Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

NYC Mayor Announces Plan to Guarantee Health Coverage for All Residents

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Mayor Bill de Blasio has announced the launch of a comprehensive, universal healthcare coverage plan that will guarantee benefits for every New Yorker. “Healthcare is a right, not a privilege reserved for those who can afford...

Change Healthcare, Health Fidelity Apply AI to Risk Adjustment

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Change Healthcare and Health Fidelity have announced a collaboration to offer AI-driven risk adjustment coding solutions for Medicare Advantage, ACA commercial, and Medicaid payers. The tool leverages natural language processing (NLP) and...

Government Shutdown Spares Medicare, Medicaid, But Has Other Impacts

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The partial government shutdown will have no impact on Medicare and Medicaid at the federal level, CMS has stressed to industry observers. The nation’s public payers will continue to operate as normal, since funding for CMS is...

Patient-Centered Methods Help Health Plans Boost Cancer Care

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Employers and payers should ensure their health plans use patient-centered methods and provider performance measurement strategies to reduce costs and improve cancer care, a report from the National Alliance of Healthcare Purchaser...

Verma: Price Transparency Rule a “First Step” for Consumerism

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The hospital price transparency mandate that went into effect on January 1 is still ruffling feathers among healthcare providers, leading CMS Administrator Seema Verma to reiterate the importance of giving consumers access to pricing...

CA Governor Addresses Prescription Drug Costs, Healthcare Access

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California Governor Gavin Newsom has announced a series of major executive actions and budget proposals to reduce prescription drug costs and move California closer to the goal of healthcare coverage for all. Newsom’s healthcare...

60% of Medicare Advantage Members Feel Little Motivation from Plans

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Medicare Advantage (MA) plans are not doing enough to motivate their members to improve their personal health, according to a new survey from HealthMine. Sixty percent of members participating in the poll said that their MA plans do not...

Steward Health Care Joins Mission to Expand Generic Drug Access

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Steward Health Care has become a founding member of Civica Rx, a collaborative, non-profit drug company with the mission to reduce drug costs and increase the supply of life-saving generic medicines. Approximately 800 US hospitals have...

Nearly 50% of Pre-Medicare Adults Worried About Healthcare Costs

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Forty-five percent of adults aged 50 to 64 are not confident that they will be able to afford healthcare coverage in retirement, according to a poll conducted by the University of Michigan Institute for Healthcare Policy and Innovation and...

AHIP Urges “Careful Planning” of Health Reimbursement Arrangements

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AHIP is cautioning federal regulators to move slowly and carefully when expanding the availability of health reimbursement arrangements (HRAs) as a more prominent means of paying for healthcare services. In response to a request for...

DOJ Recovers $2.5B in Healthcare Fraud, False Claims in 2018

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2018 was a bad year to be a healthcare fraudster.  The Department of Justice (DOJ) has announced that $2.5 billion of the total $2.8 billion recovered under the False Claims Act can be attributed to fraud and improper claims from...

CVS Health to Begin Important Work of Integrating Aetna

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On the eve of Christmas, Judge Richard Leon of the United States District Court for the District of Columbia decided against halting the integration of the two companies in a merger valued at $69 billion. “Based on CVS’s...

Hospital Price Transparency Rule Takes Effect January 1, 2019

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Starting January 1, 2019, hospitals will be required to post their price lists online in an effort to increase price transparency and empower consumers to make informed choices about their care. The mandate stems from the 2019 inpatient...

47% of Payer, Provider Business Tied to Value-Based Care

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Value-based care is nudging the half-way mark as more and more payers and providers shift their contracts away from fee-for-service arrangements, according to the Health Care Transformation Task Force (HCTTF). In a new report, the Task...

Cigna Announces Closing of $67B Purchase of Express Scripts

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Cigna is officially the new owner of Express Scripts after announcing on December 20 that the $67 billion acquisition has closed. Cigna calls the acquisition a “blueprint to transform the healthcare system,” indicating that...

ACA, Member Engagement Challenges Led Top 10 Stories of 2018

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It’s fair to say that the health payer community had a lot to process in 2018.  Mergers, partnerships, and new entries into the field rocked the traditional industry setup, while federal efforts to chip away at the Affordable...

HHS Signals End to Health Plan Identifiers in New Proposed Rule

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Years of pushback from industry stakeholders has motivated an HHS proposal to eliminate a federal requirement for identifying health plans in HIPAA transactions. As everyone prepares to break for the holidays, the federal agency formally...

Humana Value-Based Care Program Unveils First Participants

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Nearly seven months since announcing its value-based care incentive program for hospitals, Humana has revealed its first participants. Four hospitals have agreed to participate in the Hospital Incentive Program (HIP) for commercial...

Prescription Drug Prices Rise Again After Brief Pause

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Several dozen pharmaceutical companies are planning to raise their prices again in 2019 after temporarily holding off on increases as a result of federal pressure. Reuters reports that nearly thirty drug makers, including Novartis, Bayer,...

Leadership Plays Key Role in Effective Workforce Wellness Efforts

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A new report from the Health Enhancement Research Organization (HERO) and Mercer reveals just how vital leadership support is to high-quality workforce wellness initiatives. “These findings suggest organizations that want to improve...

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