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HealthPayerIntelligence News

Healthcare Payers Struggle with Price Transparency, Technology

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Health insurance companies are still struggling with improving price transparency in order to gain greater trust from their consumer base. One survey has shown low customer service satisfaction and a need for payers to inform consumers on their...

Private Payers Face Challenges on Health Insurance Exchanges

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The health insurance exchanges created after passage of the Affordable Care Act may not serve as a truly effective marketplace for commercial payers since some national insurers like Aetna and UnitedHealthcare have been dropping out of operating...

How a Public Option May Preserve Health Insurance Exchanges

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Multiple healthcare payers have been struggling with operating successfully on the Affordable Care Act’s health insurance exchanges. Some experts and lawmakers suggest that establishing a public option on the health insurance exchanges...

Top 4 Best Practices for Transitioning to Value-Based Care

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With the healthcare industry continually reforming toward better patient outcomes and reduced medical spending, health insurance companies have been moving away from fee-for-service payment structures and adopting value-based care reimbursement...

Did HHS Act Illegally in Transitional Reinsurance Program?

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At the end of September, the Government Accountability Office (GAO) announced in a briefing that the Department of Health & Human Services (HHS) does not have the authority to transfer funds from the collections within the transitional reinsurance...

Children’s Health Insurance Program Enrollment Expands in Flint

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The Centers for Medicare & Medicaid Services (CMS) announced earlier this month in a press release that it will be awarding $300,000 to the Greater Flint Health Coalition (GFHC) so that more children in Flint, Michigan will be connected to...

CMS Comprehensive Primary Care Program Gained $57M in Savings

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Dr. Patrick Conway, Principal Deputy Administrator and Chief Medical Officer at the Centers for Medicare & Medicaid Services (CMS), announced in The CMS Blog that 95 percent of all primary care practices participating in the Comprehensive...

New Leadership at Veterans Affairs Results from Transfers

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One public health payer that has had a wide amount of controversy regarding its operations is Veterans Affairs. The latest controversy comes regarding the Veterans Affairs claim that it has new leadership and leadership teams. USA Today conducted...

Payers Slow to Adopt Value-Based Care Payment Arrangements

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A new survey from the healthcare alliance Premier found that healthcare payers are not transitioning to value-based care payment arrangements as quickly as medical providers would like, according to a company press release. With the Centers for...

How Investing in Social Services Could Cut Healthcare Spending

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While healthcare spending is continually increasing, patient outcomes and overall health has not necessarily improved greatly, according to a report from Leavitt Partners and the Robert Wood Johnson Foundation. However, the study also...

How Stakeholder Input on Quality Payment Program Differs

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At the end of last week, the Department of Health & Human Services (HHS) released a final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its policies on the new Quality Payment Program. HHS reiterated in a press...

Private Payers Follow CMS Lead, Adopt Value-Based Care Payment

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Commercial payers are following the lead of the Centers for Medicare & Medicaid Services (CMS) when it comes to adopting value-based care payment protocols. More private payers have implemented various value-based CMS programs such as accountable...

HHS, CMS Announce Finalized Ruling for MACRA Legislation

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The Department of Health & Human Services (HHS) announced in a press release the discharge of the final ruling on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The MACRA legislation replaces the flawed Sustainable Growth...

Misalignment of Healthcare Quality Measures Impacts Payers

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In the healthcare industry’s move toward value-based care reimbursement, public and private payers create healthcare quality measures meant to align with how providers are paid and what type of financial penalties will be instituted for...

Six Medicaid ACOs Vary in Consumer Engagement Success

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Consumer engagement in a number of Medicaid accountable care organizations (ACOs) tend to vary significantly, according to a September 2016 report from the Center for Consumer Engagement in Health Innovation. With providers being incentivized...

MA Proposed Rule May Cut Savings from Ambulatory Surgery Centers

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New proposed changes to current legislation from the Massachusetts Department of Public Health may either decrease the use of or potentially eliminate ambulatory surgery centers, according to a press release from Healthcare Bluebook. The reason...

How Provider-Sponsored Health Plans Can Compete for Consumers

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Provider organizations that take the leap to develop their own health plans compete in a highly competitive healthcare environment with established national, regional and local plans, and in some markets, new non-traditional entrants in the health...

Two Legal Arguments For and Against Health Insurance Mergers

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In 2015, the national insurer Anthem began proceedings to acquire Cigna while Aetna planned to merge with Humana. Very quickly, opposition lined up against the two planned health insurance mergers, with some arguing that bringing the top five...

Latest CMS Bundled Payment Strategies May Need Revision

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The Health Care Incentives Improvement Institute has found problems with some of the latest bundled payment strategies coming from the Centers for Medicare & Medicaid Services (CMS) including flaws surrounding clinic-centric control of the...

VT All-Payer Model Aligns Costs for Public, Private Insurers

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The state of Vermont is moving forward with establishing an all-payer model that uses accountable care organizations and ensures a provider is reimbursed by an equal amount among all healthcare payers for a particular service. The Vermont government...

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