Care Coordination

What Utilization Management Strategies Do Payers Use to Lower Costs?

January 16, 2024 - As healthcare spending rises in the United States, stakeholders are constantly working to address the drivers of high costs. The overutilization of healthcare services—including the provision of low- or no-value care—not only impacts patients’ physical and mental health but also contributes to rising costs. Health plans leverage utilization management strategies to...


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Does Integrating Medicare and Medicaid Improve Care for Dual Eligibles?

by Victoria Bailey

Integrating Medicare and Medicaid coverage for dual eligible beneficiaries was associated with higher use of home- and community-based services (HCBS) but did not reduce hospitalization or improve care...

CQMC Revises Quality Measures, AHIP Advocates for Better Alignment

by Kelsey Waddill

Core Quality Measures Collaborative (CQMC) released new core quality measures and the implementation guidelines for certain core sets. More than 75 healthcare organizations, including payers,...

4 Essential Components of Chronic Disease Management Strategies

by Kelsey Waddill

With the US spending $3.7 trillion on diseases like diabetes, cancer, and other long-term conditions each year, payers cannot afford to falter on chronic disease management. Chronic disease spending and prevalence trends are stark, but...

Medicare, Medicaid Spending Similar Among Dual Eligible Beneficiaries

by Victoria Bailey

Need-based subgroups of dual eligible beneficiaries utilized both Medicare- and Medicaid-funded services, identifying the need for an integration program that includes benefits from both payers, a...

Humana Seeks to Improve Medicare Advantage Specialty Needs Benefits

by Kelsey Waddill

Humana has announced a partnership with Longevity Health Plan to improve Medicare Advantage members’ specialty needs plan benefits. Humana’s partner is both a clinical services company and...

States Use Managed Care, PACE, FAIs to Boost Dual Eligible Care Coordination

by Kelsey Waddill

Updated 5/2/2023: This article's title has been updated to say "States Use Managed Care, PACE, FAIs to Boost Dual Eligible Care Coordination." A previous version misspelled the acronym FAI as...

ACHP Addresses Proposed Rule on Substance Use Disorder Patient Data

by Kelsey Waddill

The Alliance of Community Health Plans (ACHP) was among around 50 organizations—including AHIP and Blue Cross Blue Shield Association—to sign a letter to HHS that supported fully aligning...

Tufts Health Plan, Harvard Pilgrim Collab Boosts Access to LGBTQ+ Care

by Victoria Bailey

Tufts Health Plan and Harvard Pilgrim Health Care have partnered with a connected healthcare delivery platform to improve access to LGBTQ+ care for commercial health plan members. The collaboration...

Independence Expands Value-Based Care Relationship, Seeks to Boost Primary Care

by Kelsey Waddill

Independence Blue Cross (Independence) announced that it will expand its value-based care relationship with Penn Medicine by selling a minority equity stake in one of Independence’s...

Payer, Walgreens Partner to Improve Equity, Care Coordination

by Kelsey Waddill

Blue Shield of California (Blue Shield) has partnered with Walgreens to launch more Walgreens Health Corner locations to reduce care disparities and facilitate better care coordination for members with...

AHIP: Next Steps Toward Primary, Behavioral Healthcare Integration

by Kelsey Waddill

AHIP called on providers and policymakers to join payers in their efforts to integrate behavioral healthcare and physical healthcare in an issue brief on the subject. The payer organization laid out...

Medicaid Managed Care Models May Improve Outcomes for Elderly, Disabled

by Victoria Bailey

Transitioning elderly and disabled Medicaid beneficiaries from fee-for-service Medicaid to a managed care model may lead to improved health outcomes and more than $100 billion of savings for states and...

5 Steps Employers Can Take To Implement Advanced Primary Care

by Kelsey Waddill

Advanced primary care can help employers control costs and coordinate care, but many employers do not know how to start and scale such a solution in their employer-sponsored health plans, according to...

Payer Virtual Care Management Platform Prioritizes Holistic Care

by Victoria Bailey

Blue Cross Blue Shield of Rhode Island (BCBSRI) has introduced a new virtual care management platform to offer a more convenient way for members to receive care coordination services and to improve...

Alignment Expands Medicare Advantage for Seniors in 3 States

by Victoria Bailey

Alignment Healthcare (Alignment) is extending its Medicare Advantage (MA) footprint in Arizona, North Carolina, and Nevada to provide coverage for more senior beneficiaries. Starting in 2022,...