Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability
  • Top 10 Highest Performing Medicare Advantage Health Plans

    August 16, 2018 - Medicare Advantage (MA) plans are growing in popularity as an aging consumer population seeks comprehensive coverage for acute and chronic care needs. A competitive, lucrative market for high-performing plans has emerged, giving payers an incentive to craft quality offerings at reasonable prices.   As the MA environment heats up, insurance companies are also feeling pressure to...

  • Nearly 20% of Employees Have Inpatient Out-of-Network Claims

    August 14, 2018 - Approximately twenty percent of employees with insurance had at least one out-of-network claim for inpatient care, according to a Peterson-Kaiser Tracker analysis. Employees with out-of-network provider bills may experience increased stress due to the cost of healthcare because they are largely responsible for out-of-network costs. In 2016, 15.5 percent of all inpatient admissions...

  • Medicare Advantage Part B Plans Can Use Drug Step Therapy

    August 13, 2018 - CMS is allowing Medicare Advantage (MA) health plans to implement step therapy protocols in order to decrease prescription drug spending. On January 1, 2019, MA health plans can apply step therapy guidelines for physician-administered medications. Step therapy requires beneficiaries to use condition-based prefered medications before using more expensive drugs. MA plans can also...

  • How to Improve Cost Sharing to Enhance Chronic Disease Management

    July 31, 2018 - A tailored cost sharing program that helps beneficiaries pay for chronic disease care can reduce wasteful spending and increase access to chronic disease management services. However, relying on one-size-fits all cost-sharing plans can make it difficult for patients to access the preventive services they need to avoid costly acute events down the line. One-size-fits-all cost sharing,...


Today's Top Stories

CMS Processes State Medicaid Requests, Approvals 23% Faster

CMS has announced that an agency initiative to streamline state Medicaid approvals and state plan amendments (SPAs) has increased approval processing speed by 23 percent. In 2017, CMS sent a bulletin to state Medicaid programs informing...

Top 10 Highest Performing Medicare Advantage Health Plans

Medicare Advantage (MA) plans are growing in popularity as an aging consumer population seeks comprehensive coverage for acute and chronic care needs. A competitive, lucrative market for high-performing plans has emerged, giving payers an...

Google Invests $375M in Oscar Health for Medicare Advantage

Google’s parent company, Alphabet, has invested $375 million in Oscar Health to help the tech-focused payer enter into Medicare Advantage markets by 2020, according to multiple news outlets, including Reuters. Oscar Health said in...

OH Medicaid Adopts Pass-Through Model for Managed Care Drugs

Ohio’s Medicaid program has issued a mandate that requires managed care health plans to re-negotiate pharmacy benefit manager (PBM) contracts to transition from a spread-pricing drug purchasing model to a pass-through model. The...

Commercial Payers See Promise in Diabetes Prevention Program

The Diabetes Prevention Program could offer commercial payers an impactful way to prevent chronic disease for beneficiaries, according to a new report from AHIP.   In 2012, AHIP recruited seven large payers to a pilot program which...

Nearly 20% of Employees Have Inpatient Out-of-Network Claims

Approximately twenty percent of employees with insurance had at least one out-of-network claim for inpatient care, according to a Peterson-Kaiser Tracker analysis. Employees with out-of-network provider bills may experience increased...

Managed Care Accounted for 38% of Medicaid Spending in 2012

Medicaid managed care accounted for 38 percent of total Medicaid spending in 2012, according to a Congressional Budget Office analysis. The report found that the majority of states in the US have implemented some form of a managed care...

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