Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

AMA: Health Insurance Merger Cuts Medicare Advantage Competition

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The American Medical Association (AMA) announced in a press release earlier this week their position against the health insurance merger between Aetna and Humana, particularly regarding its impact on the Medicare Advantage market. The AMA is...

Patient Engagement Helps Payers on Affordable Care Act Exchanges

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Many health insurance companies selling health plans through the Affordable Care Act exchanges have been seeing higher and higher rates of financial losses. Some payers such as Aetna, Humana, and UnitedHealth Group have even pulled back from...

Payers See High Financial Losses on Health Insurance Exchanges

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Healthcare payers have been facing significant financial losses on the health insurance exchanges in recent years. UnitedHealth Group lost $475 million in 2015 and was predicting a loss of $650 million in 2016, according to Kaiser Health News....

Clinical Data Analytics Key for Value-Based Care Reimbursement

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Many medical facilities have seen how the healthcare industry has been moving away from fee-for-service payment to value-based care reimbursement. Revere Health is one organization that jumped on the bandwagon early on and has quickly moved forward...

Premier Offers Healthcare Policy Improvements for ACOs, Payers

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Earlier this year, the provider alliance organization Premier Inc. announced in a company press release a number of recommendations meant to improve the framework of healthcare policy. The key points meant to improve the creation of healthcare...

How the 21st Century Cures Act will Impact Healthcare Payers

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Last week, the House of Representatives passed the 21st Century Cures Act by 392-26 votes. The 21st Century Cures Act affects the health insurance market through a provision that establishes small business health reimbursement arrangements (HRAs),...

Payers Continue to Drop Out of the Health Insurance Exchanges

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Healthcare payers have seen significant obstacles when it comes to operating on the public health insurance exchanges with large, national insurance companies losing money through this marketplace. Below we outline some key insurers that have...

Top 3 Trends Affecting the Health Insurance Market in 2016

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Looking back at 2016, there were a number of different trends that continued to impact the health insurance market. The Triple Aim of Healthcare continues to be a major part of the ongoing reforms and trends throughout the insurance industry...

Why Value-Based Care Reimbursement, MACRA are Here to Stay

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The outcome of the presidential election has led to some uncertainty throughout the healthcare industry when it comes to legislative changes and medical coverage. However, providers and payers will need to keep a clear head in the coming months...

CMS Commits to Improved Care Quality, Medical Spending Cuts

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The Centers for Medicare & Medicaid Services (CMS) will continue to work toward creating a better healthcare system for patients while keeping close track of medical spending regardless of which political party is in charge, said Andy...

UnitedHealth Group Adopts Bundled Payment Models for Surgeries

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The commercial payer UnitedHealth Group has begun expanding its involvement in bundled payment models. Forbes reported that UnitedHealth will be implementing bundled payment models for spinal surgeries as well as hip and knee replacement operations...

Health Payer Solutions for Improving HEDIS Quality Scores

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Payers and providers transitioning to value-based care reimbursement need to commit to meeting and improving their HEDIS quality scores. However, the documentation involved in reporting HEDIS quality scores tends to become complex. Johns...

How Health Payers Could Help Reduce High Out-of-Pocket Costs

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A major problem still impacting consumers within the health insurance market is the potential for seeing high out-of-pocket costs. Many individuals are still underinsured despite the significant decrease in the uninsured rate around the country...

How Payers Could Gain Success in Value-Based Care Models

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Value-based care models are on their way to becoming the main form of reimbursement between payers and providers especially when considering the goals of the Centers for Medicare & Medicaid Services (CMS) to position 50 percent of Medicare...

Humana Serves 63% of Members through Value-Based Care Payment

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The future for the health insurance industry likely revolves around value-based care payment, which has grown in use steadily over the last several years. Recent healthcare reforms have centered around tracking the quality of care, reducing spending,...

Population Health Helps Medicare ACO Models Earn Shared Savings

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Medicare ACO models operating through the Medicare Shared Savings Program have faced some significant challenges in garnering shared savings and taking on more financial risk. With multiple programs competing for funding from the Centers for...

Quality Metrics Pose Problems for Value-Based Care Reimbursement

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The healthcare industry’s fast pace transition to value-based care reimbursement has led to some major challenges for both providers and payers. Adopting completely new payment contracts based on quality metrics is not a simple maneuver...

Affordable Care Act Replacement Seeks Automatic Enrollment

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Since the Presidential election of Donald J. Trump, a number of differing viewpoints came out emphasizing how the Patient Protection and Affordable Care Act will be impacted. For the last several years, the Republican Party has attempted to repeal...

Health Insurance Merger Lawsuit Considers Efficiencies Factor

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On Monday, November 21, the court trial filed by the Department of Justice against the health insurance merger between Anthem and Cigna began. The drive to stop the $48 billion health insurance merger started due to concerns over a negative impact...

CMS Cuts Wasteful Medical Spending, FFS Improper Payments

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The Centers for Medicare & Medicaid Services (CMS) has reduced the Medicare fee-for-service improper payment rate from last year’s 12.1 percent to 11 percent in 2016, The CMS Blog reports. CMS has dedicated itself in recent years to...

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