Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability
  • Risk Scoring, New Payment Models Can Reduce Medication Non-Adherence

    September 20, 2018 - Adopting new payment models, engaging in targeted risk scoring, and improving prior authorization processes may help payers address medication-non adherence among members with mental health concerns, says a report from the National Council on Behavioral Health (NCBH).   Nearly half of patients that require a prescription to treat their conditions are not picking up their...

  • Earning Top Medicare Advantage Ratings Requires Data, Ambitious Goals

    September 18, 2018 - Succeeding in the highly competitive Medicare Advantage (MA) market requires more than just a sense that there are financial gains to be had in this growing health insurance segment. Payers that wish to reap some of the many financial rewards of becoming an MA plan sponsor also need to deliver impeccable services to consumers, both in the clinic and at the help desk. The Medicare...

  • Reference Pricing Models for Prescription Drugs May Contain Costs

    September 17, 2018 - Reference pricing models for prescription drugs may help to contain spending and reduce high costs for beneficiaries, says a new report from the Commonwealth Fund. Currently, most payers use tiered drug formularies to manage drug costs, but tiered formularies are not helpful for addressing variations in drug prices, the team said. A tiered drug formulary requires consumers to pay more...

  • Employers Could See High Financial Returns for Mental Healthcare

    September 13, 2018 - More comprehensive coverage for mental healthcare could bring a financial return of four dollars for every one dollar spent by employers, says a report from the National Alliance of Healthcare Purchaser Coalitions (NAHPC). One in five adults experience mental illness in a given year but only 41 percent of people with a mental illness receive treatment for their condition, said the...


Today's Top Stories

Narrow Network Alignment Could Drive Value-Based Payment Reform

Investment in high-performance narrow networks, creating new payment incentives, and leveraging digital innovation could help to increase adoption of value-based payment reform across the healthcare industry, say experts in a New England...

Risk Scoring, New Payment Models Can Reduce Medication Non-Adherence

Adopting new payment models, engaging in targeted risk scoring, and improving prior authorization processes may help payers address medication-non adherence among members with mental health concerns, says a report from the National Council...

Senators Propose Limits on Surprise Healthcare Billing

A bipartisan group of Senators has introduced legislation that aims to end surprise healthcare billing, a practice which can lead to extremely high out-of-pocket costs for consumers. The Protecting Patients from Surprise Medical Bills Act...

Payers Play Crucial Role in Healthcare Quality Transparency

Payers will need to take the lead in being transparent about healthcare quality and costs in order to improve patient safety and reduce unnecessary spending, experts told the Senate HELP Committee. Payers can take a more proactive role in...

Consumers Struggle with Health Plan Finances, Healthcare Literacy

The majority of consumers with employer-sponsored health plans lack the necessary financial health literacy to optimally manage their health plan finances, according to a new report from Alegeus. As high-deductible health plans (HDHPs)...

Medicare-Medicaid Dual Eligible Care Models Aim to Coordinate Care

Medicare and Medicaid dual-eligible care models provide extensive care coordination to ensure beneficiaries with multiple chronic conditions can access healthcare services, according to a new AHIP report.   Twelve million Americans...

Earning Top Medicare Advantage Ratings Requires Data, Ambitious Goals

Succeeding in the highly competitive Medicare Advantage (MA) market requires more than just a sense that there are financial gains to be had in this growing health insurance segment. Payers that wish to reap some of the many financial...

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