Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Health Insurance

CMS Proposes New Rule to Stabilize Health Insurance Exchanges

February 16, 2017 - CMS recently announced a proposed rule designed to help stabilize health insurance exchanges by promoting more coverage options and improving the risk pool for insurers. The proposed rule comes just one day after Humana publicized its decision to quit the health insurance exchanges after the 2017 open enrollment period. The payer backed out because of an “unbalanced risk pool”...


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CMS Proposes New Rule to Stabilize Health Insurance Exchanges

by Jacqueline Belliveau

CMS recently announced a proposed rule designed to help stabilize health insurance exchanges by promoting more coverage options and improving the risk pool for insurers. The proposed rule comes just one day after Humana publicized its decision...

Federal Court Blocks Aetna-Humana Health Insurance Merger

by Vera Gruessner

Today, a federal judge ruled that the health insurance merger between the healthcare payers Aetna and Humana should be blocked on the grounds that it would create antitrust issues, according to The New York Times. The health insurance...

How Blue Cross Health Plans Affect Anthem-Cigna Merger Lawsuit

by Vera Gruessner

The Anthem-Cigna merger lawsuit has brought significant evidence to light ever since the case began on November 21, 2016. The Department of Justice has been able to illuminate that the health insurance merger would create major market concentration...

Senate, House of Representatives Pass 21st Century Cures Act

by Vera Gruessner

This week, Congress passed the 21st Century Cures Act. President Obama signed the legislation into law on Tuesday, December 13. The 21st Century Cures Act passed with bipartisan support 94-5 in the Senate and 392-26 in the House of Representatives....

How Health Payers Could Help Reduce High Out-of-Pocket Costs

by Vera Gruessner

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 decrease in the uninsured rate around the country...

Health Insurance Merger Lawsuit Considers Efficiencies Factor

by Vera Gruessner

On Monday, November 21, the court trial filed by the Department of Justice against the health insurance merger between Anthem and Cigna began. The drive to stop the $48 billion health insurance merger started due to concerns over a negative impact...

Rise in High-Deductible Health Plans Requires Cost Transparency

by Vera Gruessner

High-deductible health plans are becoming more and more common across the health insurance industry. With the many changes that the Affordable Care Act (ACA) has brought, payers are attempting to control costs by offering more high-deductible...

Healthcare Insurance Literacy Vital for Higher Coverage Rate

by Vera Gruessner

New research from the RAND Corporation shows that uninsured Americans who have better healthcare insurance literacy were more likely to purchase coverage when the Affordable Care Act’s health insurance exchanges opened in 2014, according...

AMA Pledges to Prevent Loss of Americans’ Healthcare Coverage

by Vera Gruessner

The American Medical Association (AMA) released a statement yesterday reaffirming its commitment to ensuring that every American who currently has healthcare coverage will continue to have insurance and access to medical care. In particular,...

How Payers Could Use Price Transparency to Boost Satisfaction

by Vera Gruessner

In order to reduce ever rising healthcare costs, health insurance companies will need to improve price transparency among their health plans as well as within their provider networks. The Robert Wood Johnson Foundation released a report showing...

Medicare Diabetes Prevention Program Saves $2,650 per Patient

by Vera Gruessner

In March 2016, the Department of Health & Human Services (HHS) proposed the expansion of Medicare coverage for the Diabetes Prevention Program. The funding for this program comes from the Affordable Care Act and research shows that Medicare...

Data Analytics Key for Strengthening Employer-Payer Relationship

by Vera Gruessner

Health insurance companies, employers, and the workforce take a number of different steps to ensure that the best decisions are made in terms of health plan policies and covered benefits. For a variety of reasons, some businesses choose employer-sponsored...

Two Legal Arguments For and Against Health Insurance Mergers

by Vera Gruessner

In 2015, the national insurer Anthem began proceedings to acquire Cigna while Aetna planned to merge with Humana. Very quickly, opposition lined up against the two planned health insurance mergers, with some arguing that bringing the top five...

49M Americans Risk Losing Fixed Indemnity Health Insurance

by Vera Gruessner

A new proposed rule called Expatriate Health Plans, Expatriate Health Plan Issuers, and Qualified Expatriates; Excepted Benefits; Lifetime and Annual Limits; and Short-Term, Limited-Duration Insurance may negatively impact access to fixed indemnity...

Presidential Election Brings Two Opposing Healthcare Policy Proposals

by Vera Gruessner

With the Presidential election heating up and the debate season upon us, last week The Commonwealth Fund detailed the stark differences seen between the two presidential candidates healthcare policy proposals in a new report. The research comes...

Comprehensive Primary Care Plus Program Selects Anthem BCBS

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has selected Anthem Blue Cross and Blue Shield in Colorado as a participant for their Comprehensive Primary Care Plus (CPC+) initiative, according to a company press release. The Comprehensive...

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...

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...

35 Audits Find Medicare Advantage Plans Overbilling CMS

by Vera Gruessner

Audits conducted by the Government Accountability Office (GAO) reveal that up to 35 Medicare Advantage plans fraudulently billed the federal government for medical care provided to many of its elderly patients. The Center for Public Integrity...

Affordable Care Act’s Reinsurance Programs Keep Market Stable

by Vera Gruessner

One way that health payers can compete more effectively in the current destabilized environment is by investing resources in reinsurance programs. Reinsurance is a method in which a payer can buy a policy from other insurers in order to manage...

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