Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

NCQA Proposes New Changes to HEDIS Quality Measures in 2017

by Vera Gruessner

The National Committee for Quality Assurance (NCQA) is looking to broaden a number of HEDIS quality measures for the 2017 edition, according to a news release from NCQA. These changes include the addition of four new HEDIS quality measures and...

Health Insurance Mergers May Harm Consumer Interests

by Vera Gruessner

What does the future hold for the Cigna-Anthem and Aetna-Humana health insurance mergers? Currently, many experts point at the possibility that these health insurance mergers will face regulatory blockage and won’t continue. A large number...

Minnesota’s Biggest Payer Leaves Health Insurance Exchanges

by Vera Gruessner

State health insurance exchanges are likely to see more disruption in the health insurance market with some payers either leaving the individual consumer marketplace or limiting their offerings in the coming year. The health payer UnitedHealthcare...

Major Health Insurance Mergers May Leave Consumers “Worse Off”

by Vera Gruessner

Four of the top five major payers in the nation are looking to consolidate into two combined health insurance companies. The Anthem-Cigna and Aetna-Humana health insurance mergers could lead to a complete transformation of the market and impact...

29% of Doctors Have Tools Needed for Value-Based Care Payments

by Vera Gruessner

While value-based care payments are making headway across the country, there are still barriers that stand in the way of payers and providers fully embracing these alternative payment models. A report from Quest Diagnostics and Inovalon found...

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...

Indiana, Florida Approve Anthem, Aetna Health Insurance Mergers

by Vera Gruessner

The major health insurance mergers taking place between Anthem-Cigna and Aetna-Humana have shown some progress of late. Recently, the Indiana Department of Insurance approved the acquisition between Cigna and Anthem, according to a press release...

Payers Adopt Value-Based Care via Health Insurance Marketplace

by Vera Gruessner

The health insurance marketplace created through the Patient Protection and Affordable Care Act has had a variety of success ever since its inception. This new model of healthcare coverage has provided health insurance for an additional 20 million...

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...

How State Policymakers Impact the Health Insurance Mergers

by Vera Gruessner

In the state of Missouri, policymakers issued an order that would prevent the Aetna-Humana acquisition from proceeding in post-merger activity within Missouri's Medicare Advantage plans as well as some commercial health plans. The two biggest...

Key Ways Blue Cross Blue Shield Raises its HEDIS Scores

by Vera Gruessner

The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of all health plans situated around the country to compare performance and year-to-year success. HEDIS scores allow health plans to determine where...

Is the Health Insurance Industry Heading on a ‘Death March?’

by Vera Gruessner

The health insurance industry has been undergoing tremendous reforms in recent years due to new federal regulations including the Affordable Care Act. Reimbursement between payers and providers have been changing as well. Coverage for the majority...

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...

Pediatric Care Out-of-Pocket Spending Rose 5.5% in 2014

by Vera Gruessner

Both public and private health payers have been searching for ways to reduce healthcare spending as a whole, but rising prices may be making it more difficult to combat medical care expenditure. The Health Care Cost Institute (HCCI) released...

Health Insurance Exchange Consumers Satisfied with Health Plans

by Vera Gruessner

Despite the fact that the House of Representatives and the Senate attempted to repeal the Affordable Care Act at the end of 2015, consumers seem to be satisfied with their healthcare coverage options after purchasing health plans on the health...

Consumer Engagement Vital in Health Insurance Exchanges

by Vera Gruessner

The Patient Protection and Affordable Care Act has brought a variety of changes for both insurers and healthcare providers with the establishment of health insurance exchanges holding a top place in reforming reimbursement between payers and...

Risk Adjustment Affects Plans on Health Insurance Exchanges

by Vera Gruessner

The trade association AMGA, which entails a large membership of medical groups and healthcare delivery systems, submitted comments last week to the Centers for Medicare & Medicaid Services (CMS) regarding its proposal to change risk adjustment...

Why Health Insurance Claims Data Needs Medical Device ID

by Vera Gruessner

If health insurance companies truly want to improve patient health outcomes including the quality of care and boost patient safety in an effort to reduce wasteful spending, it may be beneficial for health insurance claims data to include medical...

Could Electronic Processing Reduce Medical Spending Rates?

by Vera Gruessner

The US healthcare system is one of the most expensive around the world and the rising costs haven't diminished significantly in recent years. Today, health payers and providers have been working together to reduce medical spending around...

Insurer Participation in Health Insurance Exchange Decreases

by Vera Gruessner

Health payers around the country may not be faring as well as hoped within the federal health insurance exchange. The Affordable Care Act may have had a negative impact on health insurance companies, as some are experiencing financial loss when...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks