How Payers Can Identify Providers for High-Performing Networks
HealthPayerIntelligence Enrolling in the right health plan can significantly influence healthcare costs and consumer health outcomes. Despite significant healthcare spending, the United States has the worst health outcomes among high-income countries. In 2021, the US spent 17.8 percent of gross domestic product on healthcare, nearly twice as much as the average high-income country, a study from the Commonwealth...
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How Long-Term Health Plan Enrollment Supports Value-Based Care
Realizing value-based care success is easier said than done. While a primary goal of value-based care is to improve long-term health outcomes and costs, that can be difficult when consumers’ healthcare journeys are disrupted each...
How Plans Can Improve Race and Ethnicity Data Collection for HEDIS
One question kept coming up when Keirsha Thompson, manager at National Committee for Quality Assurance (NCQA), and her team talked to payers: How can our health plan improve its performance on race and ethnicity data collection for the...
Slow but Steady: Experts Report on 2023 Mergers and Acquisitions Trends
What will happen to the volume and value of mergers and acquisitions in 2023? This is a question at the forefront of payers’ minds as the healthcare industry emerges from the uncertainties of the coronavirus pandemic. The twelve...
How to Personalize Chronic Disease Management through Concierge Care
Updated 6/21/2023: This article has been updated to correct a name and title error. The interviewee's name and title have been corrected to "Anthony Nguyen, chief clinical officer at Elevance Health." A previous version incorrectly...
6 Key Payer Benefits that Support Behavioral Health Prevention
With behavioral healthcare demands on the rise, payers must not only be aware of the current trends but establish pathways toward behavioral health prevention through their health benefits. Half of employer-sponsored health plan enrollees...
What Employers Need to Know About ERISA Compliance for Health Plans
The Employee Retirement Income Security Act of 1974 (ERISA) dominates the health insurance industry and regulates coverage for around 139 million Americans in 2.5 million health plans, making familiarity with ERISA compliance critical for...
Improve Coverage, Health Equity By Diversifying Broker Recruitment
When Access Health CT (AHCT), Connecticut’s marketplace, published its health equity report, leaders of the state health insurance marketplace knew that something needed to change. In a state that ranks among the healthiest and...
The History of Medicare Advantage: From Inception to Growing Popularity
Medicare Advantage’s popularity continues to grow in 2023 as enrollment figures and plan options increase. The private program has received mixed reviews from healthcare stakeholders, with members generally reporting high plan...
3 Ways Payers Can Employ Machine Learning, Advanced Analytics
MVP Health Care (MVP) has been piloting machine learning and advanced analytics solutions and, in the process, explored three key uses for these types of tools. Machine learning falls under the umbrella of artificial intelligence tools. It...
How One Payer Redesigned Wellness Program Rewards Around Choice, Tech
UnitedHealthcare was well-supplied in fitness and wellness programs, but payer executives knew its rewards program was lacking. The major payer organization already offered Motion, Real Appeal, Quit for Life, and other programs dedicated to...
The Future of Medicare Advantage Risk Adjustment Data Validation
Around four years passed between when CMS proposed the new rule on Medicare Advantage risk adjustment and when the Medicare Advantage Risk Adjustment Data Validation final rule was published. As stakeholders review the long-awaited final...
How States Can Prepare for 2023 Medicaid Redeterminations
On April 1, 2023, states will begin the Medicaid redetermination process as part of the public health emergency unwinding. After anticipating this moment for the last two years, states finally received an official start date in the...
Going Beyond Benefits: How Employers Can Assess, Create Wellness Culture
In the wake of the coronavirus pandemic, many employers expanded their mental health benefits to improve employee wellness. However, research has indicated that more mental health benefits do not necessarily equate to a robust wellness...
Top Predictions for Health Insurers, Employers in the New Year
Health insurers and employers face a challenging landscape in 2023, but these obstacles are accompanied by opportunities for growth, according to experts’ top predictions. Three years after the first wave of the coronavirus pandemic...
How Payer, Provider Alignment Enables Simplified Medical Billing Format
When Banner|Aetna conducted market research and asked their members to name the primary barrier that prevented them from engaging easily with healthcare, the payer’s leadership did not expect the answer to involve medical billing....
Understanding the Different Metal Plans in the ACA Marketplace
The Affordable Care Act (ACA) marketplace allows individuals to purchase health plans through the federal insurance marketplace or state-based marketplaces, depending on the state. HealthCare.gov offers four categories of health plans that...
Improving Accessibility for Spanish-Speaking Seniors in Medicare Advantage
Over the phone, a Spanish-speaking senior explains to an Anhelo Salud (Anhelo) representative her recent history with Medicare. During the conversation, the representative realizes that different health plans have enrolled the senior in a...
How Employers Can Achieve a Fair Price in Hospital Negotiations
Across the nation, Americans are feeling the pressure of escalating prices in nearly every area of life, from the grocery store to the clothing store to the gas pump. The hospital room is no exception. Hospital costs represent a significant...
How AZ Medicaid Expanded Its Role in Social Determinants of Health Coverage
In September 2022, Arizona Health Care Cost Containment System (AHCCCS)—Arizona’s Medicaid program—received the Robert Wood Johnson Foundation’s 2022 Medicaid Innovation Award in “Initiatives to Address Social...
