| 04.26.17 | Anthem CEO talks exchanges, PBMs, Cigna merger

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April 26, 2017 Subscribe Our Team Contact Us
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Today’s Rundown

  1. Anthem CEO Joseph Swedish talks ACA exchange plans, Express Scripts rift, Cigna merger
  2. GOP finalizes healthcare bill changes; funding battle over ACA subsidies continues
  3. 4 ways to stabilize the individual marketplaces
  4. [Sponsored] Blair Uses Advanced Analytics to Increase Medicare Stars Rating to 4.5*
  5. OIG’s chief data officer explains how analytics uncovered a $1B fraud scheme

Featured Story


Anthem CEO Joseph Swedish talks ACA exchange plans, Express Scripts rift, Cigna merger

Wednesday, April 26, 2017 It is still too soon to say what Anthem will do about the individual marketplaces next year, CEO Joseph Swedish said Tuesday, noting that a lot depends upon whether the government decides to keep funding a key Affordable Care Act subsidy. Swedish also commented on the insurer’s strained relationship with Express Scripts and its appeal of a judge’s ruling against its merger with Cigna.


GOP finalizes healthcare bill changes; funding battle over ACA subsidies continues

Wednesday, April 26, 2017 Republicans have finalized a revised plan to repeal and replace the Affordable Care Act, which includes changes that have brought some conservative GOP lawmakers on board but may have alienated moderates. Meanwhile, Congress is continuing to negotiate another key piece of the ACA: funding for cost-sharing reduction payments.


4 ways to stabilize the individual marketplaces

Wednesday, April 26, 2017 The future of the Affordable Care Act is still unclear, but a few key steps could make the law’s beleaguered individual marketplaces more sustainable, according to a new report. “Actions need to be taken to reduce legislative and regulatory uncertainty and to improve market stability,” said the American Academy of Actuaries.


[Sponsored] Blair Uses Advanced Analytics to Increase Medicare Stars Rating to 4.5*

Monday, April 24, 2017 Geneia’s advanced analytics coupled with its three-step process helps payers attain the coveted Medicare Stars rating of four or more stars. Read how.  


OIG’s chief data officer explains how analytics uncovered a $1B fraud scheme

Tuesday, April 25, 2017 To hear one Department of Health and Human Services senior official tell it, a $1 billion Medicare fraud scheme was “hiding in the data.” All it took was some targeted analytics to tease it out. The OIG has increasingly relied on data to improve fraud detection, but last year’s massive bust was a moment of clarity for the OIG’s Chief Data Officer Caryl Brzymialkiewicz after she saw how analytics could influence investigations.

News of Note

The integrated health system Partners HealthCare and the software company Persistent Systems are collaborating to develop an “industrywide open source platform” with the goal of bringing digital transformation to clinical care. Announcement America’s Health Insurance Plans outlined recommendations for how health plans and government regulators can work collaboratively to enhance the flexibility, innovation and efficiency of the Medicare Advantage and Part D programs. Letter (PDF) While President Donald Trump had promised religious groups that he would reverse the Affordable Care Act requirement that employers provide birth control to their employees, his Justice Department indicated Monday that it’s not yet giving up a fight with religious schools and nonprofits that are suing over the contraception mandate. The Washington Post article (sub. req.)

Resources


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Sponsored By: DocuSign The U.S. Department of Justice has collected upwards of $17 billion in settlements from the healthcare industry since 2009, including more than $2 billion from a single life sciences company.

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