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HealthPayerIntelligence News

Health Insurance Exchanges Require Engagement, Narrow Networks

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Since some private health payers are struggling with enrollment and the ability to make a profit on the health insurance exchanges, engaging consumers, reducing the administrative burden, and creating a narrow provider network will become an...

How MACRA Requirements Impact Accountable Care Organizations

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MACRA legislation impacts a number of healthcare providers and entities including accountable care organizations (ACOs). Only a few Medicare accountable care organizations will actually be able to participate in Advanced Alternative Payment Models...

Blue Cross to Expand Value-Based Care Reimbursement in 2017

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The coming years will further position the medical industry including payers to adopt value-based care reimbursement models and new healthcare delivery systems partially due to the reforms that came about from the Patient Protection and Affordable...

Humana’s Value-Based Care Platform Decreased Costs by 20%

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The health payer Humana released positive results within its Medicare Advantage program for the third year in a row, according to a company press release. The value-based care platform used at Humana indicated 19 percent higher HEDIS scores among...

How Blue Cross Blue Shield Achieved Value-Based Care Payment

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The transition to value-based care payment from fee-for-service payment methodology has come about due to the constant rise of healthcare spending. In fee-for-service, healthcare providers are incentivized to perform more services and offer often...

CMS Releases Final Rule for Medicare Physician Fee Schedule

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Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that updates a number of reimbursement policies and rates under the Medicare Physician Fee Schedule (PFS), a CMS press release states. The new payment policies...

Medicare Diabetes Prevention Program Saves $2,650 per Patient

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In March 2016, the Department of Health & Human Services (HHS) proposed the expansion of Medicare coverage for the Diabetes Prevention Program. The funding for this program comes from the Affordable Care Act and research shows that Medicare...

MACRA Implementation Solutions Payers, Providers Should Follow

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MACRA implementation will take place across the healthcare industry starting next year, as more and more providers begin participating in Advanced Alternative Payment Models (APMs) and and the Merit-Based Incentive Payment System (MIPS). Commercial...

How Payers Could Compete in Midst of Health Insurance Mergers

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Among the payers facing a Department of Justice lawsuit against their health insurance mergers, Aetna and Humana have requested sanctions due to the government allegedly delaying the release of documents the two insurers need. The Motion for...

How Provider Portals Streamline Medical Claims Management

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Healthcare payers have often struggled to process claims and provide effective customer service in a more streamlined manner due to technological inefficiencies. Insurers have faced challenges with engaging both their consumer base as well as...

Data Analytics Key for Strengthening Employer-Payer Relationship

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Health insurance companies, employers, and the workforce take a number of different steps to ensure that the best decisions are made in terms of health plan policies and covered benefits. For a variety of reasons, some businesses choose employer-sponsored...

Vermont’s All-Payer Model Limits Medical Spending Growth

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Vermont has been working on regulatory actions that would reform healthcare payment throughout the state specifically through an all-payer model. Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a press release the...

High-Deductible Health Plan Consumers Seek Price Transparency

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Families and individuals who have purchased healthcare coverage on the ACA health insurance exchanges may have seen that monthly premium rates are expected to rise 25 percent in 2017, but should be aware that those eligible for tax subsidies...

Accountable Care Organizations Expand Use of Social Services

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Today, accountable care organizations (ACOs) are focused on expanding their coordination efforts with social service agencies and community resources, according to findings from a report completed by the Premier Research Institute and the Robert...

Private Payers Falling Behind in MACRA Implementation, APMs

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Earlier this month, the Department of Health & Human Services (HHS) announced the release of the finalized ruling for the MACRA legislation. Along with gutting the flawed Sustainable Growth Rate formula, MACRA legislation brings forward Advanced...

ACO Investment Model May Improve Care Delivery in Rural Areas

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While healthcare reform and legislation like the Affordable Care Act have brought medical coverage to an additional 20 million Americans across the country, the patient community still faces some challenges especially in rural areas. When comparing...

Premium Rates on Affordable Care Act Exchanges Rise 25% in 2017

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Monthly premium costs on the Affordable Care Act exchanges is expected to rise an average of 25 percent in 2017, according to a report from the Department of Health & Human Services (HHS). This percentage is based solely on the premiums for...

25% of Health Plans Implement Alternative Payment Models

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Among commercial health plans, Medicare Advantage, and Medicaid markets, approximately 25 percent of reimbursement is expected to be in the form of alternative payment models by the end of 2016, according to a new report from the Health Care...

Commercial Payers Behind CMS in Bundled Payment Models

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The Centers for Medicare & Medicaid Services (CMS) have heavily invested in pursuing bundled payment models as an alternative form of payment for medical care among Medicare beneficiaries. Commercial payers, however, have been more slow to...

Why Accountable Care Organizations Should Adopt Bundled Payment

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The Centers for Medicare & Medicaid Services (CMS) should consider allowing Track 1, 2, and 3 accountable care organizations (ACOs) to participate in cardiac and comprehensive joint replacement bundled payment models, according to a comment...

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