Third Party Administrators

November 12, 2014 | Anthony Brino

Taking stock of its diversification strategy, the nation's largest health insurer is creating a new enterprise oversight unit, moving around some key leaders and saying goodbye to others, all before a big enrollment push.

November 11, 2014 | Richard Pizzi

The California-based nonprofit health system and HMO Kaiser Permanente is hustling and bustling this year.

October 21, 2014 | Anthony Brino

Insurers that trace their ancestry back to the first days of American health insurance are now facing potentially existential challenges.

July 22, 2014 | Anthony Brino

A direct primary care company is targeting employers with a new self-funding model that could spell disruption for the third-party administrator business.

July 15, 2014 | Anthony Brino

Group plans are increasingly expanding their consumer-directed health plans with health savings accounts, after toying with lower deductibles and reimbursement account wrapping.

July 7, 2014 | Anthony Brino

The insurer-owned Allegheny Health Network is partnering with a national cancer center to offer new therapies and trials in western Pennsylvania, a sign of heightening regional competition and the emergence of new models for pursuing innovative treatments.

June 16, 2014 | Anthony Brino

Even amid delays in enforcement of the Affordable Care Act's employer mandate, tax and reporting regulations are sowing confusion among employers and putting large businesses on edge.

May 9, 2014 | Kelsey Brimmer

Increased admissions drove revenue gains for Tenet Healthcare Corporation and Community Health Systems in the first quarter of 2014 compared to 2013. Both for-profit hospital firms appear confident midway through Q2.

May 5, 2014 | Anthony Brino

With more employers adopting high deductible plans for their workers, the market is opening up for supplemental benefits in some of healthcare's most expensive areas.

April 24, 2014 | Anthony Brino

So far, 2014 is not looking too shabby for some large insurers. Aetna, the Hartford-based giant, raised its outlook following a record quarter, but that doesn't mean there aren't headwinds.

April 22, 2014 | Anthony Brino

Midwest managed care insurer Centene is on a roll. It beat Wall Street's first quarter expectations, increased membership and has its eyes on a new international venture.

April 10, 2014 | Anthony Brino

Many startups and companies from other industries have physicians, hospitals, insurers and medtech manufacturers in their sights, betting that they can offer better services at cheaper prices for dissatisfied consumers.

September 25, 2014 | White Papers
Are you "rolling the dice" when it comes to healthcare payments? Read the WEX Health whitepaper on "Healthcare Claims Payment Optimization: 7 things to consider" that presents a methodology to help you determine your optimal payment mix.

March 11, 2014 | White Papers
For health insurers, data integrity and visibility are key to successful integration with the Federal Marketplace. However, complex processes and trivial errors can lead to data gaps that impact revenue, profitability and member satisfaction. Adopting a standarized approach to data integrity early in the process is critical to succesfully adapting to the technologies and processes of the Affordable Care Act.

June 19, 2012 | White Papers
Insurers are efficiently and accurately paying millions of claims that they should never pay at all. In this white paper we define state-of-the-art prepayment analytic strategies and explain how they differ from both claims edit and postpayment detection systems.

June 19, 2012 | White Papers
In this case study, you’ll learn how Highmark dramatically reduced losses with a new analytic approach to preventing and detecting fraud, waste and abuse in submitted claims. Learn how this approach enabled Highmark to identify hundreds of new pursuable cases in the first year over and above cases identified through other methods.

June 6, 2012 | White Papers
This paper examines why health care reform is causing a shift to a consumer-driven business model and the role analytics plays in helping organizations make the transformation successfully. Read this white paper to gain insight on how health insurance plans can come out ahead with advanced customer intelligence and engagement strategies.

December 19, 2011 | White Papers
Although the health insurance industry has undergone significant changes over the past few years and continues to evolve at a rapid pace, now is the time to begin preparing for growth. And, with statistics showing that the member experience has not significantly improved in the last five years, it should move to the top of the list of “growth enablers”. Download this whitepaper to discover the eight steps health plans can apply to optimize the quality of the member experience.

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