Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

UnitedHealthcare Partners with Accountable Care Organizations

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In December, UnitedHealthcare announced in a company press release the release of NexusACO, a new health plan option for self-funded employers that is available in 15 markets. Tier 1 of NexusACO involves offering healthcare access to members...

Top 3 Reasons to Partner with Accountable Care Organizations

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With value-based care reimbursement becoming the standard across health insurance companies and medical facilities around the country, stakeholders are investing more time and resources in accountable care organizations (ACOs). Why should healthcare...

How to Reduce Obesity Rates, Increase HEDIS Quality Scores

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When attempting to improve provider performance on HEDIS quality scores, healthcare payers may need to pick and choose the quality measures that could be realistically raised. For example, childhood obesity may be one of the most common health...

UnitedHealthcare Adopts Bundled Payment Model for Surgeries

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The national health insurance company UnitedHealthcare has followed the lead of the Centers for Medicare & Medicaid Services (CMS) and implemented a bundled payment model specifically for hip, spine and knee surgeries much like...

Value-Based Care Drives Progress in Population Health Management

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Population health management is becoming a more prominent topic of interest among healthcare payers as they strive to transition to value-based care reimbursement and improve patient outcomes. A report from the Institute for Health Technology...

Aetna, Humana, Harvard Pilgrim Target Patient Health Outcomes

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Commercial health insurance companies have pursued a number of different approaches to improve patient health outcomes and reduce wasteful medical spending. The payers Aetna, Humana, and Harvard Pilgrim conducted some key collaborations to achieve...

Why Payers Should Reduce Cost Sharing for High-Value Care

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Today, more healthcare payers are positioning greater cost-sharing onto the consumers to keep from raising premium rates, according to commentary published in JAMA Internal Medicine. The 2016 National Health Insurance Survey discovered that 40...

How 3 Healthcare Insurers Expand Value-Based Care Payment

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National health plans are leading the way in alternative reimbursement structures such as bundled payment models and shared saving programs. Blue Cross Blue Shield health plans, Cigna, and UnitedHealthcare have worked to expand their value-based...

3 Ways Bundled Payment Models Brought Hospital Cost Savings

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Case studies of bundled payment models show significant cost savings among hospitals and both public and private health insurers. The Centers for Medicare & Medicaid Services (CMS), for instance, invested in bundled payment models for lowering...

Humana Advances Population Health Management, Value-Based Care

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The health insurer Humana has been progressing with population health management and value-based care by partnering with the population health company FullWell in December 2016, according to a company press release. The partnership creates a...

20% of Surveyed Physicians Familiar with MACRA Regulations

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No more than 20.6 percent of primary care physicians and 19.5 percent of specialists are “very or somewhat familiar” with MACRA regulations, according to a survey completed in 2016 by Merritt Hawkins for The Physicians Foundation....

Cigna Partners with Scripps Health in Pay-for-Performance Model

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The national health insurer Cigna announced in a company press release yesterday that it will be partnering with the nonprofit healthcare delivery system Scripps Health through a pay-for-performance contract to provide employers in the San Diego...

Prospective vs. Retrospective Healthcare Bundled Payment Models

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When implementing healthcare bundled payment models, providers and payers have two main strategies to choose from: prospective or retrospective bundles. A prospective healthcare bundled payment model involves creating a budget when the episode...

Cigna’s Key Principles for Healthcare Quality Measures

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Cigna is one national health insurance company that has moved forward with creating successful healthcare quality measures for their provider networks. The company uses national standards along with physician feedback when creating its own healthcare...

5 Best Practices to Advance Value-Based Care Reimbursement

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When payers begin to transition to value-based care reimbursement from the more traditional fee-for-service payment system, company executives and financial experts may find it takes longer than expected to adopt the new payment structures while...

Key Steps for Payers to Improve Population Health Management

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In recent years, population health management has become a larger factor in the success of a health insurance company. With more payers transitioning to value-based care reimbursement platforms, the quality of care and patient outcomes have grown...

Medical Organizations Advise Changes for Quality Payment Program

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The healthcare provider community has shown some concern about MACRA implementation and the quality payment program. The Advisory Board released a survey last month showing that 70 percent of 30 medical groups were concerned about MACRA regulations...

Why Healthcare Bundled Payment Models May Expand in 2017

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The Centers for Medicare & Medicaid Services (CMS) have advanced bundled payment models by implementing these value-based payment structures in orthopedic and cardiac care. CMS released a finalized bundled payment model for cardiac and orthopedic...

Humana, Aetna, Cigna Invest in Value-Based Care Payment Models

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Value-based care payment models are continuing to make headlines among major health insurance companies around the nation. Last month, Humana entered into a value-based care arrangement with the population health management company Fullwell,...

Accountable Care Organizations May Improve Diabetes Management

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Diabetes is a major public health concern for the medical industry with 29.1 million Americans or 9.3 percent of the population diagnosed with the disease in 2012, according to the American Journal of Managed Care (AJMC). In fact, the American...

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