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Category: Anthem

  • Offering Personalized, At-Home Benefits in MA Remains ‘Key Part’ of Anthem’s Strategy

    Anthem Inc. (NYSE: ANTM) believes that its dedication to supplement benefits – including at-home care offerings – is strengthening its value proposition among other health plans. “In Medicare Advantage (MA), our continuing work to strengthen Anthem’s value proposition helped drive another strong annual election period,” Gail Boudreaux, the president and CEO of Anthem, said on […]

  • Evaluating Home Care’s Progress in Medicare Advantage

    Many of the in-home supplemental benefits offered by Medicare Advantage (MA) plans are new. But whether they are through the primarily health-related pathway, which began in 2019, or through Special Supplemental Benefits for the Chronically Ill (SSBCI), which came a year later, these benefits are still being experimented with. Generally, the plans offering these new […]

  • Providence St. Joseph, Anthem Accelerate Value-Based Care with Vim

    What You Should Know:  – Anthem Blue Cross and Providence St. Joseph Health are accelerating value-based care by using a new technology partner, Vim. The partnership enables the organizations to scale their tech solutions for better payer-provider collaboration to ultimately improve healthcare performance in California. – Vim offers an EHR-integrated application suite that includes Digital […]

  • Anthem MA Plans to Offer New In-Home Support Benefit in 2022

    Newer supplemental benefits like access to in-home support services or a personal care helper have helped Anthem Inc. (NYSE: ANTM) attract and retain Medicare Advantage (MA) members over the past couple of years. Perhaps it’s no surprise then that the Indianapolis-based Anthem and a number of its affiliated health plans are adding on to their […]

  • CMS suspends enrollment in UnitedHealthcare, Anthem MA plans

    The agency has suspended enrollment in three UnitedHealthcare plans and one Anthem plan for 2022 because the plans did not spend enough of their premium incomes on medical benefits and claims. The payers can contest the suspension, though it is unclear if they plan to.

  • How payers, providers are tackling homelessness & extending care access

    Homelessness, a key social determinant of health, is on the rise, prompting action from payers and providers. Though their efforts are varied, ranging from subsidizing housing to making it easier for those living in encampments or temporary housing to access care, they have a common goal.

  • Anthem, Humana join hedge fund to launch PBM

    The hedge fund SS&C Technologies Holdings will be the majority stakeholder, while the two payers will each hold a minority interest in the PBM, dubbed DomaniRx. The joint venture will develop a claims adjudication platform to support its operations.

  • Anthem CEO Breaks Down myNEXUS Acquisition, Touts At-Home Care Capabilities

    Anthem Inc. (NYSE: ANTM) continues to tout its positioning when it comes to home-based care. The Indianapolis-based insurer acquired myNEXUS — a convener that manages home-based care for payers — earlier this year. Anthem’s focus on how that acquisition improves its overall network since then reflects its home-based commitments. “We closed on the acquisition of […]

  • Anthem, Epic strike data exchange partnership

    The EHR giant will integrate its payer platform with the insurer’s operating system to facilitate two-way data exchange with providers. Through this integration, the organizations hope to support clinical decision-making and streamline administrative processes like prior authorizations.

  • Bright Health follows rival Oscar Health down IPO path

    Bright Health has filed preliminary paperwork for an IPO, joining its rivals in the insurance technology space in going public. Though there are few confirmed details at the moment, Bright Health is reportedly looking to raise $1 billion through the offering.

  • LHC Group Expands Texas Joint Venture; Anthem Completes myNEXUS Acquisition

    LHC Group announces JV expansion LHC Group Inc. (Nasdaq: LHCG) as well as partners Texas Health Resources and Methodist Health System are expanding their joint venture in Texas. The three health care organizations announced on Thursday that they’re purchasing and sharing ownership of Regent Home Health, a provider that currently serves patients and families in […]

  • Stanford Health Care seeks up to $1.9M from Anthem in new suit

    The California-based provider has filed a lawsuit against the payer, claiming Anthem has yet to pay for the care it provided to patients covered by its affiliate. Stanford and Anthem had an implied contract, and if it is not upheld by the court, the provider is seeking $1.9 million in reimbursement.

