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...
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...
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...
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...
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...
Health payers looking to increase consumer satisfaction and member retention may need to reach care quality metrics and HEDIS measures. The National Committee for Quality Assurance (NCQA) is...
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...
For many years, the health insurance industry has been working to address wasteful spending among hospitals and medical practices. Some of the areas of wasteful spending relate to duplicative medical...
Last week, Humana announced in a company press release the development of a Clinical Quality Metrics Alignment (CQMA) program meant to simplify and regulate healthcare quality measures. The new...
The Centers for Medicare & Medicaid Services (CMS) announced last week the creation of the CMS Person and Family Engagement Strategy, The CMS Blog states. This CMS initiative is meant to stimulate...
Healthcare price transparency remains a key issue for health payers across the country. In order to strengthen member retention efforts especially during open enrollment periods, payers will need to...
Medical claims management is a key aspect of the payer-provider relationship. However, medical claims management tends to include multiple challenges for both payers and providers. Some of the problems...
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...
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...
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...
In recent years, healthcare reforms have set out to reduce constantly rising medical costs, improve coverage for the many Americans who lacked primary care access, and advance population health outcomes. Over the past few years, the...
Payers and providers transitioning to value-based care reimbursement need to commit to meeting and improving their HEDIS quality scores. However, the documentation involved in reporting HEDIS quality...
A major problem still impacting consumers within the health insurance market is the potential for seeing high out-of-pocket costs. Many individuals are still underinsured despite the significant...
Value-based care models are on their way to becoming the main form of reimbursement between payers and providers especially when considering the goals of the Centers for Medicare & Medicaid...
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....
