controls cost while managing medical inflation because it is tied to Medicare’s medical trend not arbitrary pricing. Critically important for RBP plans is enhanced patient/member satisfaction and improved outcomes as medical care is based on value and provider performance. Read More: BenefotsPRO

How Payers Can Calm Member Fears, Push Virtual Care Adoption

As the healthcare landscape is becoming more digitized, payers can take steps to prevent members from falling back into old, non-digital forms of care, a recent Accenture report highlighted.

The report followed up on Accenture’s previous 2020 Digital Health Consumer Survey, which had discovered that patient engagement technology adoption dipped for the first time.

That survey revealed that mobile phone and tablet app usage dropped from 48 percent of consumers using them in 2018 down to 35 percent using these devices and wearable technology dropped around 15 percentage points.

The new report examined whether this downward trend had changed in light of the coronavirus pandemic. Read More: HealthPayerIntellegence

New Aetna Health Plan Leverages CVS’s Retail Reach

The new plan, Aetna Connected, will offer no-copay appointments at CVS MinuteClinics and HealthHUBS, as well as 1- or 2-day prescription delivery, discounts on health-related items and greater access to CVS’s managed pharmacy network. It will be available to employers with 101 or more employees beginning this January.

As part of the health plan, CVS HealthHUBs will also offer concierge services to help facilitate communication between the patient’s primary care provider, pharmacy and Aetna’s Care Manager program. Read More: BenefitsPRO