  • Q1 2021 Health IT/Digital Health PC/VE, M&A, IPOs/ SPACs Activity

    The first quarter of 2021 has been one of investor optimism as the vaccine rollout continues ahead of expectations and economic activity begins to accelerate in response.  Within the Health IT industry, the already strong investment and M&A trends seen in 2020 have only accelerated.  Over the course of the quarter, we observed $7 billion in private […]

  • Anthem to Buy Home-Based Care Management Company myNEXUS

    Anthem Inc. (NYSE: ANTM) is bolstering its home-based care capabilities. The Indianapolis-based health insurer announced Wednesday that it has entered into an agreement to buy myNEXUS Inc., a technology-enabled company that manages home-based care for payers. Financial terms of the agreement were not disclosed. “Providing timely care for members in their homes allows for both […]

  • Payers Increasingly Turning to Home-Based Care to Shoulder COVID-19 Costs

    Back in 2018, it felt like the health care sector was on the verge of a massive shift, driven by a desire from payers to better manage their members’ total cost of care with enhanced in-home capabilities. Much of that feeling came from watching Humana Inc. (NYSE: HUM). The Louisville, Kentucky-based health insurer teamed up […]

  • Sharecare to Go Public in SPAC IPO Deal, Reaching $3.9B Valuation

    What You Should Know: – Digital health company Sharecare and special purpose acquisition company (SPAC), Falcon Capital Acquisition Corp, today announced an agreement to merge to go public on the NASDAQ under the ticker symbol SHCR at enterprise value of $3.9B. – The transaction is expected to be funded through a combination of Falcon’s $345 […]

  • Mercy, Anthem ink agreement to enhance care, drive down costs

    The Missouri-based health system and payer have entered into a new cooperative care agreement that aims to reduce costs while improving both outcomes and patient experience. The agreement includes a closer alignment between clinical care and reimbursement as well as increased data flow between Mercy and Anthem.

  • Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan

    What You Should Know: – Anthem, Inc. has entered into an agreement with InnovaCare Health, L.P., to acquire its Puerto Rico-based subsidiaries, including MMM Holdings, LLC (“MMM”) and its Medicare Advantage (MA) plan MMM Healthcare, LLC as well as affiliated companies and Medicaid plan.   – MMM is Puerto Rico’s largest MA plan and one […]

  • Sharecare Acquires AI-Enabled Digital Transformation Platform doc.ai

    doc.ai logo What You Should Know: – Sharecare acquires doc.ai to expand its engineering expertise, accelerate digital transformation of healthcare through innovative AI platform for an undisclosed sum. – Founded in 2016, the company licenses AI modules and creates products for a portfolio of clients, including payers, pharma and providers. – As part of the […]

  • #Healthin2Point00, Episode 166 | $100 million, scandal, & more

    Today on Health in 2 Point 00, we have scandal, drama, intrigue, $100 million and murder! Wait, no; not murder. On Episode 166, we catch up on more deals before Jess gets carried away again. The $100 million goes to Carbon Health in a Series C, which is another Bay Area-based primary care startup; they’re […]

  • Lark Health raises $70M

    Lark Health, which offers AI-powered digital care platforms for chronic diseases, has raised $70 million in new funds, which it plans to use to expand its relationship with Anthem and eventually deepen partnerships with other payers and telehealth providers.

  • Number of MA Plans Offering In-Home Support Services to Increase by 93% in 2021

    The U.S. Centers for Medicare & Medicaid Services (CMS) last month released new Medicare Advantage (MA) figures highlighting a massive expansion of plans offering home-focused supplemental benefits in 2021. The agency shared additional data on Wednesday — and it now appears the ongoing home care MA movement is even bigger than originally anticipated. “These benefit […]

  • Walmart to Offer Medicare Insurance Plans During 2020 Open Enrollment

    What You Should Know: – Walmart announced it will begin selling Medicare insurance plans during this year’s annual enrollment period, Oct. 15 through Dec. 7. Today, Walmart announced the launch of Walmart Insurance Services, LLC, a licensed insurance brokerage, which will assist people with enrolling in insurance plans—and simplify what’s historically been a cumbersome, confusing […]

  • Anthem Expands Relationship with doc.ai to Power Digital Health Offerings

    What You Should Know: – Anthem extends the use of doc.ai’s platform and portfolio of privacy-first technologies and artificial intelligence software services to drive the personalization of Anthem’s digital assets and create improved value for users. – doc.ai’s product offerings are deployed on its cloud-agnostic and zero-trust infrastructure that lets clients like Anthem launch products […]

  • New Attacks, Regulations, and Stakes Call for New Security Strategies

     Tim Callan, Senior Fellow, Sectigo The amount of data generated by the healthcare industry is staggering—and constantly increasing.  Healthcare data encompasses the personal information of patients, doctors, nurses, and administrators. It includes diagnostic information, test results, ultrasound images, x-ray images, and of course insurance and financial information. With so much sensitive patient information there for […]

  • Big profits put insurers on awkward footing 

    During the height of the Covid-19 pandemic, all of the seven largest commercial insurers saw their profits rise, with some seeing their profits double. Will they have to pay some of it back? 

  • Ginger Lands $50M to Expand On-Demand Mental Health Support Platform

    What You Should Know: – Ginger announces $50 Million in Series D funding to expand access to its on-demand mental healthcare system led by Advance Venture Partners and Bessemer Venture Partners; joined by Cigna Ventures and existing investors. – Company has more than tripled revenue over the past year, now brings access to on-demand mental […]