Reimbursement
Total Medicaid revenues for these MCOs soared 103 percent to $110.6 billion in 2014 from $54.6 billion in 2010, according to a study by Milliman.
A "sleeper" provision when Congress created Medicare in 1965 to cover healthcare for seniors, Medicaid now provides coverage to nearly one in four Americans, at an annual cost of more than $500 billion. Today, it is the workhorse of the U.S. health system, covering nearly half of all births, one-third of children and two-thirds of people in nursing homes.
A $57 million experiment to deliver better, more efficient care at federally funded health centers struggled to meet its goals and is unlikely to save money.
Anthem will buy Cigna for $54.2 billion, the insurer announced on Friday, in a deal that will reduce the former "Big Five" private health insurers to just three.
The insurer's rise, fall and later rebound poses a cautionary tale in today's consolidating healthcare market. And some of the strategies behind Aetna's $37 billion takeover of Humana invoke themes from the failed 1990s-era HMO empire.
The announcement comes just weeks after Cigna turned down a $54.2 billion offer by Anthem, which runs Blue Cross Blue Shield, and publicly rebuked its suitor over security issues and future uncertainty.
The public health pitch for making Medicare available at 50 comes with some strong evidence and business opportunity for population health.
Most U.S. healthcare providers are simply unprepared to convert to new payment models, according to a recent survey by KPMG's Healthcare & Life Sciences Practice, which found only 15 percent of the 164 healthcare professionals surveyed said their finance departments can support capitation, bundled payments and quality-based payments.
Under the Affordable Care Act, state agencies largely retain the right to regulate premiums in their states, but so far only a handful have finalized premiums for the coming year, for which enrollment begins in November.
Amid a planned acquisition by Aetna, Humana is still going forward with new models, including an expanded deal with one of several promising primary care ventures.