Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

HHS Pilot Encourages Streamlined Health Plan HIPAA Compliance

by

HHS is launching a pilot program that streamlines reviews of health plan HIPAA compliance, the organization announced in an email to the CMS listserv. The HHS HIPAA Administrative Simplification Optimization Project pilot is an effort to achieve...

CMS Updates Payer Guidelines for 2019 Qualified Health Plans

by

CMS has issued a draft letter that outlines guidelines, dates, reporting, and regulatory requirements for payers that want to sell qualified health plans (QHPs) in 2019. The Annual Letter to Insurers includes new information, and updates from...

CVS Caremark Provides Real-Time Benefits Data to Pharmacies

by

CVS Caremark, the pharmacy benefit manager (PBM) of CVS Health, will provide pharmacies and prescribers with real-time benefits data on patients as a way to reduce payer and patient drug costs, the organization announced in a press release. The...

The Pros and Cons of Pharmacy Benefits Managers for Payers

by

Prescription drug spending is a billion-dollar problem for the payer industry. While pharmacy benefit managers (PBMs) are often a positive way for payers to manage prescription drug benefits for their members, savings for payers can be limited...

Health Plan Partnership Aims to Boost Care for Native Americans

by

A merger between Tribal First (a subsidiary of Alliant Specialty Insurance Services) and American Indian Health Services (AIHS) will combine two national leaders in providing quality care to Native Americans, the organizations announced in a...

How Payers Can Improve the Value of Small Business Health Plans

by

Payers offering insurance plans for the employer market need to provide flexible benefits and cost-saving strategies that create value for small businesses. Small businesses are an excellent market opportunity for payers because health plans...

Medicare Advantage Value-Based Insurance Design Updates for 2019

by

The Medicare Advantage (MA) Value-Based Insurance Design Model (VBID) for 2019 will extend into fifteen new states, allow Chronic Condition Special Needs plans to participate in the model, and allow all participating plans to specialize benefits,...

Medicare Advantage, Part D Updates to Shift Control to Health Plans

by

CMS is proposing regulatory changes that would offer health plans additional flexibility to design and implement Medicare Advantage (MA) and Part D Medicare benefits.   The rule would reduce administrative burdens by allowing plans to communicate...

Ensuring High Out-of-Pocket Spending Won’t Lead to Negative Outcomes

by

High deductible health plans (HDHPs) are intended to reduce payer and beneficiary spending on healthcare services, but untenable out-of-pocket spending for beneficiaries could lead to patients letting preventable conditions develop into catastrophic...

Integrated Medical, Pharmacy Benefits Help Costs, Member Engagement

by

Integrating medical benefits with pharmacy benefits can help healthcare payers and employer sponsors lower spending, improve member engagement, raise satisfaction, increase care coordination, and manage population health – ticking all the...

Employer Health Plans Can Engage Members with Data, Targeting

by

The use of data analytics and employee wellness engagement platforms may help employer health plans improve spending efficiency while producing a healthier, more productive workforce.    Employees are not always ready to take part in...

Medicare Advantage Consumers Seek New Plans as Risk Scores Rise

by

Medicare Advantage (MA) consumers who switch to new health plans may have higher risk scores than beneficiaries who are content with their current options, indicates a Congressional Budget Office (CBO) report.   Payers who are actively recruiting...

ACA Individual Mandate Repeal Could Cut Insured Number By 13M

by

As a potential repeal of the ACA’s individual mandate faces the US Senate, the Congressional Budget Office (CBO) and Joint Tax Committee (JTC) found that a repeal would cut the number of insured individuals by four million in 2019. In an...

Single-Employee Businesses Experience High, Burdensome Premiums

by

Single-employee businesses paid an average of $500 per month on premiums, experienced high premium payment growth, and experienced polarizing financial burden based on their premium payment amounts, a new report from JPMorgan & Chase reveals....

Humana Adds Former ONC Chief Karen DeSalvo as Board Member

by

Former National Coordinator for Health IT and Assistant HHS Secretary Karen DeSalvo, will join Humana’s board of directors, the payer announced in a press release. Humana believes that the addition of DeSalvo to the board will improve its...

Payer Housing Programs Address Social Determinants of Health

by

Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services. A new report from the...

Value-Based Care Outperforms Fee-for-Service Health Plans

by

Health plans that include value-based care (VBC) principles are more cost-effective than fee-for-service (FFS) options and are starting to produce better patient outcomes, Humana asserts in a new report. The total healthcare costs associated...

AHIP Supports Demo of Medicare Advantage Plans as Advanced APMs

by

AHIP has voiced its support for a CMS demonstration project that would allow Medicare Advantage (MA) plans to qualify as Advanced Alternative Payment Models (APMs), the organization wrote in a statement to CMS. The payer advocacy group believes...

11 Healthcare Payers to Enhance Substance Use Treatment Access

by

Executives from 11 healthcare payers have pledged to enhance substance use disorder (SUD) treatment access and offer provider incentives to more effectively address opioid misuse and other substance use issues. In a joint letter, payer executives...

Top 5 Most Common Healthcare Provider Fraud Activities

by

Healthcare provider fraud is extraordinarily common and can be conducted at a shockingly large scale.  The largest healthcare provider fraud takedown in US history was announced just recently, resulting charges against 400 defendants in...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks