Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Best Practices

Why HEDIS Quality Measures Matter for Value-Based Care

by Vera Gruessner

The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of health payers to assess and collect data on the performance of providers. HEDIS consists of a number of different measures on which healthcare providers...

Population Health Vital for Medicare ACO Models to Succeed

by Vera Gruessner

Accountable care organizations (ACOs) have taken on a larger role in delivering services throughout the continuum of care. Initially, these establishments were created under the Medicare Shared Savings Program but have slowly moved toward contracting...

Why Payers Should Include Consumer Engagement in Health Plans

by Vera Gruessner

In order to ensure that the health insurance exchange successfully reduces healthcare spending, it may be necessary to strengthen consumer engagement and education so that policyholders continually purchase the right health coverage for their...

How to Strengthen Accountable Care Organizations, MSSP

by Vera Gruessner

Accountable care organizations (ACOs) continue to gain greater acknowledgement within the healthcare industry as the field transitions to value-based care reimbursement and moves away from the fee-for-service payment model. It began with the...

Payers Seek Cost, Integration Efficiencies for Value-Based Care

by Anand Natampalli, MBA

Health insurance is no longer primarily a business-to-business transaction between payer organizations and employers. Today, payers must be prepared to holistically meet the needs of millions of individual consumers—from onboarding and...

How Pharmacy Benefit Managers Could Reduce Drug Cost Growth

by Vera Gruessner

From a health insurance perspective, more analysis needs to be taken into account when attempting to reduce healthcare spending. For instance, health payers may be interested in learning that pharmacy benefit managers (PBM) actually play a role...

CMS Seeks Input to Implement Modular Medicaid IT Solutions

by Vera Gruessner

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a request for information called Modular Solutions for Medicaid IT Enterprise and Pre-certification of Solutions. Essentially, CMS is seeking more information regarding...

Ambulatory Surgery Centers Decrease Costs by $38 Billion

by Vera Gruessner

Health payers are often looking for ways to reduce healthcare spending, especially with regard to the costs of covering medical claims. Many have focused on implementing value-based care reimbursement structures like bundled payments while others...

What Repealing the Affordable Care Act Would Mean for America

by Vera Gruessner

While the Patient Protection and Affordable Care Act was passed into law six years ago, there is still plenty of controversy that surrounds this landmark legislation. For instance, the Senate and House of Representatives passed a bill that would...

Why Payers Should Adhere to Patient Engagement, Consumer Choice

by Vera Gruessner

Consumer choice in health plans and provider networks is becoming a more popular topic of late among payers looking to increase patient engagement. There is a growing movement around the nation aimed at improving consumer satisfaction and healthcare...

Why Patients Need More than Reduced Healthcare Spending

by Vera Gruessner

Is lower healthcare spending truly tied to improved quality of care among hospitals? New research published in Health Affairs begs to differ when it comes to rewarding lower quality hospitals that achieved a reduction in healthcare spending....

Why Maternity Care Needs Episode-Based Bundled Payments

by Vera Gruessner

Episode-based bundled payments are becoming a sought-after reimbursement model throughout the healthcare industry. Along with the Centers for Medicare & Medicaid Services and its focus on implementing bundled payments, private payers are...

Top 6 Factors for Success in Provider-Sponsored Health Plans

by Vera Gruessner

The health insurance industry may have a complete transformation on their hands with regard to hospital and medical practice reimbursement. The number of provider-sponsored health plans is growing among physician groups and hospitals, according...

What Health Insurance Exchanges Should Do to Cut Premium Costs

by Vera Gruessner

The costs of premiums sold on the state health insurance exchanges tend to vary greatly, finds a report from The Commonwealth Fund. For instance, in 2016, the state of Tennessee saw a 38 percent increase in their health insurance premium costs...

Health Plan Solutions: Do Employers Choose Private Exchanges?

by Vera Gruessner

Today employers are searching for multiple solutions to meet their health plan needs in order to reduce costs and provide the optimal benefits to their employees. The multitude of healthcare regulations hitting the market today is making quite...

CMS Bundled Payment Program Reduces Costs for Consumer

by Vera Gruessner

At the end of last year, the Centers for Medicare & Medicaid Services (CMS) finalized their bundled payment rule for hip and knee replacement surgery. This type of bundled payment program will hold hospitals more accountable for patient health...

Coordination, Interoperability Key for MACRA Requirements

by Vera Gruessner

Last month, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will essentially drop meaningful use requirements in favor of the Merit-based...

Medicare Advantage Plans Decrease Avoidable Hospitalizations

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) may be able to reduce healthcare spending by decreasing the number of hospitalizations, emergency room visits, and other expensive medical care services.  This could be done by bringing...

Health Insurance Market Faces Restricted Provider Networks

by Vera Gruessner

Last week, Scott Gottlieb, MD, Resident Fellow at the American Enterprise Institute, spoke in front of the House Committee on Energy and Commerce Subcommittee on Health delivering key information about certain reforms for the health insurance...

Why Payers Need to Address Patient-Centered Medicine

by Vera Gruessner

The healthcare insurance industry needs to meet the demands of consumers looking for quality provider data. Patient-centered medicine is becoming a mainstay throughout the country and cost transparency is a major aspect of this movement. Along...

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