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HealthPayerIntelligence News

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...

70% of Medical Groups Concerned About MACRA Regulations

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MACRA regulations have impacted the revenue cycle of providers across the country particularly regarding Medicare reimbursement from the Centers for Medicare & Medicaid Services (CMS). The American Academy of Family Physicians outlined how...

How Payers, Providers Could Streamline Medical Claims Management

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Successful medical claims management and processing is not always easy to garner for health insurance companies due to a lack of training among insurance agents, missing or inaccurate documentation, and the general time-consuming aspect...

Blue Cross Health Plans Expand Value-Based Care Reimbursement

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Along with other national payers, Blue Cross Blue Shield health plans have been investing in expanding value-based care reimbursement. For example, New York-based Excellus Blue Cross Blue Shield has partnered with vendors to use analytics and...

5 Solutions for Conquering Challenges of Bundled Payment Models

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Despite strong optimism and stakeholder enthusiasm, a new bundled payment program operated by the Integrated Healthcare Association and the RAND Corporation faced major problems and delays. A report from the Agency for Healthcare Research and...

How Blue Cross Health Plans Affect Anthem-Cigna Merger Lawsuit

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The Anthem-Cigna merger lawsuit has brought significant evidence to light ever since the case began on November 21, 2016. The Department of Justice has been able to illuminate that the health insurance merger would create major market concentration...

Communication Key for Transition to Alternative Payment Models

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Along with health insurers, more and more providers are expected to transition to alternative payment models (APMs) especially due to MACRA’s Quality Payment Program. For example, urology group practices are likely to adopt advanced alternative...

Top 3 Health Insurance Industry Headlines of December 2016

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Now that the final month of the year is wrapping up and everyone is planning their New Year’s celebrations, a review of the most popular headlines for the health insurance industry may be beneficial as we head into 2017. Patients Need More...

4 Major Ways to Succeed in Value-Based Care Payment Strategies

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What areas should payers and providers focus on when contracting through a value-based care payment strategy? In order to succeed in value-based care payment models, insurers and practitioners may need to focus on population health management,...

6.4 Million Enrollees Sign Up on Affordable Care Act Exchanges

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As of December 21, a total of 6.4 million consumers have enrolled in health plans through the Affordable Care Act exchanges on HealthCare.gov, reported the Centers for Medicare & Medicaid Services (CMS) in a fact sheet. The number of enrollees...

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