Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Best Practices

How MACRA Resolves Sustainable Growth Rate Formula Challenges

by Vera Gruessner

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will likely simplify and improve Medicare reimbursement processes due to the fact that it repeals the flawed sustainable growth rate (SGR) formula. The problems associated with...

Affordable Care Act Reduced Uninsurance Rate to 8.6% in 2016

by Vera Gruessner

The latest data from the National Center for Health Statistics shows that the uninsurance rate during the first three months of 2016 has decreased to 8.6 percent, or 27.3 million Americans, thanks to the continued impact of the Affordable...

Why Health Insurance Claims Should Include Medical Device UDIs

by Vera Gruessner

More and more healthcare associations have been emphasizing the need to incorporate unique device identifiers (UDIs) from medical devices within health insurance claims. In fact, professionals from The Brookings Institution have spoken in favor...

Where the Medicare Shared Savings Program May be Lacking

by Vera Gruessner

The latest news from the Medicare Shared Savings Program and its associated accountable care organizations shows that some goals of the project have been gained such as ongoing cost savings and quality performance benchmarks. However, there are...

Consumer-Driven Health Plans Reduce Medical Care Utilization

by Vera Gruessner

The Health Care Cost Institute released new findings that show consumer-driven health plans are leading individuals to utilize less medical care as well as spending more on out-of-pocket costs. Among consumer-driven health plans, enrollees spend...

CMS Grants Navigators $63M to Boost Health Insurance Marketplace

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced in a press release earlier this week that it will be providing $63 million in grants to both new and older organizations returning to offer health plans through the public health...

Public Health Insurance Marketplace Still Benefits Consumers

by Vera Gruessner

The public health insurance marketplace created through the Affordable Care Act (ACA) may have fewer and fewer health plans participating in the coming years since a number of major insurers have dropped out of the exchanges. This would lead...

3 Strategies to Follow in Value-Based Care Reimbursement

by Vera Gruessner

In order to have an effective value-based care reimbursement strategy, healthcare payers and providers will need to implement a number of steps in their pursuit of rewarding quality of care instead of quantity as seen in fee-for-service payment...

Could Public Option Strengthen ACA Health Insurance Exchanges?

by Vera Gruessner

The ACA health insurance exchanges are facing greater risk now that a number of healthcare payers have decided to drop out of the marketplace. UnitedHealthcare was the first to announce its departure from the ACA health insurance exchanges. More...

Empire BlueCross BlueShield Rewards Strong Care Coordination

by Vera Gruessner

Healthcare payers are often looking for ways to improve care coordination in an effort to enhance patient outcomes and reduce medical spending. Empire BlueCross BlueShield is one healthcare payer that has implemented care coordination measures...

UnitedHealth’s Value-Based Care Reimbursement Improves Outcomes

by Vera Gruessner

Value-based care reimbursement has been hitting both payers and providers as a surefire way to promote payment reform and reduce medical spending. The new models of payment are coming straight from public payers including the Centers for Medicare...

Trial Date Set for Aetna-Humana Health Insurance Merger

by Vera Gruessner

Health insurance companies and private physician practices or hospitals have often been on opposite sides of the fence when it comes to operating their organizations and managing their patient base. The typical stereotype is that payers and providers...

CMS Redesigns Value-Based Model for Medicare Advantage Plans

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has recently announced in a new fact sheet that their Medicare Advantage Value-Based Insurance Design model will be changing slightly during its second year of operation. These different...

Why Provider-Sponsored Health Plans are Gaining Ground

by Vera Gruessner

There are a number of reasons why provider-sponsored health plans are growing and more hospitals are considering investing in their own health plans instead of partnering with health payers, says Paul Keckley, Ph.D., a healthcare industry expert...

Why Payers Should Educate Providers on Value-Based Care

by Vera Gruessner

Both private payers and public payers like the Centers for Medicare & Medicaid Services (CMS) have a long road ahead of them in supporting healthcare providers and consumers with the transition to value-based care reimbursement. For example,...

Does Reference Pricing Reduce Costs of Diagnostics for Payers?

by Vera Gruessner

Health insurers and consumers can benefit from seeking reference pricing when it comes to choosing specific diagnostic tests among a set of different laboratories. Researchers from the University of Southern California and the Brookings Institution...

Why Bundled Payments are Essential for Payers to Adopt

by Vera Gruessner

While the Centers for Medicare & Medicaid Services (CMS) was first to implement bundled payments in one of its many programs meant to renovate provider reimbursement processes, private health payers would also benefit from pursuing bundled...

One-third of Hispanic Texans Lack Medical Insurance in 2016

by Vera Gruessner

There is still more work that needs to be done to ensure all American citizens have access to healthcare coverage. The Episcopal Health Foundation and Rice University’s Baker Institute for Public Policy found that approximately 32 percent...

1.5M Workers Gained Employer-Sponsored Healthcare Coverage

by Vera Gruessner

The number of employees who have gained healthcare coverage through employer-sponsored health plans has been rising in recent years as the economy recovered and more Americans gained a foothold in the workplace. With a stronger economy, the health...

Should CMS Incorporate More Bundled Payment Programs?

by Vera Gruessner

Last month, the Center for American Progress (CAP) issued a statement urging the Department of Health & Human Services (HHS) to expand their work in bundled payment programs so that medical costs would decrease and even greater focus can...

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