Innovating Employee Health: Time to Break the Mold?

Employers have rapidly adapted during the COVID-19 pandemic: Can they now apply that level of speed to innovating employer-sponsored insurance?

Payer Investment in Virtual Substance Abuse Treatment Grows

Payers are adding benefits around substance abuse treatment in an effort to retain employees, as well as interrupt members’ costly visits to the emergency rooms, said Dr. Vikram Bakhru, a practicing physician at the University of California at San Francisco’s Medical Center and chief medical officer at Medicaid managed-care startup Circulo. Relaxation of state laws around the types of drugs that can be prescribed via telehealth, as well as federal rules around payment parity for video visits have also driven growth for these startups, Bakhru said.

Census: Insured Population Holds Steady, with a Slight Shift from Private to Public Coverage

Despite a pandemic-fueled recession, the number of uninsured Americans has increased only slightly since 2018, according to Census Bureau health insurance data released Tuesday. Twenty-eight million people, or 8.6% of Americans, were uninsured for all of 2020. In 2019, 8% of people were uninsured during the full year; in 2018, it was 8.5%.Still, the annual report shows a shift in where Americans get their insurance coverage. Private insurance coverage decreased by 0.8 percentage points from 2018. Public coverage rose by 0.4 percentage points from 2018. That shift was likely driven partly by older Americans becoming eligible for Medicare, at age 65, and showed a 0.5 percentage point increase from 2018 to 2020.

CMS Requiring Insurers to Submit Data on Air Ambulance Services, Broker Compensation

The Biden administration rolled out new transparency requirements for insurance brokers, short-term plans and air ambulance services, which are a common source of surprise medical bills. The departments of Labor, Health and Human Services (HHS) and the Treasury issued a notice of proposed rule-making on late Friday that if finalized would require plans, issuers and providers for air ambulance services to give detailed data on the services. The regulations also call for data on the compensation being paid to agents and brokers that help consumers select insurance plans.

Edifecs Announces Acquisition of Talix

Edifecs, Inc., a health information technology solutions company, announced today that it has acquired Talix, an information technology company that provides risk and quality solutions to healthcare payers and providers. The integration of Edifecs’ and Talix’s technologies will create an expanded risk adjustment solution with critical workflows and insights that improve efficiencies and directly support payer and provider collaboration.

King Insurance Adds Medical Malpractice Specialists with Acquisition of Corsair Insurance

King Insurance (“King” or the “Company”), a fast-growing full-service insurance brokerage firm that provides a variety of property & casualty as well as employee benefits solutions, announced Thursday the acquisition of Corsair Insurance Agency (“Corsair”). Corsair has been insuring physician practices and healthcare facilities in and around central Florida since its inception in 2011. Founded by Michael Carroll, the agency is laser focused on the medical field, helping administrators navigate their liability insurance needs with a primary focus on medical malpractice.

Highmark Completes Acquisition of Gateway Health Plan

Highmark has closed on its acquisition of Gateway Health Plan Inc., an affiliated Medicaid managed care health insurer that boosts Highmark’s enrollment by 355,000 members. Highmark had owned 50% of Downtown-based Gateway with Livonia, Mich.-based Trinity Health subsidiary Mercy Health since 1992, when Gateway was created. Gateway is among the private insurers in Pennsylvania that are paid by the state to cover people with Medicaid or Medicare benefits.

Senior Market Sales Acquires Senior Savings Network as Part of New Growth Strategy

Marking a notable, new direction in its growth strategy, Senior Market Sales® (SMS), one of the industry’s premier insurance marketing organizations, has acquired Senior Savings Network, a rapidly growing national insurance agency and field marketing organization specializing in Medicare insurance. Senior Savings Network includes a Medicare insurance agency based in South Carolina with dedicated employees and many external, independent agents serving thousands of clients nationwide with their Medicare needs.

The Partnership Strategy Medicare Advantage Plans Are Banking On

The booming Medicare Advantage market has become a strategic focus for major insurers and retailers to band together and grow their businesses. Insurers partnerships are reflective on the growing population of enrollees. Over the past few years, the number of Medicare Advantage enrollees has exploded, thanks to an increasingly diverse, cost-conscious and aging population that prefers the extra benefits not offered in traditional Medicare.

Alight Signs Definitive Agreement to Acquire ConsumerMedical

Alight Solutions, a leading cloud-based provider of integrated digital human capital and business solutions, today announced it has signed a definitive agreement to acquire ConsumerMedical, a leading clinical advocacy and expert medical opinion company. ConsumerMedical will enhance Alight’s ability to help employers around the world build a healthier workforce through its data-driven, personalized solutions. ConsumerMedical has a 25-year history of helping employers simplify and improve the way employees make medical decisions.