Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability
  • Planning for Individual Insurance Exchange Stabilization in WA

    September 25, 2017 - 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 returning insurance consumers. As premiums go up, healthier consumers are unlikely to enroll and plans become financially unsustainable for payers which leads to market exits. Public payer administrators,...

  • Top 10 Healthcare Spending Categories in the United States

    September 20, 2017 - The upward trajectory of US healthcare spending doesn’t seem to be slowing down anytime soon, leaving payers, providers, and beneficiaries wondering how to control costs while maintaining a high level of quality. Value-based contracting has started to slow the growth curve, but the industry still spends $3.2 trillion on a wide variety of services, according to the latest data from CMS...

  • How Pharmacy Benefit Managers Lower Prescription Drug Prices

    September 19, 2017 - Payers in both the private and public sectors require new strategies that offset the rising cost of prescription drugs. Pharmacy benefit managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS programs with the goal of lowering prescription drug costs, improving convenience, and ensuring patient safety for payers and their beneficiaries. As...

  • Medicaid Analytics Support Social Determinant Incentive Payments

    September 14, 2017 - 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 access, non-adherence, and the development of chronic disease. Social determinants contribute to the billions of dollars spent on chronic disease management, yet are rarely addressed sufficiently...


Today's Top Stories

Medicaid Directors Voice Concerns for Graham-Cassidy Bill

The National Association of Medicaid Directors (NAMD) argues that a hasty passage of the Medicaid reforms presented in the Graham-Cassidy bill will have significant consequences for public payer programs and the health outcomes of their beneficiaries....

Planning for Individual Insurance Exchange Stabilization in WA

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 returning insurance consumers. As premiums go...

AHIP: Graham-Cassidy Bill a Poor Choice for Payers, Patients

AHIP believes that passage of the Graham-Cassidy Bill making the rounds in the Senate would adversely affect payer market through policies that destabilize the health insurance markets, reduce patient access to healthcare, and fail to meet the...

Anthem to Acquire FL Medicare Advantage Organization HealthSun

Anthem entered into an agreement to acquire Florida-based HealthSun, a payer and integrated health system that provides care and coverage to 40,000 Medicare Advantage beneficiaries, the payer announced in a press release.   Leaders at Anthem...

Pharmaceutical Industry Slow to Embrace Value-Based Contracts

Sixty-one percent of pharmaceutical companies are not yet participating in value-based contracts due largely to the belief that current policies make it too difficult to negotiate with payers and see a return on investment, according to a PricewaterhouseCoopers...

Top 10 Healthcare Spending Categories in the United States

The upward trajectory of US healthcare spending doesn’t seem to be slowing down anytime soon, leaving payers, providers, and beneficiaries wondering how to control costs while maintaining a high level of quality. Value-based contracting...

How Pharmacy Benefit Managers Lower Prescription Drug Prices

Payers in both the private and public sectors require new strategies that offset the rising cost of prescription drugs. Pharmacy benefit managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS...

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