Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Medicare Shared Savings Program Seeks High ACO Performance

by Vera Gruessner

As part of the Patient Protection and Affordable Care Act, goals of improving the quality of healthcare services and reducing costs led to the creation of Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program. Both quality...

How MACRA Affects Future of Healthcare Payment Models

by Vera Gruessner

Earlier this year, the federal government repealed the Medicare Sustainable Growth Rate (SGR) Formula, which affected the future of healthcare payment models all across the board. Recently, the Centers for Medicare & Medicaid Services (CMS)...

Accountable Care Organizations, Technology Cut Medical Costs

by Vera Gruessner

The healthcare system has a multitude of gaps that cause spending to continue rising without an effective method to reign in these high costs. For example, a major problem has been ongoing redundant tests and unnecessary, expensive procedures...

OPA Report Cards Let CA Healthcare Consumers Compare Choices

by Jacqueline DiChiara

The California Office of the Patient Advocate (OPA) has released the latest edition of online quality Report Cards intended to help healthcare consumers better compare care quality with the mere click of a mouse or finger swipe across a mobile...

What to Consider During Medicare Open Enrollment Period

by Vera Gruessner

Health payers and consumers need to be aware that the Medicare open enrollment period begins this week on Thursday, October 15. This means that individuals aged 65 years old and older who have health insurance through Medicare will have the chance...

Poor Consumer Decision-Making in Health Insurance Marketplace

by Vera Gruessner

The health insurance exchange set up by more recent healthcare reforms including the Affordable Care Act was established in order to give consumers more choice in their medical coverage options. This was essentially expected to provide more competition...

Major Iowa Insurer Joins Obamacare Health Insurance Exchange

by Vera Gruessner

The Patient Protection and Affordable Care Act under the Obama administration, which is colloquially known as Obamacare, set up a health insurance exchange platform that enables consumers to pick and choose which type of healthcare coverage is...

Will New Model of Accountable Care Organizations Cut Costs?

by Vera Gruessner

There are a variety of policy changes and healthcare reforms that have taken place since the Patient Protection and Affordable Care Act was passed in 2010. The development of Accountable Care Organizations (ACOs) is one such reform. With the...

Will the Move to ICD-10 Medical Coding Delay Claims Processing?

by Vera Gruessner

The health insurance space is about to have a major transformation in medical coding that could potentially cause financial barriers and claims processing issues. If the transition to ICD-10 medical coding is not properly managed, a variety of...

Issues Surround Health Insurance Marketplace despite ACA

by Vera Gruessner

The health insurance marketplace underwent tremendous transformations with the passage of the Obama administration’s Patient Protection and Affordable Care Act. New regulations have required everyday citizens to purchase health insurance...

Do All Health Insurance Exchanges Follow Federal Regulations?

by Vera Gruessner

Ever since President Barack Obama and his administration passed the Patient Protection and Affordable Care Act, the development of the health insurance marketplace was born. The law requires every individual to purchase health insurance or else...

ICD-10 Implementation Deadline Affects Claims Processing

by Vera Gruessner

Healthcare payers have a wide variety of concerns with regard to the coming ICD-10 implementation deadline and will need to be prepared for any potential issues that may pop up after the October 1, 2015 deadline. With a mere six days left, those...

NCPA Urges Policymakers Promote Medicare Price Sensitivity

by Jacqueline DiChiara

If policymakers fail to advance price sensitivity among beneficiaries, Medicare spending will only escalate, confirms a new study from Devon M. Herrick, PhD, Health Economist and Senior Fellow with the National Center for Policy Analysis (NCPA)....

Accountable Care Organizations Cut Costs by $411 Million

by Vera Gruessner

The medical industry has been focused on improving coordinated care across the spectrum of healthcare delivery. With ongoing healthcare reforms taking place around the country and the federal government taking a stronger role in improving patient...

ACA Medicaid Expansion Leads to Decreased Uninsurance Rates

by Sara Heath

As a result of Medicaid expansion as a part of the Affordable Care Act, many previously uninsured patients are shifting to Medicaid as their health insurer. A recent study by Kaiser Family Foundation shows that this shift in payer is decreasing...

Healthcare Insurance Rates Rise by 2.9% in 2014, Census Says

by Jennifer Bresnick

The rate of uninsured Americans decreased by 2.9 percent between 2013 and 2014, says the latest data from the US Census Bureau, thanks to higher rates of coverage for private and government payers.  In 2014, only 33 million Americans lacked...

GAO Report Uncovers 2015 Healthcare Premium Range Variation

by Jacqueline DiChiara

The United States Government Accountability Office (GAO) has released a report providing new information about 2014 and 2015 healthcare premium ranges and plan availability. GAO examined levels of disparity among health plan options and premiums,...

Insurance Mergers Will Not Benefit Consumers, AHA CEO Says

by Sara Heath

Health insurance mergers continue to raise antitrust concerns for the American Hospital Association (AHA). On September 10, AHA President and CEO Rick Pollack testified before the House Judiciary Committee panel regarding the association’s...

AMA: Insurer Mergers Expand Market Power, Reduce Competition

by Sara Heath

Healthcare mergers have been of great discussion as of late, as  Aetna announced its $37 billion acquisition of Humana, and Anthem its acquisition of Cigna. Although Aetna and Anthem officials state that these mergers will benefit the healthcare...

$67M ACA Funds to Help Affordable Health Insurance Enrollees

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) announced yesterday an abundant $67 million in Affordable Care Act (ACA) grant awards to aid outreach initiatives and help those individuals confused about health coverage and financial assistance...

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