Member Content

To access this category, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Harvard Pilgrim, Tufts Ink Merger Deal That’s Been ‘Percolating’

with Chart: Harvard Pilgrim/Tufts Deal Would Reshape Massachusetts Market

August 19, 2019

Harvard Pilgrim Health Care, Inc. and Tufts Health Plan said Aug. 14 that they intend to merge — a move that industry experts say will give them the scale they need to compete in an ever-more-consolidated health care market.

“There’s been massive consolidation in Massachusetts’ health systems and health insurance industry, and this is the latest and largest merger — but likely not the last,” Joseph Paduda, a principal with Health Strategy Associates, LLC, tells AIS Health.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Employers Seek Health Plan, PBM Help to Drive Innovation

August 19, 2019

As they continue to take a more active role in driving health care delivery system change, large employers are increasingly leaning on their health plan and PBM partners to devise and streamline innovative solutions.

That’s just one key finding from the 2020 Large Employers’ Health Care Strategy and Plan Design Survey conducted by the National Business Group on Health (NBGH), which also revealed a decrease in the share of companies offering only high-deductible health plans to their workers

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

August Proves to Be Challenging For Some Major Medicaid MCOs

August 19, 2019

It’s been a rough August in Medicaid managed care in various ways, as is perhaps best illustrated by two publicly traded giants in the field: CVS Health Corp.’s Aetna Medicaid unit and Centene Corp. Both Aetna Better Health of Louisiana and Centene’s Louisiana Healthcare Connections, incumbents together covering 500,000-plus Medicaid lives, recently learned they lost out on Louisiana’s Medicaid plan contracts for 2020.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Insurers Seek Modest ACA Rate Hikes for 2020

August 19, 2019

by Jinghong Chen As of mid-August, all states released their proposed individual market premium rates for 2020. Charts below detail the proposed year-over-year rate changes in 27 states in alphabetical order. Mississippi, Nebraska and Wyoming have only one insurer participating in the exchange. An infographic detailing rate filings of the remaining states appeared in the […]

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

News Briefs

August 19, 2019

✦ CMS is bringing the star rating system to the Affordable Care Act exchanges. Under the new Quality Rating System, all exchange plans will be given a rating on a scale of one to five based on three main factors: medical care, member experience and plan administration. Beginning with the 2020 open enrollment period, consumers shopping on the exchanges will see each plan’s five-star ranking.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

CMS Opens Additional Doors With 2020 Marketing Updates

August 15, 2019

In keeping with the administration’s theme of lessening the burden for Medicare Advantage and Medicare Part D organizations, CMS’s newly updated Medicare Communications and Marketing Guidelines (MCMG) contain multiple flexibilities that were previously unavailable to plan sponsors. These include a loosening of rules around co-branding, educational events and marketing of rewards and incentives programs (RI programs), as well as the ability to operate a call center dedicated to prospective enrollees.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.