Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability
  • Commercial, Managed Care Insurance Sectors Profits Boom in Q3

    November 6, 2018 - Commercial and managed care payers experienced significant third quarter profits, reductions in healthcare spending, and enrollment growth, according to the latest financial statements from insurance companies. Medicare Advantage (MA), Medicaid managed care, and commercial group health plans experienced upticks in member enrollment and profitability. A few of the largest commercial...

  • Consumer Demand for High-Deductible Health Plans Dwindles

    November 1, 2018 - Consumer demand for high-deductible health plans (HDHPs) is expected to decline in 2019 as more beneficiaries look for health plans with customized benefits instead, according to a new survey from Oliver Wyman. Half of consumers surveyed said they would prefer a health plan with more upfront costs and lower out-of-pocket expenses, while only 21 percent said they wanted a plan with...

  • CMS Extends Medicare Advantage Audit Program in 2019 Rule

    October 31, 2018 - CMS will be continuing its Medicare Advantage audit program, the agency indicated in a proposed 2019 rule, in an effort to ensure program integrity and reduce inappropriate payments to insurers. The changes are part of CMS’s new initiatives to modernize Medicare Advantage. The proposed rule emphasizes changes that allow insurers to experiment with new benefit designs and leverage...

  • 60% of Employers Fail to Address Healthcare Spending Waste

    October 30, 2018 - Sixty percent of employers don’t capitalize on opportunities to address healthcare spending waste, even though they say wasteful spending is a key concern, according to a new survey from the National Alliance of Healthcare Purchaser Coalitions. Fifty-seven percent of employers believe at least one-fourth of their spending on primary treatments is wasteful, yet many employers do...


Today's Top Stories

HealthCare.gov Breach Exposes Data of 75K Individuals

Last month, a breach of HealthCare.gov took place that affected those applying for coverage under the Affordable Care Act, HHS reported last Friday. The intrusion led to inappropriate access to the personal information of about 75,000...

Strategies for Designing Consumer-Centric Health Plans

The Health Care Transformation Task Force recently released a new set of guiding principles to help healthcare industry leaders and policymakers better integrate consumer needs into benefit design. The goal of the task force, a consortium...

CMS Proposes to Deregulate, Fast Track Medicaid Managed Care Programs

CMS has proposed a new rule to reduce regulation around Medicaid managed care programs and allow states to contract with private payers to deliver managed care at faster rates. CMS developed the rule in coordination with the National...

CMS to Audit Premium Subsidy Eligibility for Individual Health Plans

CMS has proposed a new rule that would audit premium subsidy eligibility for individual health plan beneficiaries and monitor premium assistance programs through the federal insurance exchanges. The Patient Protection and Affordable Care...

US District Court Denies Appeal to Resolve Risk Corridor Payments

Federal judges for the US Federal District Court of Appeals denied a request to reopen a case that could provide over $12 billion in risk corridor payments to payers. Moda Health Plan, BlueCross BlueShield of North Carolina, and Land of...

Employer-Sponsored Medicare Advantage Enrollment Up 12% for 2019

Employer-sponsored Medicare Advantage (MA) enrollment for plan year 2019 increased by 12 percent, representing a bump of more than 443,000 individual members, according to a new analysis by Mark Farrah Associates. Individual Medicare...

Poor Data Quality in CA Medicaid Drives $4B in Improper Payments

California's Medicaid program, Medi-Cal, made over $4 billion in improper payments to cover benefits for ineligible beneficiaries because of poor data quality and insufficient oversight, according to a new report from state...

View all stories

X

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...