Employers, Physicians and Insurers all Moving Away from Fee-for-Service Model

The health care industry has slowly been pushing away from the traditional “fee for service” model over the past several years, embracing outcome- and value-based payment models. Now, with many health care providers struggling financially and in danger of closing permanently amid the COVID-19 pandemic, the need for a new model is ever more apparent.

“Due to COVID-19 primary care practices are on life support,” Elizabeth Mitchell, president and CEO, Pacific Business Group on Health, said in a press release. “Employers know that primary care is essential to a healthy workforce. Businesses believe now is the time to take action and harness the lessons learned from the pandemic to fundamentally reorganize primary care and reinvent our health system.”

PBGH is one of several employer groups joining the effort, the first of its kind between a primary care organization and employer coalition. The collaboration will build on the principles of advanced primary care (APC), which focuses more on quality of care and patient outcomes, as opposed to physicians being forced to rely on patient volume to meet financial needs. Read More: BenefitsPRO

Sidecar Health Raises $20 Million to Provide Transparency and Consumer Choice to Health Insurance

Health insurtech company Sidecar Health has raised $20 million in its most recent funding round. The company intends to save the U.S. $1 trillion in healthcare costs annually by empowering consumers to shop around for health services using its Visa payment card and mobile app. The round was led by Cathay Innovation and joined by new investors Comcast Ventures, Kauffman Fellows and Anne Wojcicki, co-founder and CEO of 23andMe. Previous investors GreatPoint Ventures and Morpheus Ventures also participated meaningfully in the round. The company has raised $40 million to date.

The funding will be used to fuel company growth by expanding to new geographies and growing the Sidecar Health team. With Coronavirus-related job losses leaving an estimated 26.8M people without employer-provided health insurance, according to an analysis by the Kaiser Family Foundation, the time is right to offer consumers a new solution to the healthcare crisis.

Sidecar Health offers a new approach to health insurance, allowing its members to take advantage of doctors’ discounted “self-pay” or “cash” rates, saving members 40% compared to traditional insurance. Its proprietary payment technology lets members pay doctors at the time of care from the plan’s claims account using a Sidecar Health Visa card. Sidecar Health’s approach enables members to comparison shop for care as they would for any other product or service, bringing market forces to healthcare that will ultimately lower costs. Read More: BusinessWire

Beyond Covid-19: 5 opportunities for startups to reshape the future healthcare landscape

The novel coronavirus pandemic has upended the world as we know it, taking an unprecedented toll on health and human life. The healthcare ecosystem has quickly mobilized to mitigate the crisis – modifying care access points and modalities while producing financing mechanisms to sustain patient care amidst dire circumstances.

Targeted evolution around key areas of change will be required to successfully navigate the healthcare world beyond Covid-19. We believe the areas that will require the most adaptation are in value-based care payment models, digitally integrated and tailored care delivery and automation. As the healthcare industry begins this dynamic journey, we believe early-stage companies have a once-in-a-generation opportunity to shape the future ahead. Read More: MedCityNews

‘Alexa, refill my prescription.’ Anthem launches voice-activated health plan assistant

Anthem Blue Cross and Blue Shield in Connecticut has launched its enhanced Anthem Skill program for its medical and dental health plans. Anthem plan holders will be able to order prescription refills and take other health plan actions through Alexa-enabled devices like the Amazon Echo or the Alexa app.

As part of its efforts to provide members with a digital first healthcare experience, Anthem Skill offers 24/7, voice-activated access to their health and dental plan benefit information. Read More: ebn

HealthEdge Software Acquires The Burgess Group

HealthEdge Software, Inc.® (“HealthEdge”), a provider of the industry’s leading integrated financial, administrative and clinical platform for health insurers, HealthRules® Payor, today announced the acquisition of The Burgess Group, LLC (“Burgess”), an innovative payment integrity software company focused on improving healthcare payment operations through technology.

