Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability
  • Bundled Payments Require Clinical Insights, Provider Buy-In

    April 19, 2018 - Payers see bundled payments as a way to promote value-based reimbursement practices but must first leverage clinical insights and provider buy-in to maximize a bundle’s potential effectiveness. Bundled payments are valuable to payers because of their capabilities to support population management initiatives, save on healthcare costs, and reduce wasteful spending. Providers may also find...

  • How Payers Can Succeed in Association Health Plan Markets

    April 16, 2018 - Association health plans (AHPs) may completely alter the nation’s health insurance markets with increasing support from federal entities and a handful of state insurance commissions. An expansion of the AHP market may materialize based on recent decisions made by federal leaders. President Trump issued an executive order at the end of 2017 that allows groups of people to enroll...

  • CMS: Mix of Racial, Ethnic Disparities in Medicare Advantage

    April 11, 2018 - CMS found significant racial and ethnic disparities related to patient experience and chronic disease management in the Medicare Advantage (MA) program, revealing potential health equity concerns within MA. A report published by CMS and the RAND Corporation found that minority groups experienced poorer overall healthcare experiences than non-minorities during 2016. The team used Medicare CAHPS...

  • Payers Add Preventive Care, Wellness to Holistic Health Solutions

    April 5, 2018 - Payers have developed several initiatives to incorporate preventive care and wellness as part of their larger holistic health solutions. Adding wellness and preventive care can help payers keep their beneficiaries from developing costly chronic conditions and improving their overall health. Employers recently expressed high interest in wellness and preventive care investments. Wellness and...


Today's Top Stories

Senate Bill Proposes Medicare Health Plan for All Ages

Senator Jeff Merkley (D-OR), with sponsorship from 11 other Democrats, has introduced a bill to create a Medicare health plan for all ages that would be offered in state and federal health exchanges, as well as the employer-sponsored market....

Humana Launches Bundled Payment Model for Maternity Care

Humana has launched a bundled payment model to improve outcomes and lower costs of maternity by partnering with OBG-YNs across the country. Humana’s Maternity Episode-Based Model bundles payments that covers the cost of a mother’s...

HHS Appoints James Parker to Address Health Insurance Costs

HHS Secretary Alex Azar has appointed James Parker as Senior Advisor to the Secretary of the Office of Health Reform to address healthcare challenges related to health insurance costs and health plan availability. Parker previously served as...

HHS Must Address Adverse Selection in Medicaid, Medicare Renal Care

AHIP is urging HHS secretary Alex Azar to address adverse selection related to Medicaid or Medicare end stage renal disease (ESRD) in order to ensure that vulnerable beneficiaries continue to receive appropriate healthcare services. AHIP asserted...

Bundled Payments Require Clinical Insights, Provider Buy-In

Payers see bundled payments as a way to promote value-based reimbursement practices but must first leverage clinical insights and provider buy-in to maximize a bundle’s potential effectiveness. Bundled payments are valuable to payers because...

Health Plan Variety Does Not Boost Managed Medicaid Performance

Managed Medicaid performance does not increase as state Medicaid programs introduce more health plan variety, but a single health plan with value-based characteristics may be more effective in improving performance, a new JAMA commentary...

AMA Promotes Alternative Payment Model for Opioid-Use Disorder

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) have announced plans to promote an alternative payment model to address opioid use disorder. Leaders at ASAM and AMA are encouraging payer and provider...

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