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Change Healthcare Inc. (known as Emdeon before rebranding in 2015, which followed its acquisition of Change Healthcare) is a provider of revenue and payment cycle management that connects payers, providers, and patients within the U.S. healthcare system. [2]
As of 2023, PBMs managed pharmacy benefits for 275 million Americans and the three largest PBMs in the US, CVS Caremark, Cigna Express Scripts, and UnitedHealth Group’s Optum Rx, make up about 80% of the market share covering about 270 million people [4] [5] with a market of almost $600 billion in 2024.
Feb. 2014: Optum purchases a majority stake in Audax Health Solutions, a patient engagement [clarification needed] company. Audax is later rebranded as Rally Health. April 2015: Optum acquires MedExpress, an urgent care and preventative services company. [9] July 2015: Catamaran, a pharmacy benefit manager, joins OptumRx. [3]
The report, based on Medicare data obtained from the federal government under a research agreement, calculated that diagnoses added by UnitedHealth for diseases patients had never been treated for had yielded $8.7 billion in payments to the company in 2021 – over half of its net income of $17 billion for that year. [140]
The new model, Optum Rx Clear Trend Guarantee, will provide value-based pricing of drugs per member combining the cost of these medicines from various sources such as retail pharmacy, home ...
HealthCare.gov is a health insurance exchange website operated by the United States federal government under the provisions of the Affordable Care Act (ACA), informally referred to as "Obamacare", which currently serves the residents of the U.S. states which have opted not to create their own state exchanges.
In 2000, CMS changed the reimbursement system for outpatient care at Federally Qualified Health Centers (FQHCs) to include a prospective payment system for Medicaid and Medicare. [2] Under this system, health centers receive a fixed, per-visit payment for any visit by a patient with Medicaid, regardless of the length or intensity of the visit.
Catamaran Corporation (formerly SXC Health Solutions) is the former name of a company that now operates within UnitedHealth Group's OptumRX division (since July 2015). It sells pharmacy benefit management and medical record keeping services to businesses in the United States [3] and to a broad client portfolio, including health plans and employers. [4]