Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

HHS to Spend $10M on Affordable Care Act Navigator Program

by

HHS and CMS announced that they will allocate $10 million to support the Affordable Care Act Navigator program, which helps health insurance consumers find coverage solutions during the Open Enrollment period. Launched in 2013, the Navigator...

20.5 Million More Insured Since Start of Affordable Care Act

by

20.5 million more individuals have gained health insurance coverage since the implementation of the Affordable Care Act (ACA) in 2010, according to a new report from the CDC and the National Center for Health Statistics (NCHS). In the first three...

Medicare Shared Savings Program ACOs Cut Spending by $1 Billion

by

Accountable care organizations in the Medicare Shared Savings Program (MSSP) lowered net spending by $1 billion and could help control high expected Medicare spending in the future, a report from the Office of the Inspector General (OIG) found....

MS Medicaid Recovers $8.6M in Fraud, Improper Payments

by

The Mississippi Division of Medicaid (DOM) recovered $8.6 million dollars from claims that were either directly fraudulent or improperly filed, the DOM announced in a press release. Through collaboration between Medicaid Fraud Control Units (MFCUs)...

Competitive Bidding Curbs Medicare Durable Medical Equipment Costs

by

A research team from the Health Care Cost Institute (HCCI) found that the Competitive Bidding Program (CBP) lowered Medicare costs on durable medical equipment (DME), bringing spending down to levels experienced by many commercial payers. The...

How Preventive Healthcare Services Reduce Spending for Payers

by

Reducing healthcare spending is a multi-faceted challenge for payers that requires creative and innovative strategies like offering a wide range of preventive healthcare services in health plans. Payers that encourage beneficiaries to take advantage...

ACA Risk Adjustment Leads Northwell to Shutter Insurance Plan

by

Northwell Health will end the sale of its CareConnect health plans in New York after hefty risk adjustment payments resulted in financial losses for the program, the health system announced. ACA risk adjustment payments totaling $112 million...

Employers Must Prepare Retirees for $275K in Expected Care Costs

by

Employers are starting to prepare and educate retirees for expected post-retirement care costs of $275,000, according to market analysis published by Fidelity Investments. The analysis found a 6-percent increase in costs over a similar report...

Pre-Authorizations, Rx Limits Cut Opioid Abuse by 30% Nationwide

by

Anthem BlueCross BlueShield (BCBS) organizations across the country collectively pledged to lower opioid abuse by 30 percent, and the company as a whole reached that goal two years ahead of schedule according to a press release. Declared a national...

Small Employer Health Plan Quality on Par with Larger Groups

by

Small employer health plans can deliver similar levels of quality with many of the same cost controls as larger employers, according to new research from United Benefits Advisors (UBA). A “less is more” approach can provide significant...

Employer Reference Pricing Lowers Prescription Drug Expenses

by

As payers and employers learn to counter significant increases of prescription drug expenses, reference pricing may hold the key to lowering drug spending and increasing consumer purchases of lower cost drugs, according to research published...

Medicaid Reform Requires Outcomes-Based Innovation, Better Data

by

Medicaid has steadily provided low-income patients with quality healthcare coverage and could further improve by addressing problematic areas through outcomes-based innovation and data analytics infrastructure, according to commentary published...

Tufts Health Plan Launches Four Medicaid ACO Partnerships

by

Tufts Health Plan has signed contracts to form Medicaid accountable care organizations (ACOs) with Atrius Health, Beth Israel Deaconess Care Organization, Cambridge Health Alliance, and Boston Children’s Hospital ACO, according to a press...

Stop-Loss Insurance a Growing Market Opportunity for Healthcare

by

Even though payers may experience higher total revenues on commercial self-insurance, stop-loss and third-party protected insurance revenues have been growing at a higher rate with stronger market stability according to market research from AM...

CMS: Payers Will Have More Time to File 2018 Health Plan Rates

by

Payers still debating how uncertainty over cost-sharing reduction (CSR) subsidies will alter their insurance prices now have more time to submit 2018 health plan rates, CMS announced in a letter to insurers. While the letter says there's...

Explaining Out-of-Pocket Costs May Ease Cancer Care Stress

by

Patients who are not prepared for the magnitude of their out-of-pocket costs for cancer care are more likely to be distressed and less likely to pay their bills than other individuals, according to a research letter published in JAMA Oncology....

As ACA Debate Lingers, Non-Marketplace Members Present Risks

by

While much of the national debate over health insurance has focused on the options open to ACA marketplace enrollees, payers should be careful not to neglect coverage choices for their private plan customers, who tend to be healthier and wealthier,...

Payers May Be Neglecting a Growing Medicare Advantage Market

by

Payers may be able to secure more of the growing Medicare Advantage (MA) marketplace by expanding their member messaging efforts and improving consumer education about what the supplementary plan has to offer, according to a new J.D. Power survey....

Can Healthcare Price Transparency Tools Cut Costs for Payers?

by

As out-of-pocket costs for patients continue to rise alongside payer spending on services, many health insurance companies are turning to online price transparency tools to help beneficiaries decide how to purchase low cost, high quality care....

BCBS Minnesota Launches Prediabetes Prevention Campaign

by

Blue Cross Blue Shield (BCBS) of Minnesota is launching a prediabetes prevention campaign to lessen the rate of diabetes in local communities, the payer announced in a press release. Titled “Reverse It,” the campaign focuses on helping individuals...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks