Minnesota health insurers reported $687 million in operating losses for 2016, according to information released today by the Minnesota Council of Health Plans. Medical reserves were tapped to pay for doctor visits, nursing, hospital stays, medications and other care.

Overall, revenue from premiums increased 4 percent over the prior year to nearly $25.9 billion, while expenses increased 6 percent to $26.6 billion. State public programs accounted for more than half of the overall red ink, followed by continued losses in the individual market. Insurance employers provide remained steady. On average, health insurers paid $763 per second for care. To pay those bills, insurers withdrew nearly $560 million from state-mandated medical reserves.

Sirius International Insurance Group, Ltd. has acquired ArmadaCorp Capital, LLC., a market leading provider of supplemental healthcare insurance products and administration services in the United States. [Read more…]

The Texas Association of Freestanding Emergency Centers (TAFEC) supports legislation introduced in the Texas Legislature aimed at increasing oversight of health insurance companies and protecting consumers from surprise medical costs. [Read more…]

More than half of commercially-insured patients’ out-of-pocket spending for brand medicines is based on the full list price, according to a new analysis from Amundsen Consulting, a division of QuintilesIMS. The data also show cost -sharing for nearly one in five brand prescriptions is based on the list price. [Read more…]

The Pharmaceutical Care Management Association (PCMA) today released the following points regarding a new PhRMA report on patient out-of-pocket spending:

— According to the Centers for Medicare and Medicaid Services (CMS), the average amount spent out-of-pocket for drugs continues to decline, projected to be 13% of drug spending in 2016, down from 23% in 2006.

— Rising drug costs is a pricing problem, not a coverage problem. Health plans don’t have unlimited funds to pay first dollar coverage on every drug, regardless of its price.

— The simplest, most obvious way for drugmakers to reduce costs and improve access is to cut their prices.

— The report ignores the most obvious and important point: rising out-of-pocket costs are a by-product of rising drug prices and the wave of new high-priced specialty brands coming to market.

— While not all health plans apply manufacturer rebates to reduce cost-sharing on each drug, it’s usually because the savings are being used to reduce premiums.

— Higher cost-sharing on certain brand drugs is often used to promote less expensive but equally effective generics, which comprise almost 90% of prescriptions.

— The employers and unions that offer coverage know better than the drug industry what’s best for their patient populations. Whether health plans decide to reduce costs by reducing premiums for all or cost-sharing on certain drugs should be up to them – not drugmakers.

PCMA is the national association representing America’s pharmacy benefit managers (PBMs). PBMs administer prescription drug plans for more than 266 million Americans who have health insurance from a variety of sponsors including: commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, Medicaid plans, and others.

SOURCE Pharmaceutical Care Management Association

WellCare Health Plans, Inc. (NYSE: WCG) today announced that it will release its financial results for the first quarter of 2017 on Wednesday, May 3, 2017, at approximately 6:00 a.m. EDT. The company will also host a conference call at 8:00 a.m. EDT that morning to discuss its financial results. [Read more…]

DW Healthcare Partners, a private equity firm focused exclusively on the healthcare industry, announced today the closing of its fourth fund totaling USD $295 million in total capital commitments. This brings DW Healthcare Partners’ total capital under management to USD $800 million. [Read more…]

Symbility Solutions Inc. (“Symbility”) (TSX.V: SY), a global software company focused on modernizing the insurance industry, confirmed that it will release its fourth quarter and full year 2016 financial results before market open Tuesday, April 11, 2017. The press release, with accompanying financial information, will be posted on the Symbility’s website at www.symbilitysolutions.com and on www.sedar.com [Read more…]

ASPiRA Labs, a Vermillion company (NASDAQ: VRML), today announced it has signed an in-network, contracted agreement with TriCare South for ASPiRA’s U.S. FDA cleared, Centers for Medicare and Medicaid Services (CMS) covered, American College of Obstetricians and Gynecologists (ACOG) Level B recommended ovarian cancer risk assessment test, OVA1® (Multivariate Index Assay or MIA). TriCare South serves about 2.5 million beneficiaries in the states of Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee, Texas (excluding El Paso) and Fort Campbell, Kentucky. [Read more…]

Combined Insurance, a leading provider of individual supplemental accident, disability, health, and life insurance products, and a Chubb company, demonstrates its continued commitment to giving back to U.S. servicemen and women with a $30,000 donation to Luke’s Wings—recipient of the company’s philanthropic sales program for the third consecutive year. [Read more…]

It is that time of year when offers of university places start to drop into electronic mailboxes around the world. Higher education is big business now, places at UK universities are some of the most sought after in the world. These institutions will often charge overseas student annual fees of well over £25,000, so for the parents, ensuring the success of the academic investment is as significant as it is for a company sending key employees abroad. [Read more…]

Recondo Technology, the market leader in cloud-based single-platform revenue cycle management (RCM) solutions, has released a suite of application programming interfaces (APIs) to significantly streamline payment, improve patient satisfaction, and simplify technology innovation. [Read more…]

