Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability
  • Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

    January 16, 2018 - Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in 2017. In 2016, opioid abuse was responsible for 42,000 deaths. Forty-percent of all deaths from an opioid overdose were from either a legally or illegally obtained...

  • Top 10 Highest Performing Commercial Health Plans

    January 9, 2018 - The top performing commercial health plans in the US for 2017-18 exceeded expectations for customer satisfaction, preventive care, and outcomes of their beneficiaries, according to the National Committee for Quality Assurance (NCQA). NCQA aggregated HEDIS measures, NCQA Accreditation scores, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey scores to rate commercial...

  • How Payers Can Build a Successful Bundled Payment Strategy

    January 5, 2018 - Bundled payment models are a popular reimbursement option for payers because they present an opportunity to improve healthcare quality, lower costs, and participate in value-based agreements with limited financial risk.   However, if payers arrange a bundled payment without the proper tools and data to fairly define bundle amounts, then providers could experience challenges with bundled...

  • All-Payer Claims Databases Offer Insights into Healthcare Spending

    January 2, 2018 - All-payer claims databases (APCDs) allow payers, providers, and regulators to analyze claims from millions of beneficiaries to learn where spending is directed and whether or not spending on certain healthcare services is avoidable. State-level all-payer claims databases can help stakeholders to manage population health and identify opportunities to reduce wasteful or preventable healthcare...


Today's Top Stories

Payers, Providers Pledge to Improve Prior Authorizations

AHIP, BCBSA, AHA, and other leading payer and provider organizations announced an industry pledge to improve the efficiency of prior authorizations while reducing administrative burden. Leaders of organizations participating in the pledge claim...

AMGA: Align Quality, Performance across Medicare Advantage, ACOs

CMS should work to align quality and performance standards across all Medicare programs, including Medicare Advantage (MA) and the Medicare accountable care organization (ACO) initiatives, says AMGA. In a letter issued in response to proposed...

GAO: Medicaid Home, Community Care Create Financial Conflicts

Home and community-based services (HCBS) programs funded by Medicaid require additional protections from possible financial conflicts of interest, a new GAO report found. Program assessors, including HCBS providers, state and local agencies,...

Provider Health Insurance Fraud Schemes, Settlements Top $310M

Law enforcement agencies and federal healthcare administrators including HHS, the Office of the Inspector General (OIG), the FBI, and US Attorney's Offices across the country investigated provider healthcare schemes that defrauded Medicare...

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in 2017. In...

KY Gets Approval for 1115 Medicaid Waiver with Work Requirements

Kentucky is the first state to receive approval for a 1115 Medicaid waiver demonstration that adds work requirements in order for able-bodied adults to be eligible for the public health insurance program. The Kentucky Health program demonstration...

Payers Support Integrated Care Services for NC Medicaid Patients

Payers and provider organizations that support integrated care systems can help lower healthcare costs by addressing the healthcare concerns of vulnerable patient populations, including Medicaid beneficiaries. Several commercial payers have recently...

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