Revenue Cycle and Payer News 8-27-2019

In the News:

CVS’ Aetna Targets 4 In 5 Medicare Seniors For Advantage Plans
Forbes reports that CVS Health’s Aetna health insurance business has an aggressive plan to woo more eligible Medicare beneficiaries in 2020 to increasingly popular Medicare Advantage plans.

To Save Money, American Patients And Surgeons Meet In Cancun
Kaiser Health News reports why it often makes financial sense for companies to offer employees medical treatment outside of the country. In the case of Donna Ferguson, not only was her knee replacement surgery 100% free but she and her husband received a $5000.00 check for choosing the option to be treated in Cancun, Mexico.

The CARIN Blue Button® Data Model and Draft Implementation Guide
Recently, the private sector released the CARIN Blue Button® data model and draft implementation guide as part of the White House Blue Button® Developers Conference. The CARIN Blue Button® draft implementation guide includes more than 240 claim data elements that have been agreed on by multiple regional and national health plans. These data elements are included in what we are calling the common payer consumer data set or CPCDS. We have taken these data elements and mapped them to HL7® FHIR® resources to better assist health plans implement the CMS Interoperability and Patient Access proposed rule.

Financial News:

Cigna seeks sale of group benefits insurance business -sources
Financial Post reports that U.S. health insurer Cigna Corp (@cigna) is exploring a sale of its group benefits insurance business, which could be valued at as much as $6 billion, four people familiar with the matter said on Tuesday.

To Listen:

CTO Talk
CTO Talk airs weekdays at 7:00 am, 3:00 pm and 11:00 pm ET. On this episode, host Matt Ferrari’s guest is Lee Green, Chief Architect BCBSMA. As the Chief Architect to a large payer system, Matt and Lee discuss the challenges of legacy systems and how they are looking at transforming from just a transactional system to delivering experiences that inspire outcomes and move toward interoperability.


Brian Marsella Nmaed Cigna Market President for Midwest Health Plans
Cigna has named Brian Marsella as market president for its health care and related benefits plans in the Midwest market, which includes Illinois, Indiana, Michigan, Minnesota and Wisconsin. Marsella is based in Chicago.

Humana Names Kathie Mancini President, East Central Medicare Region
Leading health and well-being company Humana Inc. (@humana) announced that Kathie Mancini has been named Regional President for Humana’s East Central Medicare operations, effective immediately.

State News:

Blue Cross Announces No-Charge Insulin
According to Brainerd Dispatch Blue Cross and Blue Shield of Minnesota (@BCBSAssociation) on Thursday, Aug. 22, announced it will cover all costs of insulin for certain customers, beginning January 1, 2020. Blue Cross becomes the third Minnesota insurer to cap out-of-pocket insulin costs. Previously, both Medica and UCare announced plans to offer policy holders a $25 cap on monthly out-of-pocket insulin charges.

UnitedHealthcare to Continue to Serve Louisianans Enrolled in Medicaid
The Louisiana Department of Health selected UnitedHealthcare (@UnitedHealthGrp) Community Plan to continue administering its Louisiana Medicaid program, effective Jan. 1, 2020.

Medica Introduces Insulin Cost Relief Program
In Medica’s (@Medica4Me) continuing efforts to address the rising cost of insulin, Medica is introducing a cap on the maximum amount members in four states will pay for their insulin. Starting Jan. 1, 2020, all members of fully insured employer groups headquartered in Minnesota, North Dakota, South Dakota and Wisconsin, and members who have ACA-compliant coverage in Minnesota, North Dakota and Wisconsin, will pay no more than $25 for each 30-day supply of insulin. This enhancement will apply to all insulin covered by their plan.

WellCare to Hire Hundreds to Support Transition to Medicaid Managed Care in North Carolina
WellCare (@wellcare_health) was one of four health plans selected by the North Carolina Department of Health and Human Services (DHHS) to serve North Carolina’s Medicaid beneficiaries on a statewide basis. One additional health plan led by providers was selected to operate in certain regions. The state is expected to implement the new Medicaid managed care program in 27 counties beginning Nov. 1, 2019, and the remaining counties on Feb. 1, 2020.

Upcoming Events

National Conferences on Medicare, Medicaid, and Dual Eligibles
When: September 23 – 26, 2019
Save when you register by July 29, 2019.
Where: Washington, D.C.
Twitter: @ahipcoverage

National Conferences on Medicare, Medicaid, and Dual EligiblesHealth care remains at the top of the to-do list for the administration, lawmakers, and health care professionals. Yet as the intensity of debate surrounding health care intensifies, one thing remains the same: changes to health care impact people in very real and personal ways. This fall, join health care experts, government officials, academics, health insurance providers, and industry thought leaders as we discuss strategies to make the Medicare and Medicaid programs better for the people they serve while making them affordable and fiscally sustainable.

TPA Connect
When: November 5 – 6, 2019
Save when you register by July 29, 2019.
Where: Lord Baltimore Hotel, Baltimore
Twitter: @HCAAinfo
Hashtag: #TPAConnect

TPA Connect – HCAA is proud to announce its inaugural TPA Connect event. This intimate gathering of TPA leaders serves as an important step in expanding the networking, education and advocacy reach of HCAA to new faces in new markets.