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Risk-Spreading Tools for Healthcare Financing (PDF)

"[S]ignificant developments in the U.S. healthcare industry have begun to change how provider institutions and payers are aligned to achieve better health, affordability, and experience for targeted populations. As many insurers and providers are progressively focusing on population management, there is also an opportunity to develop risk management tools that can enable participants to spread the risk of above-average healthcare expense outcomes to third parties."

Employers Combat Healthcare Costs Through HSAs, Wellbeing and Pharmacy Benefit Measures

"Though companies expect a slight upswing in healthcare cost increases over the next two years or so, cost trends remain at or below 5 percent after plan changes ... This is due, in part, to the maturing of account-based health plans, a strategy that combines a group health insurance plan with an employee flexible spending account or health savings account.... [E]mployer confidence in offering health benefits in 10 years remains strong, and in fact that confidence is close to its highest level in 15 years."

Employers Drive Healthcare Change Through Direct Contracting, ACOs, Combatting Opioid Epidemic

"[E]mployers are projecting a 5 percent hike in 2019 for the total cost of providing medical and pharmacy benefits for the sixth consecutive year.... 35 percent of respondents [said] they are implementing alternative payment and delivery models such as accountable care organizations and high performance networks either directly or through their health plan.... 3 percent of respondents in 2018 said they were contracting directly with health systems and providers and that number is slated to grow to 11 percent in 2019."

Justice Department Seeks Dismissal of Moda, BlueCross BlueShield Risk Corridor Lawsuits

"The Department of Justice has filed a motion to dismiss a lawsuit filed by Moda Healthcare that claims it is owed more than $191 million in the risk corridors program. The DOJ has filed a similar motion to dismiss the claim of BlueCross BlueShield of North Carolina ... [T]he DOJ is arguing no deadline was established for HHS to pay risk corridors payments."

Banner Health Nailed by Huge Cyberattack

"Banner Health revealed that hackers may have accessed the healthcare, payment and health plan information of up to 3.7 million individuals. Attackers reportedly gained access through payment processing systems for food and beverage purchases at the Phoenix-based health system.... Stolen information may have included names, birthdates, social security numbers, addresses, dates of service and claims information, as well as health insurance information as a current or former member of one of Banner's health plans or as a beneficiary of a Banner Health employee benefits plan."

UnitedHealthcare Debuts Resource Hub in Bid to Expand Wellness Programs, Lower Costs

"The UHC Hub, which debuted this month, includes more than 20 stand-alone health programs available for self-funded customers to purchase, including point solutions focused on healthy living, financial planning, complex health conditions and digital coaching."

Anthem Wins Restraining Order Blocking Cigna's Withdrawal from Merger

"On [Feb. 15], Anthem won a temporary restraining order that blocks Cigna Corp. from immediately terminating the $54 billion merger. Anthem had filed the lawsuit in a Delaware court to compel Cigna to comply with the merger agreement that has been extended until April 30.... In its own lawsuit filed in Delaware, Cigna is asking for the $1.8 billion breakup fee plus $13 billion in damages."

CMS Proposes New Rules to Encourage Insurers to Stay in ACA Marketplace

"The proposed rule gives states greater authority, CMS said. States with the means to do so will review qualified health plans to assess issuer network adequacy ... CMS is also releasing a revised proposed timeline for the qualified health plan certification and rate review process for plan year 2018."

Surprise Medical Bills a Costly Problem for Health Plans

"Surprise, out-of-network bills hurt consumers, but two new studies show these bills undermine competition between health insurance plans and particularly harm plans that are trying to limit costs by offering narrower network products."

CMS Announces 45 ACOs Are Now Participating in Next Generation Model

"For 2017, 28 new participants joined the Next Gen model, bringing the total number of participants to 45. CMS Innovation Center's Next Generation ACO Model was designed to test whether strong financial incentives for ACOs can improve health outcomes and reduce expenditures for Medicare fee-for-service beneficiaries. Provider groups in this model assume higher levels of financial risk and reward than are available under the shared savings program."