Aetna-Humana merger drives fee-based model

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With Aetna poised to acquire Humana in 2016, industry observers have noted how industry consolidation generally and Aetna’s growing market share in particular will lead more intermediaries to adopt a fee-based compensation model. Although fee-based compensation for intermediaries is not a new concept, it is far less common than traditional commission based compensation. However, it appears increasingly likely that fee-based compensation will become much more widespread in the coming years.

Traditionally, insurance agents and brokers have been paid for ...

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Aetna Poised to Purchase Humana

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Aetna announced plans on Friday to make the largest acquisition ever in the history of the insurance industry. Aetna, the third largest health insurer by revenue, intends to acquire the nation’s fourth largest health insurance company, Humana, for more than $37 billion in stock, cash, and debt. A combined Aetna-Humana would bypass Anthem to become the second largest insurer by revenue and total membership. The deal would also establish Aetna as the largest provider ...

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2016 Rate Review Submissions Filed

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The Affordable Care Act (ACA) requires individual and small group rate increases that exceed 10% to be published, reviewed, and approved by state or federal regulators. This requirement does not apply to grandfathered health plans that predate the ACA. This rate review process is one of two ways the ACA addresses the issue of health plan costs, with the 80/20 Medical Loss Ratio being the other.

Rates for 2015 and 2016 are now available for public viewing at Continue Reading →

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ACA Subsidies Upheld

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This morning, the U.S. Supreme Court issued its opinion in the case King v. Burwell. The Court ruled 6-3 that individuals who purchase health insurance through the federal exchange, www.healthcare.gov, can received subsidies based on their income.

The plaintiffs in the case argued that only individuals who purchased coverage through a state-based exchange should be eligible for subsidies because the text of the Affordable Care Act (ACA) says subsidies are available to people who enroll through an ...

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Carrier Consolidation to Continue

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The top of the health insurance industry is poised to become an even more exclusive club. In recent weeks, news has broken that the nation’s five largest health insurance companies (UnitedHealth, Anthem, Aetna, Cigna, and Humana) are jostling to acquire a major competitor or be acquired by one. It appears that it is only a matter of time before another round of health insurance industry consolidation commences, potentially raising anti-trust concerns.

Over the weekend, Anthem announced plans to acquire ...

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Arise to offer AboutHealth plans

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AboutHealth, one of two new health system partnerships in Wisconsin, recently announced plans to sell health plans to individuals and employer groups through a co-branding agreement with Arise Health Plan. Early announcements from AboutHealth have focused on efforts to improve clinical integration and cooperation among its members. The agreement with Arise marks the first instance in which AboutHealth member systems have negotiated a single contract with a health insurance company.

Arise Health Plan is a wholly owned subsidiary of ...

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IHN adds Kenosha’s United Hospital System

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The Milwaukee Journal Sentinel’s Guy Bolton reported today that United Hospital System of Kenosha has agreed to join Integrated Health Network of Wisconsin (IHN). United Hospital System serves patients in Kenosha, Pleasant Prairie, western Kenosha County, and Northern Illinois through its Kenosha Medical Center and St. Catherine’s Medical Center campuses.

According to United Hospital System’s website, the system has a strong relationship with Froedtert and the Medical College of Wisconsin, two of the original members of IHN. ...

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HR Award Winners Celebrated!

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Winners of the Milwaukee Business Journal’s inaugural HR Awards were celebrated last night at an awards program held at the Hilton Milwaukee City Center. The HR Award program is intended to recognize the best human resources programs or practices that have had a positive impact on employees and the overall organization. More than 200 people attended the event, which included a cocktail reception, dinner, and the awards ceremony.

The many individuals and companies that were nominated for the awards were judged ...

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Women of Influence Celebrated

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Past and current winners of the Milwaukee Business Journal’s Women of Influence Awards gathered on Thursday May 7 at Blue Mound Golf and Country Club to network and celebrate the honor. The event was hosted by Mueller QAAS CEO Jim Mueller, who also addressed the group on the importance of women and the opportunity to help Milwaukee continue to advance.

2015 is the 16th year the Milwaukee Business Journal has honored the area’s most influential women. This year’s 28 ...

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ProHealth Announces New Clinical Partnerships

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ProHealth Care is partnering with three of the Midwest’s leading health systems to operate its heart surgery and cancer programs in Waukesha County.

Last year ProHealth announced a three-year agreement with Indiana University Health to run its cardiothoracic surgery program at Waukesha Memorial Hospital. The agreement is the first instance of a Milwaukee area health system partnering with an out-of-state health system to run one of its programs. Under the terms of the agreement, three Indiana University ...

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