Revenue Cycle and Payer News 10-24-2018

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Posted By: Annmarie Budniak October 24, 2018

Anthem Pays OCR $16 Million in Record HIPAA Settlement Following Largest U.S. Health Data Breach in History
Anthem, Inc. (@AnthemInc) has agreed to pay $16 million to the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) and take substantial corrective action to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules after a series of cyberattacks led to the largest U.S. health data breach in history and exposed the electronic protected health information of almost 79 million people.

Blue Cross and Blue Shield Federal Employee Program (FEP) Keeps Medical Premiums Stable While Expanding Plan Offerings for 2019
The Blue Cross and Blue Shield (@BCBSAssociation) Government-wide Service Benefit Plan, also known as the Federal Employee Program® (FEP®), introduced FEP Blue FocusSM, a new coverage option for the federal workforce and retirees in the Federal Employees Health Benefits (FEHB) Program. Also this year, some uniformed service members and their dependents are eligible to enroll in FEP BlueDental® and/or FEP BlueVision® as part of the Federal Employees Dental and Vision Insurance Program (FEDVIP).

Aetna Announces Biggest Medicare Advantage Expansion in Its History
Aetna (@aetna) announced its 2019 Medicare plans, featuring expanded plan options with low or $0 monthly plan premiums in many areas, enhanced benefits and a more personalized member experience.

CVS Health Acquisition of Aetna Moving Forward on Agreement with U.S. Department of Justice
CVS Health (@cvshealth) recently announced that it has entered into an agreement with the U.S. Department of Justice (DOJ) that allows it to proceed with its proposed acquisition of Aetna (NYSE: AET). DOJ clearance is a key milestone toward finalizing the transaction, which is also subject to state regulatory approvals, many of which have been granted. CVS Health’s acquisition of Aetna remains on track to close in the early part of Q4 2018.

Nation’s Medical Specialists Demand Immediate End to Prior Authorization Abuse
A coalition comprised of the nation’s major medical specialties is demanding that the Trump administration take immediate action to ensure patients’ timely access to care. They are taking this action because patients are suffering from delays in care that are caused by the misuse of prior authorization requirements by Medicare Advantage plans.

Health Action Council Introduces New Consumer Health Support Model through Collaboration with UnitedHealthcare and Optum
The Health Action Council, an organization dedicated to improving the quality and cost of care, is expanding its relationship with UnitedHealthcare (@uhc) and Optum to launch an enhanced insurance plan that will be available to Health Action Council member companies for Jan. 1, 2019, enrollment.

Humana Again Earns Top Gold Status in the American Heart Association’s Workplace Health Achievement Index
Humana Inc. (@humana) has again earned top Gold status in the American Heart Association’s Workplace Health Achievement Index, a self-assessment scorecard that measures the comprehensiveness and quality of a company’s workplace health program, and the overall heart health of its employees.

UnitedHealth Group Reports Third Quarter Results
UnitedHealth Group (@UnitedHealthGrp) reports revenues of $56.6 billion grew 12% year-over-year, earnings from Operations grew 12% to $4.6 billion and much more in their third quarter results.

UnitedHealth Group Division Combining with Genoa Healthcare
The Star Tribiune reports UnitedHealth Group is making an aggressive move into the business of filling the medication needs of people with behavioral health problems. The nation’s largest insurance company confirmed Friday that its OptumRx division for pharmacy services is combining operations with Genoa Healthcare, a company that runs more than 425 pharmacies in behavioral-health centers in 46 states.

CareSource Names Executive Vice President, Strategic and External Relations
CareSource (@caresource), a nonprofit, multistate, multiproduct health plan announced Jeff Myers has joined its leadership staff as Executive Vice President, Strategic and External Relations. Myers, an accomplished executive with experience leading high-profile initiatives, will focus on strategy and business development in order to drive new opportunities and partnerships for the company. He will also provide strategic leadership over regulatory and government affairs.

Cigna-HealthSpring Announces 2019 Medicare Advantage Plans with New Benefits Championing Access to High- Quality, Personalized and Affordable Care
Cigna-HealthSpring (@cigna), a provider of Medicare Advantage (MA) plans, introduced its 2019 plans with more comprehensive benefits and a new nationwide prescription drug plan delivering personalized, affordable and quality health and well-being services. The company continues to offer a connected approach to quality care that improves the health and well-being of customers, while increasing affordability.

In State News:

New Individual Market Plan, Elevate by Medica, Introduced in Nebraska, Iowa
Medica (@Medica4Me), in partnership with Methodist Health System and Nebraska Medicine announced a new health plan option for individuals and families in the greater Omaha/Council Bluffs area. The plan, Elevate by MedicaSM will be available November 1, 2018 when the Open Enrollment Period for 2019 begins. A variety of benefit design options are available, including copay plans, health savings account compatible plans, and a catastrophic plan for those who qualify. Enrollment in the plan is available on the Nebraska and Iowa Health Insurance Marketplaces (HealthCare.gov), through a health insurance agent or directly from Medica (Nebraska residents only) for coverage on or after January 1, 2019.

Capital BlueCross and Coordinated Health Collaborate to Deliver High-Quality, Affordable and Accessible Medicare Healthcare
Two of the most recognized healthcare brands in Northeastern and Central Pennsylvania, Capital BlueCross (@capbluecross) and Coordinated Health, have come together to improve healthcare options for Medicare beneficiaries. This relationship aligns their missions to provide a high-quality, accessible, and more affordable healthcare experience.

Centene Announces 2019 Exchange Partcipation
Centene Corporation (@Centene) announced that it is expanding its 2019 Health Insurance Marketplace, or exchange, offering under its national brand, Ambetter. The company is planning to enter Pennsylvania, North Carolina, South Carolina, and Tennessee in 2019, and expanding its footprint in six existing Ambetter markets: Florida, Georgia, Indiana, Kansas, Missouri, and Texas.