“The acquisition of Burgess is a great strategic fit for HealthEdge to enter the large, high-growth market of payment integrity, helping address the estimated $1 trillion in wasteful spending in the U.S. healthcare system. This partnership will extend HealthEdge’s best-in-class claims processing to include software-driven payment integrity, actioned before a claim is paid, delivering significant value to health plans beyond what is available in the market today,” said Ram Jagannath, Global Head of Healthcare for Blackstone Growth and Chairman of HealthEdge. Read More: BusinessWire

Appeals Court Upholds Short-Term Health Plan Expansion

While the Trump administration has been busy chipping away at the provisions of the Affordable Care Act, it’s also been expanding some alternative, lower-cost options, including short-term health insurance plans. And as the administration faces legal challenges to its attacks on the ACA, last week it earned a win against a legal challenge to its 2018 decision to expand short-term health plan term limits.

On Friday, in a 2 to 1 decision, a court of appeals rejected an argument that the Trump administration acted beyond its scope and in conflict with the intent of the law.  Judges Thomas Griffith and Gregory Katsas, who upheld the rule, wrote: ”To be sure, Congress hoped that most individuals would purchase ACA-compliant plans as their primary insurance, and it provided incentives to encourage them to do so. But it did not foreclose other options.” Read More: BenefitsPRO

Cigna Takes Action To Combat Systemic Racism And Improve Equity And Equality

BLOOMFIELD, Conn., July 17, 2020 — Cigna Corporation today issued a statement on systemic racism and a commitment to equity and equality:

“Racism and discrimination are destructive forces in any society,” said David Cordani, Cigna President and Chief Executive Officer. “We, as a global health service company, firmly and unequivocally denounce racism and discrimination in all forms and are committed to confronting these issues with intensity, empathy and accountability.”

In furtherance of this commitment, today we proudly launch our new Building Equity and Equality Program, a five-year initiative to expand and accelerate our efforts to support diversity, inclusion, equality and equity for communities of color.  Our mission is to improve the health, well-being and peace of mind of those we serve.  Key components of the programs include:

  • Improve Health
  • Improve Well-Being
  • Improve Peace of Mind

Read More: Cigna



Your Fitness Tracker Might Be Able to Predict COVID-19

Oura and other fitness-tracking companies, like Garmin and Whoop, think body-temperature, breathing, and heart-rate data from their devices can do more than assess recovery and improve fitness—they might also help users know when they’re getting sick days before they do. And with that information, perhaps they wouldn’t go out to the grocery store and get close to others. Or visit an older relative. Or decide to go for a long run, which could potentially dampen their immune system enough to give the virus an upper hand. If enough people were using trackers, public-health institutions could even use the data to create a sort of infectious disease “weather map” that alerts the public about trends in diseases like the coronavirus.

What makes these trackers compelling to researchers is that they constantly measure your body—day and night. This is different than, say, going to a doctor, who takes one measurement at one point in time. “You can think of it as analogous to your radio being on for one second a day versus all day,” says Smarr. “With just a second, all you know is that a signal is coming through. Leave it on all day, and you can hear music.” This means you can also notice an oddity that indicates an oncoming illness. Read More: Outside

10 Million Americans Expected to Lose Employer-Sponsored Insurance this Year

The COVID-19 pandemic has wreaked havoc on nearly every aspect of our health care system, including the group insurance market. As unemployment levels soar, an estimated 10.1 million people will lose their employer-sponsored insurance, according to a recent analysis from the Robert Wood Johnson Foundation and the Urban Institute.

Overall, employer-sponsored health insurance enrollment is estimated to drop by 7.3 million, as many of those who lose their current coverage will switch to a family member’s plan. As noted by other studies, many of those who lose their insurance will opt to enroll in Medicaid or purchase a plan on the ACA exchanges, and some will simply go without, adding to the current uninsured rate. According to the study, the uninsured rate is estimated to hit 9.2% in states that have expanded Medicaid, and 15.6% in states that have not. Read More: BenefitsPRO

Health Insurers Call on Congress to Provide New Funding for Coverage Amid Pandemic

Health insurance companies are calling on Congress to provide more funding to help people keep coverage, citing the more than 44 million who have filed for unemployment since the coronavirus crisis started.

The two main health insurance lobbying groups, America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association, wrote a letter to congressional leaders on Friday making a range of requests for the next coronavirus response package, expected later this month.

“The adoption of each of these recommendations is critical to assuring that health insurance providers are able to deliver coverage that is reliable and high value in all markets,” the letter states. Read More: The Hill