Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability
  • Payer Strategies for Boosting Consumer Engagement, Satisfaction

    October 19, 2017 - In an increasingly competitive health insurance environment, payers that can successfully increase consumer engagement and beneficiary satisfaction will be best positioned for success. David Biel, the US Leader for Health Plans consulting at Deloitte believes that consumer engagement will be a determining factor in the success of health plans in the near future. “A health plan is going...

  • Top Commercial Payers Offering Medigap, MA, and Medicaid Plans

    October 18, 2017 - The top payers with the highest enrollment numbers for Medigap, Medicaid, and Medicare Advantage (MA) are a unique mix of some of the largest commercial payers as well as smaller to mid-size insurers, a new report from AHIP reveals. These three health programs cover roughly 78 million individuals nationwide, with Medicaid accounting for 49 million beneficiaries, followed by 17 million Medicare...

  • Quality Measures Challenging in Pharmaceutical Value-Based Contracts

    October 17, 2017 - Healthcare payers may find it difficult to establish value-based contracts (VBCs) with pharmaceutical companies due to the challenges of creating meaningful, workable quality measures.   Pharmaceutical companies are generally reluctant to engage in value-based reimbursement contracts, says a recent PricewaterhouseCoopers survey, with 61 percent stating that negotiations with payers often...

  • How to Create Balanced Risk Pools that Lower Premiums

    October 12, 2017 - Payers have been increasingly challenged to manage the high cost of healthcare while lowering the premiums their beneficiaries pay.  Creating balanced risk pools that benefit medically complex individuals while also serving healthier consumers is a key component of keeping costs under control for all parties. Risk pools are groups of individuals across the medical complexity spectrum,...


Today's Top Stories

Anthem Adds Home Meal Delivery to Medicare Advantage Plans

Anthem is offering home meal delivery service to its post-discharge Medicare Advantage plan members in  in several states including Georgia, Kentucky, Missouri, and Wisconsin the payer announced. Anthem is partnering with GA foods to provide...

Payer Strategies for Boosting Consumer Engagement, Satisfaction

In an increasingly competitive health insurance environment, payers that can successfully increase consumer engagement and beneficiary satisfaction will be best positioned for success. David Biel, the US Leader for Health Plans consulting at...

Michigan MSSP Accountable Care Org Saves $8M for Medicare

The Physician Organization of Michigan Accountable Care Organization (POM ACO), a Medicare Shared Savings Program (MSSP) ACO, helped the state save $8 million dollars on Medicare expenses by reducing unnecessary ED utilization, preventing unneeded...

Top Commercial Payers Offering Medigap, MA, and Medicaid Plans

The top payers with the highest enrollment numbers for Medigap, Medicaid, and Medicare Advantage (MA) are a unique mix of some of the largest commercial payers as well as smaller to mid-size insurers, a new report from AHIP reveals. These three...

Bipartisan Senate Compromise May Reinstate CSRs, Alter 1332 Waivers

Senators Lamar Alexander (R-TX) and Patty Murray (D-WH)  have floated a bipartisan deal to reinstate the ACA’s cost-sharing reductions (CSRs) and boost individual enrollment outreach in exchange for alterations to the state 1332 waiver...

States Approve Premium Hikes after Loss of Cost Sharing Reductions

Several states have decided to either increase or maintain expected premium increases on individual and small group plans following the President’s decision to end the cost-sharing reductions (CSRs) that cover the cost of many Affordable...

Quality Measures Challenging in Pharmaceutical Value-Based Contracts

Healthcare payers may find it difficult to establish value-based contracts (VBCs) with pharmaceutical companies due to the challenges of creating meaningful, workable quality measures.   Pharmaceutical companies are generally reluctant to...

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