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HealthPayerIntelligence News

Rise in High-Deductible Health Plans Requires Cost Transparency

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High-deductible health plans are becoming more and more common across the health insurance industry. With the many changes that the Affordable Care Act (ACA) has brought, payers are attempting to control costs by offering more high-deductible...

Humana Spent $93M in Quality Payments for Provider Network

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The national payer Humana announced in a company press release earlier this week that it has reimbursed more than $93.6 million to more than 4,000 provider groups countrywide participating in their Provider Quality Rewards Program. These particular...

Premier Accountable Care Organizations Improved Quality in 2015

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New results from the Premier Inc. Population Health Management Collaborative (PHMC) show that accountable care organizations (ACOs) within the collaborative improved quality and cost reduction in 2015 better than other ACOs operating through...

Healthcare Insurance Literacy Vital for Higher Coverage Rate

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New research from the RAND Corporation shows that uninsured Americans who have better healthcare insurance literacy were more likely to purchase coverage when the Affordable Care Act’s health insurance exchanges opened in 2014, according...

Anthem-Cigna Health Insurance Merger Suit Starts on November 21

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The lawsuit against the Anthem-Cigna health insurance merger had its first pretrial conference this past Monday, according to The Coalition to Protect Patient Choice. Judge Amy Berman Jackson said that the two parties met to have a discussion...

AMA Pledges to Prevent Loss of Americans’ Healthcare Coverage

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The American Medical Association (AMA) released a statement yesterday reaffirming its commitment to ensuring that every American who currently has healthcare coverage will continue to have insurance and access to medical care. In particular,...

How to Favorably Manage Risk in Value-Based Care Reimbursement

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While downside risk does not incentivize providers to take part in value-based care reimbursement policies, data-driven technology and a combination of financial motivations may encourage physicians to transition to alternative payment models,...

House Speaker Paul Ryan Proposes a Privatized Medicare System

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House Speaker Paul Ryan announced in an interview with Fox News Channel several days after the presidential election that the Republican-controlled Congress and White House will look to create a privatized Medicare system and cut funding from...

Top 5 Ways Commercial Payers Could Boost Consumer Engagement

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Consumer engagement is an important factor that commercial healthcare payers may need to address in order to keep a loyal customer base throughout future open enrollment periods. Some health insurance companies have worked to address consumer...

Why Reviewing Pricing Trends is Key for Bundled Payment Models

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When payers begin to adopt bundled payment models, they may find some challenges standing in their way to truly succeed within these alternative payment solutions. For example, when attempting to contract through bundled payments, it may be difficult...

How Payers Could Adjust to MACRA Regulations, Value-Based Care

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MACRA regulations may seem overly complex and lengthy for the average medical practice but there are steps that providers can follow to succeed under MACRA’s quality payment program. Providers can work with payers to better identify similar...

Patients Need More Guidance on Medicare Prescription Drug Plans

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Among Medicare beneficiaries, 34 percent are not taking the time to review their Medicare Advantage prescription drug plan before renewing during the open enrollment period, according to a Walgreens survey. Nearly one in five or 19 percent stated...

Healthcare Payers Face Challenges with Medical Loss Ratio

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Under the Patient Protection and Affordable Care Act’s medical loss ratio, health payers are required to spend a minimum of 80 percent of their premium revenue on paying claims and boosting quality while the rest (20 percent) can be spent...

3 Key Steps for Health Payers to Meet HEDIS Quality Measures

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Health insurance companies are slowly moving toward adopting alternative payment models based on pay-for-performance metrics. This means more payers and providers are focused on meeting HEDIS quality measures. The scores payers receive on HEDIS...

Care Coordination Vital in Accountable Care Organizations

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Healthcare payers looking to transition to new payment systems and better coordinate care across multiple facilities would benefit from working within accountable care organizations (ACOs). Within ACOs, payment is linked to quality performance...

How MACRA Legislation Advances Value-Based Care Reimbursement

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MACRA legislation may play a major part in advancing the adoption of value-based care reimbursement among both payers and providers. CMS Acting Administrator Andy Slavitt emphasized this past May that MACRA legislation will bring real progress...

How Payers Could Use Price Transparency to Boost Satisfaction

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In order to reduce ever rising healthcare costs, health insurance companies will need to improve price transparency among their health plans as well as within their provider networks. The Robert Wood Johnson Foundation released a report showing...

Health Insurance Exchanges Require Engagement, Narrow Networks

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Since some private health payers are struggling with enrollment and the ability to make a profit on the health insurance exchanges, engaging consumers, reducing the administrative burden, and creating a narrow provider network will become an...

How MACRA Requirements Impact Accountable Care Organizations

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MACRA legislation impacts a number of healthcare providers and entities including accountable care organizations (ACOs). Only a few Medicare accountable care organizations will actually be able to participate in Advanced Alternative Payment Models...

Blue Cross to Expand Value-Based Care Reimbursement in 2017

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The coming years will further position the medical industry including payers to adopt value-based care reimbursement models and new healthcare delivery systems partially due to the reforms that came about from the Patient Protection and Affordable...

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