Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Primers

Healthcare Payers Face Challenges with Medical Loss Ratio

by Vera Gruessner

Under the Patient Protection and Affordable Care Act’s medical loss ratio, health payers are required to spend a minimum of 80 percent of their premium revenue on paying claims and boosting quality while the rest (20 percent) can be spent...

How MACRA Requirements Impact Accountable Care Organizations

by Vera Gruessner

MACRA legislation impacts a number of healthcare providers and entities including accountable care organizations (ACOs). Only a few Medicare accountable care organizations will actually be able to participate in Advanced Alternative Payment Models...

Humana’s Value-Based Care Platform Decreased Costs by 20%

by Vera Gruessner

The health payer Humana released positive results within its Medicare Advantage program for the third year in a row, according to a company press release. The value-based care platform used at Humana indicated 19 percent higher HEDIS scores among...

CMS Releases Final Rule for Medicare Physician Fee Schedule

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that updates a number of reimbursement policies and rates under the Medicare Physician Fee Schedule (PFS), a CMS press release states. The new payment policies...

How Payers Could Compete in Midst of Health Insurance Mergers

by Vera Gruessner

Among the payers facing a Department of Justice lawsuit against their health insurance mergers, Aetna and Humana have requested sanctions due to the government allegedly delaying the release of documents the two insurers need. The Motion for...

Vermont’s All-Payer Model Limits Medical Spending Growth

by Vera Gruessner

Vermont has been working on regulatory actions that would reform healthcare payment throughout the state specifically through an all-payer model. Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a press release the...

ACO Investment Model May Improve Care Delivery in Rural Areas

by Vera Gruessner

While healthcare reform and legislation like the Affordable Care Act have brought medical coverage to an additional 20 million Americans across the country, the patient community still faces some challenges especially in rural areas. When comparing...

Premium Rates on Affordable Care Act Exchanges Rise 25% in 2017

by Vera Gruessner

Monthly premium costs on the Affordable Care Act exchanges is expected to rise an average of 25 percent in 2017, according to a report from the Department of Health & Human Services (HHS). This percentage is based solely on the premiums for...

25% of Health Plans Implement Alternative Payment Models

by Vera Gruessner

Among commercial health plans, Medicare Advantage, and Medicaid markets, approximately 25 percent of reimbursement is expected to be in the form of alternative payment models by the end of 2016, according to a new report from the Health Care...

How a Public Option May Preserve Health Insurance Exchanges

by Vera Gruessner

Multiple healthcare payers have been struggling with operating successfully on the Affordable Care Act’s health insurance exchanges. Some experts and lawmakers suggest that establishing a public option on the health insurance exchanges...

Did HHS Act Illegally in Transitional Reinsurance Program?

by Vera Gruessner

At the end of September, the Government Accountability Office (GAO) announced in a briefing that the Department of Health & Human Services (HHS) does not have the authority to transfer funds from the collections within the transitional reinsurance...

Children’s Health Insurance Program Enrollment Expands in Flint

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced earlier this month in a press release that it will be awarding $300,000 to the Greater Flint Health Coalition (GFHC) so that more children in Flint, Michigan will be connected to...

CMS Comprehensive Primary Care Program Gained $57M in Savings

by Vera Gruessner

Dr. Patrick Conway, Principal Deputy Administrator and Chief Medical Officer at the Centers for Medicare & Medicaid Services (CMS), announced in The CMS Blog that 95 percent of all primary care practices participating in the Comprehensive...

New Leadership at Veterans Affairs Results from Transfers

by Vera Gruessner

One public health payer that has had a wide amount of controversy regarding its operations is Veterans Affairs. The latest controversy comes regarding the Veterans Affairs claim that it has new leadership and leadership teams. USA Today conducted...

How Stakeholder Input on Quality Payment Program Differs

by Vera Gruessner

At the end of last week, the Department of Health & Human Services (HHS) released a final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its policies on the new Quality Payment Program. HHS reiterated in a press...

HHS, CMS Announce Finalized Ruling for MACRA Legislation

by Vera Gruessner

The Department of Health & Human Services (HHS) announced in a press release the discharge of the final ruling on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The MACRA legislation replaces the flawed Sustainable Growth...

Misalignment of Healthcare Quality Measures Impacts Payers

by Vera Gruessner

In the healthcare industry’s move toward value-based care reimbursement, public and private payers create healthcare quality measures meant to align with how providers are paid and what type of financial penalties will be instituted for...

VT All-Payer Model Aligns Costs for Public, Private Insurers

by Vera Gruessner

The state of Vermont is moving forward with establishing an all-payer model that uses accountable care organizations and ensures a provider is reimbursed by an equal amount among all healthcare payers for a particular service. The Vermont government...

CMS Unlawfully Paid $9M to Beneficiaries for Medicare Services

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has improperly paid more than $9 million for Medicare services among 481 unlawfully present beneficiaries during the years 2013 and 2014, according to a report from the Department of Health...

CMS Medicare Value-Based Care Model Expands to 3 More States

by Vera Gruessner

The states of Alabama, Michigan, and Texas will be able to test the Medicare Advantage Value-Based Insurance Design model beginning on January 1, 2018, according to a fact sheet from the Centers for Medicare & Medicaid Services (CMS). During...

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