Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Affordable Care Act

CMS Proposes New Rule to Stabilize Health Insurance Exchanges

February 16, 2017 - CMS recently announced a proposed rule designed to help stabilize health insurance exchanges by promoting more coverage options and improving the risk pool for insurers. The proposed rule comes just one day after Humana publicized its decision to quit the health insurance exchanges after the 2017 open enrollment period. The payer backed out because of an “unbalanced risk pool”...


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CMS Proposes New Rule to Stabilize Health Insurance Exchanges

by Jacqueline Belliveau

CMS recently announced a proposed rule designed to help stabilize health insurance exchanges by promoting more coverage options and improving the risk pool for insurers. The proposed rule comes just one day after Humana publicized its decision...

Humana to Leave ACA Health Insurance Exchanges by 2018

by Thomas Beaton

Humana will halt sales of individual health insurance plans through the Affordable Care Act’s exchanges by 2018, which will leave more than 150,000 Humana customers without a carrier.   Amid ongoing political uncertainty, Humana said...

Medicaid Expansion Boosts Coverage, Quality at Health Centers

by Jacqueline Belliveau

Federally funded health centers in states that underwent Medicaid expansion through the Affordable Care Act faced higher levels of insured patients and improved care quality compared to their peers in non-expansion states, a recent Health Affairs...

Proposed ACA Replacement Moves Coverage Choices to the States

by Thomas Beaton

Several Republican lawmakers have introduced the “Patient Freedom Act” as a proposed replacement of the Affordable Care Act, emphasizing state authority and local decision-making in the health insurance market. Senators Bill Cassidy,...

Congress Votes to Nominate Tom Price as HHS Secretary

by Vera Gruessner

On February 1, House Representative Tom Price, R-Ga., was officially nominated as the Secretary for the Department of Health & Human Services (HHS), according to the US News & World Report. The Senate Finance Committee moved forward with...

74% of PCPs Prefer Affordable Care Act Changes Over Repeal

by Jacqueline Belliveau

Only about 15 percent of primary care providers favored a complete repeal of the Affordable Care Act, a recent New England Journal of Medicine study stated. While some of the 426 primary care providers surveyed between December 2016 and January...

6.4 Million Enrollees Sign Up on Affordable Care Act Exchanges

by Vera Gruessner

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...

ACA Health Insurance Exchanges Bring Challenges for 2017

by Vera Gruessner

The Affordable Care Act (ACA) health insurance exchanges will have some key differences next year. Health insurance companies have faced various obstacles when selling health plans through the exchanges. These challenges include a higher risk...

Patient Engagement Helps Payers on Affordable Care Act Exchanges

by Vera Gruessner

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

by Vera Gruessner

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....

Payers Continue to Drop Out of the Health Insurance Exchanges

by Vera Gruessner

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...

Affordable Care Act Replacement Seeks Automatic Enrollment

by Vera Gruessner

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...

How to Fix Obama’s Affordable Care Act Without a Repeal

by Vera Gruessner

Now that a new President and a Republican-controlled Congress has been elected, what does the future for healthcare reform and the Affordable Care Act (ACA) look like? What will happen to the Affordable Care Act cannot be answered simply since...

AMA Pledges to Prevent Loss of Americans’ Healthcare Coverage

by Vera Gruessner

The American Medical Association (AMA) released a statement yesterday reaffirming its commitment to ensuring that every American who currently has healthcare coverage will continue to have insurance and access to medical care. In particular,...

House Speaker Paul Ryan Proposes a Privatized Medicare System

by Vera Gruessner

House Speaker Paul Ryan announced in an interview with Fox News Channel several days after the presidential election that the Republican-controlled Congress and White House will look to create a privatized Medicare system and cut funding from...

Healthcare Payers Face Challenges with Medical Loss Ratio

by Vera Gruessner

Under the Patient Protection and Affordable Care Act’s medical loss ratio, health payers are required to spend a minimum of 80 percent of their premium revenue on paying claims and boosting quality while the rest (20 percent) can be spent...

Health Insurance Exchanges Require Engagement, Narrow Networks

by Vera Gruessner

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...

Blue Cross to Expand Value-Based Care Reimbursement in 2017

by Vera Gruessner

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...

High-Deductible Health Plan Consumers Seek Price Transparency

by Vera Gruessner

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...

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

by Vera Gruessner

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...

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