Payers see bundled payments as a way to promote value-based reimbursement practices but must first leverage clinical insights and provider buy-in to maximize a bundle’s potential...
Association health plans (AHPs) may completely alter the nation’s health insurance markets with increasing support from federal entities and a handful of state insurance commissions.
An...
Payers and employers who offer high-deductible health plans (HDHPs) to attract low-cost members may need member engagement strategies to generate higher value for these beneficiaries.
Member...
Health plan performance, and how to improve it, is always an issue at the forefront of payers’ minds. While payers have engaged in several strategies in the past aimed at improving clinical...
Commercial payers struggling to curb costs and encourage their members to make smarter financial choices may be able to save millions of dollars each year by investing in modest member...
The accountable care organization (ACO) movement has gained traction over the last year as payers and providers begin to share the same viewpoints on the benefits of value-based care.
Provider...
The use of data analytics and employee wellness engagement platforms may help employer health plans improve spending efficiency while producing a healthier, more productive workforce....
Healthcare payers may find it difficult to establish value-based contracts (VBCs) with pharmaceutical companies due to the challenges of creating meaningful, workable quality measures....
As payers vie to remain competitive in commercial insurance markets, they must be able to effectively manage consumer costs while providing beneficiaries the best possible healthcare experience now and...
State health insurance markets and their individual insurance exchanges have faced regular instability in the form of payer exits, imbalanced risk pools, and rising premiums that push out new and...
Payers looking for innovative ways to control the costs of care have been turning their attention to the social determinants of health, the non-clinical factors that often lead to issues with care...
What are some of the biggest problems around bundled payment models and value-based care causing difficulties for physicians? According to Corporate Director at Willis-Knighton Health Systems Chris...
How can health insurance companies improve their relationship with primary care practices? How can payers work with primary care providers to expand value-based care reimbursement?
For answers...
In December 2016, Aledade Inc., a leader of accountable care organizations (ACOs), and Highmark Blue Cross Blue Shield announced in a company press release a new partnership to provide quality medical...
In December, UnitedHealthcare announced in a company press release the release of NexusACO, a new health plan option for self-funded employers that is available in 15 markets. Tier 1 of NexusACO...
The Centers for Medicare & Medicaid Services (CMS) have advanced bundled payment models by implementing these value-based payment structures in orthopedic and cardiac care. CMS released a finalized...
Along with health insurers, more and more providers are expected to transition to alternative payment models (APMs) especially due to MACRA’s Quality Payment Program. For example, urology group...
When payers transition their reimbursement structures toward a value-based care payment model, healthcare quality improvement needs to be addressed. In order to boost quality, payers could target...
Healthcare payers are finding that their reimbursement totals show higher spend for hip, knee, and spine surgeries and other orthopedic care when compared to other forms of treatment. Along with the...
Many medical facilities have seen how the healthcare industry has been moving away from fee-for-service payment to value-based care reimbursement. Revere Health is one organization that jumped on the...
