CVS Health, an American drug store chain that also operates walk-in health clinics and a pharmacy benefit business, in October 2017 was reported to be in talks to purchase Aetna Insurance in a deal that could be worth more than $60 billion based on Aetna’s current market value. This would make the purchase one of the largest in the history of the health industry. CVS, with the addition of

Management consulting firm McKinsey & Company in August 2017 published an article, “A 360-degree approach to patient adherence” that discusses how an insight-driven approach can help when patients drive up healthcare costs by neglecting their treatment regimens. The article points out that 50 to 60 percent of patients are likely to skip medications, follow-up appointments and other treatment protocols, which places them at risk for complications and overall worsening

U.S. healthcare organizations are finding it increasingly difficult to transition from fee-for-service to fee-for-value care because of competing priorities and uncertainty over regulations according to a report released in July 2017 by Ernst & Young’s Health Advisory Services.  The survey queried 700 U.S. healthcare professionals. Among the findings are four key factors that challenge the shift to value-driven care: System inefficiencies that escalate the cost of care delivery Clinical

Managing regulatory and compliance risk in the face of constantly evolving rules and guidelines is a significant challenge for both the payers and the providers who make up the United States’ healthcare industry, creating a market need for systems that can consistently support regulatory, reimbursement and compliance professionals. A June 2017 white paper from management consulting firm Frost & Sullivan, The Increasing Challenge of Managing Regulatory and Compliance Risk,

U.S. health insurance comparison platform HealthCare.com in June 2017 announced the launch of The CheckUp, a new online blog meant to equip Americans with the knowledge and insight to make better-informed decisions about their healthcare. More than one-third of Americans are unaware that “Obamacare” is another name for the Affordable Care Act, according to a poll conducted by Morning Consult earlier this year. Led by Ronald Barba, a veteran

Private insurance claim lines with opioid abuse and dependence diagnoses were found in every age group from 13-18 years to over 80 years, and in urban areas, in every age group from 13-18 years to 71-80 years. Further, claim lines with opioid abuse and dependence diagnoses were more concentrated among middle-aged people in rural settings, and young and middle-aged people in urban settings. These findings are based on a

The Provider Data Action Alliance, a U.S.-based non-profit cross-section of healthcare leaders, in July 2017 began work on a wide-ranging effort to improve the accuracy of provider data for industry stakeholders and patients. The alliance, which represents health, dental and vision plans; provider organizations, health systems, government and health information exchanges, has developed a roadmap that articulates actionable strategies and vision for obtaining and sharing high-quality provider information that

After much secrecy and no public deliberation, Senate Republicans finalized release their “draft” repeal and replace bill for the Affordable Care Act on June 22. Unquestionably, the released “draft” will not be the final version.

There is increasing international emphasis on patient-centered care at all levels of health services. This shift recognizes that it is the patient, not the doctor, who should drive health care decisions. Patient-centered care involves acknowledging that each patient is unique and health care decisions should be guided by individual needs, values, and preferences (Table).

In a letter addressed to leaders in the United States’ House of Representatives and shared with all House and Senate members, the American Academy of Actuaries’ Individual and Small Group Markets Committee and Medicaid Subcommittee in April 2017 provided an actuarial perspective on the American Health Care Act (AHCA). The analysis examines the effects on enrollment and on the risk pool of the AHCA’s replacement of the individual mandate

IPMI provider Now Health International in May 2017 announced that, after a comprehensive product review, they are offering significant changes to their flagship WorldCare product. The enhanced version of WorldCare will include a simplified annual deductible structure, higher benefit limits, and new added value services in response to feedback from its members and distribution network. Key enhancements include: Simple annual deductible Now based on a new deductible structure rather

Patient-centric healthcare starts with sharing decisions with physicians. Politicians and policymakers are discussing what parts of the Affordable Care Act to change and what to keep. While most of us have little control over those discussions, there is one health care topic that we can control: what we talk about with our doctor.

Healthcare reform in the U.S. provides for a steady stream of commentary, and it is sometimes useful to repeat some basic truths about … insurance.

