Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Best Practices

MACRA Implementation Solutions Payers, Providers Should Follow

by Vera Gruessner

MACRA implementation will take place across the healthcare industry starting next year, as more and more providers begin participating in Advanced Alternative Payment Models (APMs) and and the Merit-Based Incentive Payment System (MIPS). Commercial...

How Payers Could Compete in Midst of Health Insurance Mergers

by Vera Gruessner

Among the payers facing a Department of Justice lawsuit against their health insurance mergers, Aetna and Humana have requested sanctions due to the government allegedly delaying the release of documents the two insurers need. The Motion for...

How Provider Portals Streamline Medical Claims Management

by Vera Gruessner

Healthcare payers have often struggled to process claims and provide effective customer service in a more streamlined manner due to technological inefficiencies. Insurers have faced challenges with engaging both their consumer base as well as...

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...

Accountable Care Organizations Expand Use of Social Services

by Vera Gruessner

Today, accountable care organizations (ACOs) are focused on expanding their coordination efforts with social service agencies and community resources, according to findings from a report completed by the Premier Research Institute and the Robert...

Why Accountable Care Organizations Should Adopt Bundled Payment

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) should consider allowing Track 1, 2, and 3 accountable care organizations (ACOs) to participate in cardiac and comprehensive joint replacement bundled payment models, according to a comment...

Private Payers Face Challenges on Health Insurance Exchanges

by Vera Gruessner

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...

Top 4 Best Practices for Transitioning to Value-Based Care

by Vera Gruessner

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...

Payers Slow to Adopt Value-Based Care Payment Arrangements

by Vera Gruessner

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

by Vera Gruessner

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...

Six Medicaid ACOs Vary in Consumer Engagement Success

by Vera Gruessner

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

by Vera Gruessner

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...

Latest CMS Bundled Payment Strategies May Need Revision

by Vera Gruessner

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...

Health Insurance Marketplaces Call for Plan Standardization

by Vera Gruessner

Healthcare payers are being instructed to offer standardized plan and benefit designs as the  federally facilitated health insurance marketplace is working to improve consumers’ ability to compare varying health plans during the next...

3 Key Steps for Payers to Succeed in Value-Based Care Payment

by Vera Gruessner

Commercial health insurance companies have little reason to remain attached to fee-for-service payment systems since the rate of healthcare costs continues growing and the healthcare industry as a whole is moving toward value-based care reimbursement....

4 Ways Health Payers Could Decrease Medical Spending Growth

by Vera Gruessner

Health insurance companies are often looking for key methods and best practices to reduce rising healthcare costs. Payers could avoid the continual increase in medical spending by reducing the rates of unnecessary and duplicative services, adopt...

Consumer Satisfaction Dips When Payers Lack Price Transparency

by Vera Gruessner

Eighty-eight percent of consumers are looking for their health payer to relay complete information about their overall financial responsibility, according to a new survey by HealthEdge, indicating a strong desire for price transparency and openness....

Why Payers Should Consider Consumer Needs in Value-Based Care

by Vera Gruessner

The Healthcare Financial Management Association (HFMA) released a new report called Health Care 2020: Consumerism showing that the health insurance industry has two new trends affecting it: a greater push toward patient cost sharing and outcomes-based...

Why Strengthening Affordable Care Act Could Cut Disparities

by Vera Gruessner

The Patient Protection and Affordable Care Act has significantly improved healthcare coverage and access throughout the country, but there are still some obstacles remaining to ensuring that every American has access to health insurance. While...

58% of Payers, Providers Adapt Value-Based Care Reimbursement

by Vera Gruessner

Several surveys from 2016 show that more healthcare providers and payers than ever before are implementing value-based care reimbursement contracts and moving away from traditional fee-for-service payment models. This past June, ORC International...

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