Centene Corporation (NYSE: CNC) has appointed former Missouri Attorney General Chris Koster to Senior Vice President, Corporate Services effective today. Mr. Koster will report directly to Chairman, President and CEO Michael F. Neidorff, and will assist in business-related issues, outside of Government Relations, for Centene’s locally-based health plans across the country. [Read more…]

Talix, Inc., a premier provider of risk analytics solutions for value-based care, today announced that Shahyan Currimbhoy, senior vice president of product management and engineering at Talix, and Karena Weikel, ASA, FAHM, CSFS, vice president of risk and revenue management at Geisinger Health Plan (GHP), will be presenting at the 2017 RISE Nashville Summit. The summit takes place March 6-8, 2017 at the Omni Nashville Hotel in Nashville, Tenn. [Read more…]

Don’t repeal the Affordable Care Act (ACA) without specifying what will replace it. This is among the policy recommendations issued by the National Alliance of Healthcare Purchaser Coalitions (National Alliance), a nonprofit, membership association of employer led coalitions across the country serving 12,000 purchasers and 41 million Americans.

Additional recommendations include:

— Preserve employer-sponsored coverage by refraining from capping the individual tax exclusion for premiums and continue to allow businesses to fully deduct the costs.

— Avoid increasing the number of uninsured individuals, as the cost of their inevitable medical care will get shifted to those who do pay the bills.

— Continue to move away from fee-for-service (or “volume-based reimbursement”) toward alternative payment models that reward providers for good outcomes and high quality, not medical errors, unnecessary procedures and other low value care. Preserve the ability of the federal government to partner in these efforts (Center for Medicare & Medicaid Innovation and other value-promoting elements of the ACA, and the Medicare Access and CHIP Reauthorization Act of 2015).

— Expand assistance to states, regions, and local communities promoting transparency by pushing hospitals and medical groups to report on the quality of care they provide.

— Support comparative effectiveness research. Employer-purchasers need to know which new or higher cost therapies result in outcomes that are significantly better, somewhat better, about the same, or worse than current or less costly options.

— Allow employer-purchasers maximum flexibility in experimenting with benefit designs.

A Purchaser Viewpoint on Health Policy in Transit is the result of a collaboration of the National Alliance’s Government Affairs Affinity Group led by members including the Louisiana Business Group on Health, Midwest Business Group on Health, Minnesota Health Action Group, Pacific Business Group on Health, and Wyoming Business Coalition on Health.

In three new issue briefs, the American Academy of Actuaries examines a number of key public policy considerations that policymakers should weigh when evaluating specific proposals for reforming or replacing the Affordable Care Act. Developed by the Academy’s Individual and Small Group Markets Committee, the papers address high-risk pools, selling health insurance across state lines, and association health plans. [Read more…]

America’s leading nursing organizations and the over 3.5 million nurses they represent, today called on the Trump Administration and Congress to prioritize patient health and the patient-provider relationship in any health reform proposals. [Read more…]

Consumers are just beginning to discover that Anthem eliminated coverage for out-of-network doctors now that the Affordable Care Act “Open Enrollment Period” to secure health coverage for 2017 ended on January 31. [Read more…]

Aflac, the leader in voluntary insurance sales at the worksite in the United States, is making it even easier for customers to access much-needed financial support while they are in the hospital. [Read more…]

Employer-sponsored health insurance is greatly affected by geographic region, industry, and employer size. While some cost trends have been fairly consistent since the Patient Protection and Affordable Care Act (ACA) was put in place, United Benefit Advisors (UBA) finds several surprises in their 2016 Health Plan Survey. [Read more…]

Secretary of Health Dr. Karen Murphy is urging the commonwealth’s U.S. Congressional delegation to consider the effect that repealing the Affordable Care Act (ACA) could have on all Pennsylvanians, especially children and seniors in need. [Read more…]

Discern Health has announced their affiliation with Mai Pham, MD, MPH as a Senior Advisor. Mai most recently served as Chief Innovation Officer at the Centers for Medicare & Medicaid Innovation (CMMI). Among other achievements at CMMI, Mai spearheaded development and implementation of the alternative payment model (APM) portion of MACRA, which will fundamentally change the way that Medicare pays for physician services. [Read more…]

International Medical Group® (IMG®), a leader in global benefits and assistance services, has named Craig Peters as chief revenue officer (CRO). [Read more…]

Hospitals and health systems in New Jersey have already absorbed nearly $1.5 billion in funding cuts since the Affordable Care Act was enacted in 2010, with the promise of expanded healthcare coverage to mitigate these losses. As the 115th Congress advances legislation to repeal major provisions of the ACA, healthcare providers are concerned the cuts will remain despite the coverage of 796,291 state residents being jeopardized. [Read more…]

The President and CEO of the Senior Care Pharmacy Coalition (SCPC) today predicted the increasingly apparent role of Pharmacy Benefit Managers (PBMs) as unaccountable middlemen in the national drug pricing chain will result in a higher level of scrutiny from Congress, regulators and the media in 2017. [Read more…]

The Permanente Medical Groups serving Kaiser Permanente members and patients across California received 5-star ratings for overall performance — the highest recognition possible by the California Office of the Patient Advocate — in the second annual Medical Group Report Card for Medicare Advantage Members. [Read more…]