Management consulting firm Frost & Sullivan in April 2017 announced findings by its Transformational Health team that suggest that analytics adoption among U.S. healthcare payers and providers is not consistent, and that some health systems might utilize advanced enterprise data processing architecture to derive patient-specific insight for every episode of care. Healthcare analytics is widely considered as the key enabler of value-based care, and robust use of analytics allows

Actuarial firm Milliman in March 2017 released its annual report on the U.S. commercial health insurance market’s financial results . Based on medical loss ratio data submitted in 2016 to the Centers for Medicare and Medicaid Services, the report provides a clear picture of health insurers’ financial experiences in each year, and provides a final accounting of insurers’ financial results after “3R” transfer payments have been completed. The report

Remarks by President Trump in Listening Session with Health Insurance Company CEOs Source: The White House, Office of the Press Secretary February 27, 2017 THE PRESIDENT:  You are the big ones.  You are the biggest of the big, right?  (Laughter.)  That’s very impressive.  Thank you for being here.  We just had a great meeting with the governors on the horrible effects that Obamacare is having.  We’re going to change

The U.S. district court for the District of Columbia in February 2017 has blocked health insurer Anthem’s proposed merger with Cigna, citing antitrust concerns in respect of large national employers. Anthem announced it will appeal the decision, whilst Cigna “evaluates its options”. U.S. district judge Amy Berman Jackson found that “the merger is likely to result in higher prices”. Earlier in 2017, the same U.S. district court had found

The U.S. District Court for the District of Columbia in January 2017 found that Aetna’s proposed merger with Humana fell afoul of antitrust laws and ordered it to stop. According to Judge John Bates, the efficiencies generated by the merger will not be sufficient to mitigate the anti-competitive effects for consumers, specifically in respect of individual Medicare Advantage plans and of individual commercial insurance on the public exchanges in

All over the world, people are living longer. A large part of this is due to improved treatment for illness; we can see this in the reduction in death rates from cardiovascular disease and the 32% reduction in mortality from chronic obstructive pulmonary disease worldwide in the past 20 years.

HealthMine, a healthcare technology company based in Dallas, Texas, in August 2016 released the results of a study revealing that the majority (62%) believe that all health care plan participants should join a wellness program to help them lower their health care costs. 32% responded that wellness programs helped them reduce the number of sick days logged, and 33% said their wellness program helped them be more productive at

Connecture, an IT company that provides web-based solutions to the health insurance industry, in June 2016 acquired its Chicago-based competitor ConnectedHealth, a benefits technology company that offers an e-commerce platform that helps businesses control costs and ease the process of shopping for personalized insurance benefits online. ConnectedHealth is a private company and was founded in 2009. Based in Brookfield, Wisconsin, Connecture is a provider of a web-based consumer shopping,

CareAllies, a new subsidiary of Cigna, was established in June 2016 to help health service providers transition away from fee-for-service business models to those that encourage greater risk-sharing by establishing their own care organizations or even their own health plans. These goals – value-based reimbursement schemes – are similar to those of UnitedHealth Care’s subsidiary Optum. CareAllies will work with private and public providers to provide the technology and

The average cost of care for a typical American family of four covered by an average employer-sponsored PPO has more than tripled from an average of $8,414 for a family of four in 2001, to the current average of $25,826 according to a report by the Milliman Medical Index. While the percentage increase of 4.7% is the smallest yearly increase yet, it is still well above the increase in

The National Center for Health Statistics (NHCS) in May 2016 reported that the percentage of Americans without health insurance has dropped below 10%, mostly due to provisions in the 2010 Affordable Care Act (ACA) that give federal premium subsidies to low-income individuals to help them underwrite the cost of health insurance. In many cases, the insured pay little or no money to be included under health plans available in

Researchers warn against a particular strain of E-coli bacteria found in Chinese farms and patients that is proving to be resistant to a particular group of veterinary antibiotics called polymyxins. This group of antibiotics is considered to be the last line of defense against food-borne bacteria such as E-coli and salmonella, and its overuse has created a polymyxin-resistant bacteria strain according to a report released in November 2015 in

Health care costs will continue to rise worldwide in 2016 according to the Willis Towers Watson (WTW) 2016 Global Medical Trends Survey of 174 insurers in 55 countries, employers in 34 countries, and 30,000 employees worldwide who have employer-sponsored health benefits. As private medical insurance costs continue to rise, from 7.5% in 2014 and 8.0% in 2015 to a projected 9.1% in 2016, WTW noted that more than half

250 U.S. employers, representing nearly 7 million workers, recently took part in the “2016 Hot Topics in Retirement and Financial Well-Being” survey conducted in late 2015 by Aon Hewitt that revealed plans by large employers to expand their current financial well-being programs for their employees in 2016. The survey indicated that 55 percent of employers currently offer some sort of help for workers in the areas of budgeting, money