Health Plan Business

From The AIS Report on Blue Cross and Blue Shield Plans - Almost one year into its oncology pathways initiative, Anthem, Inc. continues to expand the program aimed at rewarding oncologists for providing high-quality cancer care. Through the Anthem Cancer Care Quality Program — which is implemented through Anthem subsidiary AIM Specialty Health — oncologists in Anthem’s network can enroll patients in the program, select a treatment regimen that is on pathway and then file a claim to receive $350 per month for monthly management. They also receive a one-time $350 payment when initiating therapy for planning the treatment and coordinating care. And when providers select on-pathway regimens that need prior authorization, approval… Read more

From Health Plan Week - State legislatures are stepping into the ring in the fight over the rising cost of pharmacy drugs, introducing bills designed to limit the costs to consumers through a myriad of methods, including improved price transparency and capping member copays. Measures proposing those regulations, for instance, are currently in play in the Oregon House of Representatives, sparking an intensive debate among advocacy groups, health insurers and pharmaceutical companies. Read more

Health Plan Business Blog

By Patrick Connole - April 14, 2015
When health insurance mega-major UnitedHealth Group recently said it would acquire independent pharmacy benefit manager Catamaran Corp. for a little under $13 billion, it set the stage for a test of which business model in the PBM space will win out, or if different strategies can survive in the...
By Jill Brown - April 7, 2015
Cesarean births have risen by more than 50% over the last 10 years, despite growing efforts to curtail use of the procedure. But a California bundled payment pilot involving four hospitals and two insurers showed rapid improvement. “The big question is: Can you take a hospital with a high C-...
By Patrick Connole - April 6, 2015
The wave of health plan creation from the provider side of the sector has made headlines as it becomes apparent that the evolution of the marketplace attracts new players and new models of issuers. One such venture built from the ground up by North Shore-Long Island Jewish (LIJ) Health System in...

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