4 Strategies to Advance Value-Based Care During and After a Crisis
HealthPayerIntelligence How do major disruptions affect the US healthcare system’s progress toward value-based care? A recession, a widespread natural disaster, a public health emergency—significant national events like these have the power to build or break any healthcare system, but the American healthcare system, some have argued, is particularly vulnerable. Healthcare spending contributed over...
More Features
Navigating Medigap Plans: How Payers Can Lead the Way
Bonnie Burns, a training and policy specialist at California Health Advocates, has been advocating for consumers in the Medicare space for over four decades, including in the area of Medigap benefits. She was involved in the lawsuit that...
Beyond COVID-19: Telehealth, Partnerships, Member Engagement
While the coronavirus pandemic which gripped the nation in March 2020 is still in force, payers are beginning to look to the future as the nation emerges from crisis mode. Many uncertainties still hang in the air regarding the trajectory of...
The Building Blocks of an Effective Coronavirus Response Strategy
Payers are in a unique position to respond to many aspects of the coronavirus from payment of testing and treatment to community education. But there is no playbook for appropriate or effective responses. In such unique circumstances, payer...
How Medicare Advantage Is Leading Payers to Adopt Value-Based Care
As America strives for positive changes to the healthcare system, it may find the greatest advancements for value-based care in Medicare Advantage plans. Over 90 percent of healthcare payers in a small Health Care Payment Learning...
5 Strategies for 5 Stars: Cigna’s Approach to CMS Star Ratings
Achieving five stars in all three domains – Medicare Advantage, Part D, and overall - is difficult. The work of Cigna’s HealthSpring of Florida plan in 2018 earned them five-stars across the board, making them one of only two...
What’s the Role of Medicare Advantage for Payers and Consumers?
As the US population continues to age, older individuals are seeking out comprehensive, affordable care options that meet their specific health needs. Medicare Advantage is one of the most popular ways for consumers to round out their...
How Payer Philanthropy Can Address Social Determinants of Health
Rising healthcare costs associated with an increase in chronic diseases have led many payers to seek out strategies to get ahead of the spending curve while improving the overall health of their member populations. As population...
How Payers Can Improve HEDIS Quality Measure Performance
HEDIS quality measures have a significant role in the healthcare industry regarding closing gaps in care and decreasing the use of costly acute care through preventive services. By placing a greater focus on value-based care and quality...
Key Steps for Payer Success in Accountable Care Organizations
In recent years, healthcare reforms have set out to reduce constantly rising medical costs, improve coverage for the many Americans who lacked primary care access, and advance population health outcomes. Over the past few years, the...
The Progress and Challenges of the Affordable Care Act
Before the Patient Protection and Affordable Care Act (ACA) became law on March 23, 2010, the healthcare industry faced a number of obstacles particularly in terms of providing medical care and health insurance to many low-income families...
How Medicare, Medicaid, and CHIP Guide the Health Payer Industry
Medicare, Medicaid, and CHIP, the three major public insurance programs overseen by CMS, often set the tone for the large private health payer industry. CMS is using all three programs to actively encourage the movement towards...
How Health Insurance Mergers Could Change the Payer Industry
During the summer of 2015, Aetna and Humana, as well as Anthem and Cigna, started a merger process that would reduce four of the nation’s largest insurers down to just two. If the mergers are successful, only three payers would...
How Payers Could Succeed in ACA Health Insurance Exchanges
State and federal health insurance exchanges stemming from the Patient Protection and Affordable Care Act (ACA) offer medical coverage for families and individuals that would have otherwise had little opportunity to obtain a health plan and...
How Payers Should Prepare for Value-Based Reimbursement
Value-based reimbursement is a new payment strategy between insurers and providers meant to foster higher quality care by incentivizing strong performance with shared savings, bonuses, or other financial rewards. This diverges from the more...
How to Overcome the Challenges of Bundled Payment Models
Bundled payment models are a form of reimbursement between payers and providers that adheres to an episode of care instead of payment for a particular medical service. This reimbursement system was created to transition healthcare providers...
How the Affordable Care Act Changed the Face of Health Insurance
The Patient Protection and Affordable Care Act (ACA) has revolutionized the health insurance industry in a number of ways. Its impacts have been vast and wide. One of the most significant impacts of the landmark legislation is the upward...
What Are the Benefits of Accountable Care Organizations?
Accountable care organizations (ACOs) are provider and payer arrangements established to improve care coordination between primary care physicians, hospitals, specialists, and public or private health payers. The Centers for Medicare...
Time, Commitment Required for ACO, Value-Based Care Success
In healthcare, as in so many other areas of life, patience is a virtue. Providers and payers pursuing ACO development will need to have plenty of it before their care transformation efforts pay off with significant cost savings. As...
Why diversifying clearinghouse, banking partners is crucial
RevCycleIntelligence Clearinghouses and banks are crucial in supporting hospitals’ financial health, enabling providers to focus on delivering high-quality patient care. However, a recent cyberattack that shut down one of the largest clearinghouses in...
