The following were the most-viewed payer issues stories this year.
1. Trust issues will hold your system back: 5 ways for payers and providers to improve their relationships
Business-to-business trust levels in the healthcare industry rank among the lowest of all industries in the U.S. This may explain why the transition to value-based care delivery is crawling at a snail’s pace.
2. Texas Health Resources prepares to go out of network with BCBS
Arlington-based Texas Health Resources said it would continue to provide services regardless of its network status with Blue Cross Blue Shield of Texas. However, after continued failed negotiations, the health system warned patients of increased likelihood for greater out-of-pocket expenses if THR’s contract with the payer expired at the end of December.
3. How the ‘big 5’ payers performed financially in 2016
The five largest U.S. health insurers — Aetna, Anthem, Cigna, Humana and UnitedHealth Group — saw a range of financial results throughout the first three quarters of 2016.
4. Aetna lawyer: DOJ’s antitrust arguments in Humana case address ‘a pretend world’
The U.S. Department of Justice began its antitrust challenge to Aetna’s proposed $37 billion takeover of Humana Dec. 5, 2016, arguing the deal would limit competition between the insurers’ Medicare Advantage and ACA public exchange plans.
5. Hip insurance startup Oscar Health now struggling to keep head above water
New York City-based health insurance startup Oscar Health was once lauded as a disrupter among its more traditional contemporaries. With its quirky branding and emphasis on simplicity, it was coined the “hipster” health insurance company poised to “make health insurance suck less.”
6. Aetna executives testify in court, defend ACA withdrawal
U.S. Department of Justice lawyers questioned Aetna executives Dec. 12, 2016, about the payer’s decision to exit the majority of ACA exchanges it operated in during an antitrust trial challenging Aetna’s proposed $37 billion takeover of Humana.
More articles on payer issues:
Interpace Diagnostics, BCBS form clinical agreement
BCBS, Texas Health Resources settle contract dispute
CBO blog offers guidance on ACA replacement proposals for refundable tax credits
