Payers

Commercial insurers, the employer and individual market, plus Medicare trends, Medicare Advantage, & Medicaid managed care

Benefit innovation
Frank Diamond
Cigna–HealthSpring and Anthem expand their Medicare Advantage offerings to include such things as hot meals and transportation to providers.
Frank Diamond
UnitedHealthcare has ditched Silver Sneakers for something it says is better. Other insurers are sticking with it. Either way, wellness is looming large in the MA market.
The Payers’ Playbook
Joseph Burns
Seeking reduced costs, small businesses and sole proprietors will find AHPs tempting. The premiums are lower, but you get what you pay for, critics say.
Direct Contracting
Lola Butcher

In 1991, the world’s second richest man griped about health care costs. Today, Sam Walton’s Walmart empire is striking back with direct contracting. The retail giant is using centers-of-excellence contracts by which it pays high-value provider organizations to treat specific medical problems.

The Value Proposition: Direct Contracting
Lola Butcher

Unlike most payer–provider relationships, the parties took a go-slow approach. The plan was offered only to employees who worked in a subset of Walmart and Sam’s Club outlets and lived or worked near Emory providers, and Walmart did not set premium levels to incentivize workers to choose the Emory ACO.

2019 Year in Preview
Susan Ladika
Insurers are busy merging with retailers and providers in vertical integration deals after attempts at horizontal combinations hit antitrust roadblocks.
2019 Year in Preview
Jan Greene
The labor market is tight (an un-employment rate of under 4%) and the Cadillac tax is still a can kicked down the road.
The Payers’ Playbook
Joseph Burns
Patient advocates say ‘fail first’ rules should be available online and decisions on physician appeals should be made within 72 hours–and in a day when it is an emergency.