Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Primers

How Pharmacy Benefit Managers Could Reduce Drug Cost Growth

by Vera Gruessner

From a health insurance perspective, more analysis needs to be taken into account when attempting to reduce healthcare spending. For instance, health payers may be interested in learning that pharmacy benefit managers (PBM) actually play a role...

Republicans Release Plan to Replace the Affordable Care Act

by Vera Gruessner

It is well-known the the GOP base has attempted to repeal the Patient Protection and Affordable Care Act for years since its passage. However, the big question that everyone has always wondered is what the Republicans would replace the Affordable...

Medicare Program Expects Slow Growth in Healthcare Costs

by Vera Gruessner

The federal government is continually striving to reduce healthcare costs while providing better quality care for the patient community. Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a news release that the agency...

Healthcare Spending for Diabetes Patients Rose 6% in 2014

by Vera Gruessner

People who have to manage diabetes are in worse shape financially than those without the disease. The Health Care Cost Institute (HCCI) published a study showing that healthcare spending rates among diabetes patients with employer-sponsored health...

CMS Seeks Input to Implement Modular Medicaid IT Solutions

by Vera Gruessner

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a request for information called Modular Solutions for Medicaid IT Enterprise and Pre-certification of Solutions. Essentially, CMS is seeking more information regarding...

CMS Awards $22M for Cost Transparency Under Affordable Care Act

by Vera Gruessner

Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a press release that $22 million of funds are available to help state regulators with issuer compliance according to consumer protections under the Affordable Care...

Ambulatory Surgery Centers Decrease Costs by $38 Billion

by Vera Gruessner

Health payers are often looking for ways to reduce healthcare spending, especially with regard to the costs of covering medical claims. Many have focused on implementing value-based care reimbursement structures like bundled payments while others...

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...

CMS Awards $32M for Children’s Health Insurance Program

by Vera Gruessner

While the Affordable Care Act and other healthcare reforms have reduced the numbers of uninsured children around the nation, more work needs to be done and the Centers for Medicare & Medicaid Services (CMS) has invested more funds in ensuring...

Affordable Care Act Brought Healthcare Coverage to Rural Areas

by Vera Gruessner

The Patient Protection and Affordable Care Act has brought a fair amount of healthcare access and coverage to the American people. This does not just include those living in urban areas or the suburbs. Recent research suggests that the Affordable...

Slavitt: Health Insurance Marketplace Boosts Patient Engagement

by Vera Gruessner

The federal government has taken a wide variety of steps to strengthen patient care and healthcare revenue systems throughout the country. Specifically, the Centers for Medicare & Medicaid Services (CMS) and the health insurance marketplace...

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...

New Ruling in Medicare Shared Savings Program Changes Payment

by Vera Gruessner

As previously reported, the Centers for Medicare & Medicaid Services (CMS) have finalized a ruling that changes how the Medicare Shared Savings Program operates its payment protocols among accountable care organizations. The change impacts...

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...

Why Patients Need More than Reduced Healthcare Spending

by Vera Gruessner

Is lower healthcare spending truly tied to improved quality of care among hospitals? New research published in Health Affairs begs to differ when it comes to rewarding lower quality hospitals that achieved a reduction in healthcare spending....

Affordable Care Act Brought 30% Drop for Texas Uninsured Rate

by Vera Gruessner

The Patient Protection and Affordable Care Act has made a significant difference for the average American citizen when it comes to ensuring greater medical coverage and healthcare access. The uninsured rate has been dropping steeply throughout...

Payment Reforms in NY Medicaid Program Face Challenges

by Vera Gruessner

The state of New York has been working toward redesigning their Medicaid program and fixing the various problems plaguing this system. In particular, payment reforms within the New York Medicaid program are being implemented to advance medical...

Why Accountable Care Organizations May not Succeed in MSSP

by Vera Gruessner

Do accountable care organizations (ACOs) truly save costs for the healthcare industry? Or is forming an ACO in hopes of cutting spending a pipe dream? Last year’s results from the Medicare Shared Savings Program (MSSP) showed little positive...

CMS Healthcare Payment Strategies Cut Hospital Readmissions

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) Innovation Center was created in order to develop more revolutionary healthcare payment strategies that could reduce the cost of Medicare, Medicaid, and the CHIP programs. One of its initiatives,...

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...

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