Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability
  • How Can Payers Get Providers to Use Electronic Payment Systems?

    May 25, 2018 - Healthcare, an industry that lags behind others in technology adoption, is slow to embrace innovative solutions that address business challenges. For payers that want to implement electronic payment systems to improve claims reimbursement, it is likely that provider apprehension is a critical barrier to innovation. Providers may not move towards an electronic payment system if they feel that...

  • First Steps for Payers Developing Value-Based Care Initiatives

    May 24, 2018 - Successful value-based care initiatives require payers to learn which populations experience a high prevalence of chronic disease, where their organizations overspend, and how value-based contracting can solve these problems. Carefully assessing value-based care opportunities, implementing analytics strategies that can accurately identify opportunities, and monitoring success with meaningful...

  • How Payers Identify, Succeed in Health Plan Market Opportunities

    May 22, 2018 - Healthcare payers that wish to be known as innovators need to continually be on the lookout for emerging health plan market opportunities that offer strong profit potential. Payers need to monitor specific market indicators and implement new strategies to develop successful health plan products. In addition, health plans also require administrative advancements to ensure payers can earn higher...

  • Assessing Providers for Participation in Value-Based Care Contracts

    May 17, 2018 - Creating strong networks of high-quality healthcare providers can be a major challenge for any payer looking to expand its value-based care contract portfolio. Providers aren’t the only ones accepting risk when entering into pay-for-performance arrangements since payers are also putting revenue and reputation on the line.  In order to ensure that a contracting arrangement can deliver...


Today's Top Stories

How Can Payers Get Providers to Use Electronic Payment Systems?

Healthcare, an industry that lags behind others in technology adoption, is slow to embrace innovative solutions that address business challenges. For payers that want to implement electronic payment systems to improve claims reimbursement, it...

First Steps for Payers Developing Value-Based Care Initiatives

Successful value-based care initiatives require payers to learn which populations experience a high prevalence of chronic disease, where their organizations overspend, and how value-based contracting can solve these problems. Carefully assessing...

Pros and Cons of High Cost Sharing for Employer Health Plans

Employer-sponsored health plans that include high cost sharing expectations can help control spending for plan sponsors, but could create longer-term health risks for employee beneficiaries.   Striking the right balance between lowering...

Medicaid Plans More Cost Effective, Stable than Exchange Plans

Medicaid health plans are more cost effective than federal exchange plans and could offer beneficiaries more affordable coverage options, according to a UnitedHealth Group analysis. UnitedHealth Group said that federal healthcare agencies could...

GAO: Medicare DME Prior Authorization Programs are Effective

CMS’s prior authorization programs for durable medical equipment (DME) and mobility devices created between $1.1 and $1.9 billion in Medicare savings from 2012 to 2017 by controlling unnecessary spending, according to a new Government Accountability...

How Payers Identify, Succeed in Health Plan Market Opportunities

Healthcare payers that wish to be known as innovators need to continually be on the lookout for emerging health plan market opportunities that offer strong profit potential. Payers need to monitor specific market indicators and implement new...

MN Law Allows Some Patients to Override Payers on Step Therapy

Minnesota Governor Mark Dayton has signed a bill into law that allows patients and providers to execute overrides on payer step therapy programs for prescription drug treatments in certain clinical situations. HF 3196 requires payers to bypass...

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