Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

Care Coordination is Tops for Health Insurance Satisfaction

by

Coordination of care among healthcare providers is the single most important criteria influencing member satisfaction with their health insurance plan, according to the J.D. Power 2017 Member Health Plan study.   Members expressed clear...

BCBS of Kansas City Will Leave ACA Health Insurance Exchange

by

The exit of Blue KC from the ACA health insurance exchange in 2018 will affect a 32-county service area in Kansas and Missouri, and leave both urban and rural counties without any marketplace exchange insurers. The payer blamed losses exceeding...

AHCA CBO Score Predicts 23M Uninsured, Higher Out-of-Pocket Costs

by

The CBO report on the American Health Care Act (AHCA) found the bill would result in 23 million people losing insurance coverage over the next decade.  Other impacts of the bill include higher out-of-pocket costs for most patients and significant...

Single-Payer Healthcare Plan May Cost California $400 Billion

by

California’s proposed single-payer healthcare system would come with a $400 billion price tag, says a report from the state Senate on bill SB 562. The goal of the universal healthcare bill is two-fold: to tackle the issue of runaway premiums...

WA Health Insurance Exchange In Flux With CSR Confusion

by

Washington State has thus far been a success for the health insurance exchange marketplace.  The state has seen robust payer participation, increased enrollment and a trend-bending eight percent benchmark premium increase in 2017, versus...

Understanding the Basics of Accountable Care Organizations

by

Accountable care organizations (ACOs) are provider-based networks which utilize data analytics and population health management strategies to increase efficiency, improve patient outcomes, and reduce healthcare costs. Originally established in...

DOJ Sues UnitedHealth over Alleged $1B Medicare Fraud

by

The Department of Justice is suing UnitedHealth  for alleged Medicare Advantage fraud in a civil case.  The complaint, filed in the Western District court, is “for monies unlawfully obtained or retained from the insurers Medicare...

WI Medicaid Waiver Adds Drug Testing, Behavior Incentives

by

The Wisconsin Department of Health Services (DHS) will submit a section 1115 Medicaid waiver for the 2018 enrollment period that aims to add drug testing, healthy behavior incentives, and premium payments for certain beneficiaries. The waivers...

Employers Seek Clarity, Stability in Health Insurance Market

by

The nation’s largest employers are taking a second look at what type of health insurance they buy, and why.  The American Health Policy Institute (AHPI) surveyed over 400 large companies and found issues of transparency, tax credits...

CMS to Shutter Small Business Health Options Program Website

by

As of 2018, HealthCare.gov will no longer host the Small Business Health Options Program (SHOP) Marketplace.   Usage of the healthcare insurance exchange by insurance producers and overall enrollment through SHOP never met anticipated...

650 Medical Groups Sign On to Abolish Medicare Budget Panel

by

Over 650 medical organizations have signed a letter to Congress from the Healthcare Leadership Council (HLC) supporting the elimination of the Independent Payment Advisory Board (IPAB).  The HLC joins a chorus of support for two bipartisan...

Kaiser Permanente Will Stay in ACA Health Insurance Exchange

by

Kaiser Permanente will continue to offer coverage options through the ACA health insurance exchanges during 2018, the payer and provider announced this week. “Kaiser Permanente will continue to offer coverage -- including access to our...

CMS Offers Resources for High-Risk Pools, Reinsurance Waivers

by

The Centers for Medicare and Medicaid Services (CMS) has just released a checklist for states to use on applications for Section 1332 waivers.    The waivers are specifically targeted at helping states establish high-risk pools...

KY Medicaid Awarded for Exceeding Quality, Patient Care

by

Kentucky’s Anthem Blue Cross and Blue Shield Kentucky Medicaid has received an award from the National Committee for Quality Assurance (NCQA) for its Medicaid managed care plan.  The award recognizes the plan’s service and clinical...

CMS Adds Stricter Health Insurance Exchange Enrollment Rules

by

Slated to begin in June 2017, the Centers for Medicare and Medicaid Services (CMS) will be rolling out a pilot program aimed at tightening scrutiny of those using the special enrollment period on the ACA health insurance exchanges. The program...

Two-Thirds of Physicians Disapprove of American Health Care Act

by

Two-thirds of physicians in a new Merritt Hawkins survey reported having a negative impression of the American Health Care Act (AHCA).  This includes 58 percent of physicians who have a “strongly” negative take on the newly...

Anthem Terminates Cigna Merger, but Refuses to Pay Out $1.8B

by

After a court ruling in Delaware, Anthem has notified Cigna that their proposed $54 billion merger is off, but that doesn’t mean the two insurance companies are amicably parting ways. Anthem has stated that it will not pay Cigna a $1.85...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

by

In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the nation’s patients. ...

Maine Medicaid Waiver Would Increase Patient Responsibility

by

Maine will apply for a Section 1115 Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS) to be granted flexibility to circumvent federal regulations and impose reforms on its Medicaid program. The state’s proposed changes...

Aetna Will Abandon All Health Insurance Exchanges for 2018

by

Aetna is ending participation in the Delaware and Nebraska ACA health insurance exchanges, completing its retreat from the public marketplace.   The company also made announcements earlier this year that it would be leaving the Virginia...

Continue to site...