Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Blue Shield, Accountable Care Organization Saved $325 Million

by Vera Gruessner

In recent years, there has been plenty of concern about whether or not Accountable Care Organizations (ACOs) bring significant cost savings to the healthcare industry. However, one health payer and ACO have proven that it is possible to make...

Value-based Care, Member Incentives May be Payers’ ‘Holy Grail’

by Vera Gruessner

The healthcare payer industry is expected to change drastically over the coming years as more insurance companies adopt new business models and focus on value-based care. Moving away from fee-for-service, federal agencies and many payers are...

Value-based Payment Models Pose Challenge to Physicians

by Vera Gruessner

In HealthEdge’s State of the Payer Industry Survey, more than 80 percent of polled health payers are planning to support value-based payment models over the next three years. Additionally, nearly 77 percent of health plans are looking to...

Data Sharing Among Payers Advances Population Health Management

by Vera Gruessner

When it comes to data collection and data sharing, payers should inform beneficiaries exactly how their information is used such as public health reporting requirements or among healthcare providers. The federal government offers a background...

Altering Accountable Care Organizations May Bring More Success

by Vera Gruessner

Despite the fact that Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program was supposed to put a dent in the rising healthcare costs around the country, the latest results show that both in 2013 and 2014, only about 25...

Top 4 Policy Changes Affecting the Health Payer Market in 2015

by Vera Gruessner

The last year has had a huge impact on the health payer market as well as the entire healthcare industry from providers and educational institutions to the federal government and the patient community. Below we will outline the top four policy...

AMA, AHA Find Health Insurance Mergers Harmful to Consumers

by Vera Gruessner

Many stakeholders are concerned about the potential implications of the Aetna and Humana acquisition along with the Anthem and Cigna merger. Having the top five major health insurers merge into only three payers could block access to affordable...

Will Health Insurance Exchange Remain Intact Despite Hurdles?

by Vera Gruessner

What will happen to the health insurance exchange created by the Patient Protection and Affordable Care Act? Will it continue on as originally planned by the Obama administration? Or will new legislation and the decisions of insurance companies...

Vermont’s All-payer Model May Curb Rising Healthcare Costs

by Vera Gruessner

While healthcare reform has been taking place on a national level over the last several years, the state of Vermont is in the process of undergoing its own transformation within the medical industry through a new statewide all-payer model. The...

Health Insurance Mergers Expected to Bring Payer Concentration

by Vera Gruessner

The health insurance industry is experiencing some significant transformations not only due to new policies under the Patient Protection and Affordable Care Act but also because of upcoming health insurance mergers among the nation’s top...

Could New Legislation Stop the Hikes in Generic Drug Prices?

by Vera Gruessner

When it comes to containing healthcare costs, one of the biggest culprits of rising prices is the pharmaceutical industry, which has recently exhibited spikes in generic drug prices, according to a press release from the Healthcare Supply Chain...

How Consumer Engagement Brings Better Coverage Decision-Making

by Vera Gruessner

Consumer engagement and awareness is key when payers aim to raise their enrollment rates before the enrollment period rolls around. First, it is vital to improve the health literacy of the everyday consumer so that these individuals understand...

Medical Loss Ratio Provision Led to $2.4 Billion in Rebates

by Vera Gruessner

A new report shows that consumers have received more than $2.4 billion in premium rebates since 2011 because of the passage of the Patient Protection and Affordable Care Act. The Medical Loss Ratio provision under the Affordable Care Act gives...

How to Create a Useful Contract for Bundled Payment System

by Vera Gruessner

In 2013, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced that 450 medical providers will take part in a Bundled Payments for Care Improvement initiative. However, more recent results show that healthcare providers...

How Value-Based Care Payment Models Could Reduce Costs

by Vera Gruessner

Did you know that 8 million people gained private insurance through the health insurance exchange and 3 million young adults gained coverage since the Affordable Care Act was passed? In recent years, the health insurance market and the medical...

Insurance Mergers and Acquisitions May Increase Premiums

by Vera Gruessner

Mergers and acquisitions are popping up all over the healthcare industry from drug makers and hospital systems to health insurers. The year 2015 has been a beehive of activity for the consolidation of a large number of medical companies. The...

Does Blocking State Medicaid Expansion Create a Coverage Gap?

by Vera Gruessner

The most recent data on state Medicaid expansion shows that a total of 20 states are declining to broaden Medicaid coverage among those living below poverty level. One of the provisions under the Patient Protection and Affordable Care Act meant...

Aetna’s Humana Acquisition Bringing Strong Opposition

by Vera Gruessner

The complications between the free market of the health insurance industry tied with increasingly complex federal mandates over the last several years is coming to a head with the Humana acquisition by the insurer Aetna. According to a press...

Top 3 Ways to Reduce Healthcare Spending Across Industry

by Vera Gruessner

What new innovations and healthcare reforms are making a real benefit to cutting unnecessary healthcare spending associated with duplicative tests, hospital-acquired infections, and medical errors? While there are a wide number of transformations...

Maryland’s All-Payer Model Shows Promising First Year Results

by Vera Gruessner

Last week, the Department of Health and Human Services (HHS) announced the state of Maryland’s first year results from its All-Payer Model. Maryland has implemented a global budget payment system in which insurers are required to pay hospitals...

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