Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability
  • Medicare Advantage Savings, Outcomes Exceed Fee-For-Service

    July 12, 2018 - The Medicare Advantage (MA) program has surpassed Medicare fee-for-service (FFS) in developing positive member healthcare outcomes and reducing care costs, according to an analysis of both programs from Avalere Health. Medicare Advantage beneficiaries had 23 percent fewer inpatient stays and 33 percent fewer emergency room visits than Medicare fee-for-service beneficiaries during 2015. Inpatient...

  • Transitional Health Insurance Plays Key Role in Coverage

    July 10, 2018 - Transitional health insurance, otherwise known as a short-term health plan, is a temporary insurance policy intended to provide stop-gap coverage when an individual is in between ACA compliant policies.  The National Association of Insurance Commissioners estimates that more than 160,000 people enrolled in transitional policies during 2016. Transitional health insurance is a unique fixture...

  • CMS Suspends $10.4B in Risk Adjustment Payments to Payers

    July 9, 2018 - CMS has temporarily withheld $10.4 billion in risk adjustment payments for 654 healthcare payers, citing a ruling in the US District Court of New Mexico that invalidated the agency’s risk adjustment methodology. The ruling, which took place on February 28, 2018, said that CMS was no longer allowed to use statewide average premiums to calculate risk adjustment payments for plan years...

  • Medicare, Medicaid Home Health Benefits Stabilize Care Costs

    July 5, 2018 - Providing extended home health benefits for Medicare beneficiaries is likely to stabilize care costs for public payer programs, according to a new analysis from the Commonwealth Fund. Researchers from the Hilltop Institute and Johns Hopkins University reviewed healthcare costs and outcomes for Maryland’s Medicaid Community First Choice (CFC) Program, which provides supplemental behavioral...


Today's Top Stories

BCBSA Adds Opioid Abuse Accreditation to Treatment Facilities

The BlueCross BlueShield Association has announced a new accreditation program for opioid abuse treatment centers as a larger part of the organization’s mission to combat the US opioid crisis. In 2013, only 22 percent of treatment facilities...

CMS Proposes Drug Pricing, Price Transparency Changes for Medicare

CMS has proposed a series of policy changes for Medicare that would promote prescription drug affordability within Medicare, and has also requested stakeholder comments about ways to improve price transparency for Medicare services. As part of...

Medicare Advantage Savings, Outcomes Exceed Fee-For-Service

The Medicare Advantage (MA) program has surpassed Medicare fee-for-service (FFS) in developing positive member healthcare outcomes and reducing care costs, according to an analysis of both programs from Avalere Health. Medicare Advantage beneficiaries...

Health Plan Cost Sharing, Deductibles Outpace Members’ Wage Growth

Health plan cost sharing and deductible spending have outpaced employee wage growth in the last ten years, according to data released by the Peterson-Kaiser Health System Tracker. Employees’ total financial responsibility increased by 54...

CMS Cuts ACA Navigator Funding Grants by $26M for 2019

CMS has announced a $26 million cut to funding grants for ACA navigators, from $36 million down to $10 million. CMS will provide a minimum of $100,000 in each of the states that operate a federally-facilitated exchange (FFE). The funding will...

Medicare Advantage Star Ratings Tied to Member Socioeconomic Strata

Medicare Advantage (MA) health plans with a greater proportion of socioeconomically challenged members are more likely to have lower star ratings, according to new research from Brown University. Insufficient risk adjustment criteria in the ratings...

CMS Proposed Rule Cuts State Authority to Divert Medicaid Payments

CMS has proposed a new rule that would eliminate a state’s authority to divert Medicaid payments away from providers. The rule is intended to ensure beneficiaries have adequate access to healthcare services through direct state-to-provider...

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