Update 02/21/2020: This article has been updated to reflect that Blue Cross Blue Shield of Rhode Island partnered with the Anchor Recovery Community Center (a program of The Providence Center) to...
Behavioral healthcare is in high demand. Nearly one in five Americans have behavioral health needs, according to the American Hospital Association. And yet, fewer than 30 percent of them are receiving...
As America strives for positive changes to the healthcare system, it may find the greatest advancements for value-based care in Medicare Advantage plans.
Over 90 percent of healthcare payers in a small Health Care Payment...
Consumerism in healthcare will steer many payer decisions in 2020, perhaps more obviously than in the past.
“There are a lot of pressures out there in 2020. It’s the time to step up and...
There are two elements of value-based care that should come as no surprise to a seasoned healthcare professional regarding value-based partnerships. First, that payer-provider relationships are at the...
Payers are trying to understand their role in addressing the social determinants of health. These non-clinical factors that impact an individual’s health include environment, housing, food...
Optima Health’s Traci Massie can outline the different social determinants of health that impact Virginia’s different Medicaid populations county by county, from the opioid epidemic to...
Achieving five stars in all three domains – Medicare Advantage, Part D, and overall - is difficult. The work of Cigna’s HealthSpring of Florida plan in 2018 earned them five-stars across the board, making them one of only two...
Chronic diseases are both costly and prevalent, with the healthcare industry shelling out billions each year to manage and treat these conditions. Although illnesses like diabetes, heart disease, and...
As the US population continues to age, older individuals are seeking out comprehensive, affordable care options that meet their specific health needs. Medicare Advantage is one of the most popular ways for consumers to round out their...
Provider directories are often a patient’s primary source of information when making decisions about their care and coverage. Healthcare consumers use these directories to find out which...
With more than one out of every three Americans living with prediabetes, payers are actively seeking out innovative strategies for preventing progression of the costly and life-changing disease....
Succeeding in the highly competitive Medicare Advantage (MA) market requires more than just a sense that there are financial gains to be had in this growing health insurance segment.
Payers that wish...
A tailored cost sharing program that helps beneficiaries pay for chronic disease care can reduce wasteful spending and increase access to chronic disease management services. However, relying on...
A commercial shared savings program equipped with the right leadership, clinical insights, and comprehensive care strategies can help payers save significantly on healthcare costs and produce...
The Healthcare Effectiveness Data and Information Set (HEDIS) provides 90 percent of America’s health plans with the ability to directly compare performance across the national stage....
Hospitals generate some of the largest revenues and create exceptionally high costs for payers, which combine open the possibility for value-based hospital reimbursement programs to control...
Engaging in meaningful risk stratification of beneficiaries requires accurate data that can highlight opportunities to reduce costs and improve outcomes for plan members.
In order for payers to...
Value-based care networks are a promising opportunity for payers that want to manage costs and improve outcomes of beneficiaries. But effectively scaling collaborative, risk-based reimbursement...
The social determinants of health (SDOH) have gained traction in payer discussions and are driving payers to take a thoughtful look into factors that create long-lasting effects on healthcare costs and...
