Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Accountable Care Organizations

UnitedHealthcare Partners with Accountable Care Organizations

January 20, 2017 - 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 from physicians affiliated with accountable care organizations (ACOs). HealthPayerIntelligence.com spoke with Reed Bjergo, Chief of Staff at UnitedHealth...


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UnitedHealthcare Partners with Accountable Care Organizations

by Vera Gruessner

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

by Vera Gruessner

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 3 Healthcare Insurers Expand Value-Based Care Payment

by Vera Gruessner

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...

5 Best Practices to Advance Value-Based Care Reimbursement

by Vera Gruessner

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...

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

by Vera Gruessner

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

by Vera Gruessner

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...

Population Health Management Helps ACOs Earn Shared Savings

by Vera Gruessner

Continually rising medical costs without significant benefits to patient care have led both public and private payers to invest in value-based care payment structures such as accountable care organizations (ACOs). However, when payers and providers...

CMS Issues Bundled Payment Models for Cardiac, Orthopedic Care

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) released earlier this week the finalized bundled payment models for cardiac and orthopedic care including the Medicare ACO Track 1+ Model, according to a CMS fact sheet. The bundled payment...

MACRA Pushes Payers to Adopt Value-Based Care Payment Models

by Vera Gruessner

This past summer, the Labor Department announced that healthcare spending rose in August more steeply than at any point in more than 30 years. The costs for medical treatment grew by 1 percent in just one month, the Los Angeles Times reported....

UnitedHealth Releases Accountable Care Organization Coverage

by Vera Gruessner

On December 7, UnitedHealthcare announced in a company press release the introduction of the NexusACO, which is a new health plan product that allows consumers to obtain care from accountable care organizations. The program is expected to reduce...

CMS Accountable Care Organization Model Targets Dual Eligibles

by Vera Gruessner

On December 15, the Department of Health & Human Services (HHS) announced the creation of the new Medicare-Medicaid Accountable Care Organization (ACO) Model. The model is meant to improve the quality of care and decrease costs of beneficiaries...

Top 10 Healthcare Insurance Headlines from 2016 Involve Value

by Vera Gruessner

Over the last year, the medical insurance industry has undergone a variety of changes and overcame challenges as the space transitioned to value-based care. Below we outline ten of the most influential healthcare insurance headlines from 2016...

UnitedHealthcare Cut Costs through Value-Based Care Programs

by Vera Gruessner

Last month, UnitedHealthcare released a report outlining the benefits of value-based care programs. The report called Collaborative and Coordinated: How Value-Based Care Programs are Driving Improvements in Quality and People’s Health began...

UnitedHealth Adopts Bundled Payment Model for Orthopedic Care

by Vera Gruessner

Healthcare payers are finding that their reimbursement totals show higher spend for hip, knee, and spine surgeries and other orthopedic care when compared to other forms of treatment. Along with the higher spend, members regularly show poor health...

Premier Offers Healthcare Policy Improvements for ACOs, Payers

by Vera Gruessner

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...

Top 3 Trends Affecting the Health Insurance Market in 2016

by Vera Gruessner

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...

Population Health Helps Medicare ACO Models Earn Shared Savings

by Vera Gruessner

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...

CMS Cuts Wasteful Medical Spending, FFS Improper Payments

by Vera Gruessner

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...

Deductibles, Out-of-Pocket Healthcare Spending Rose 3% in 2015

by Vera Gruessner

Healthcare spending within the private health insurance market has grown 4.6 percent in 2015, according to a press release from the Health Care Cost Institute (HCCI). This type of growth in spending is higher than in recent years. For instance,...

Premier Accountable Care Organizations Improved Quality in 2015

by Vera Gruessner

New results from the Premier Inc. Population Health Management Collaborative (PHMC) show that accountable care organizations (ACOs) within the collaborative improved quality and cost reduction in 2015 better than other ACOs operating through...

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