- Over the last year, the medical insurance industry has undergone a variety of changes and overcame challenges as the space transitioned to value-based care. Below we outline ten of the most influential healthcare insurance headlines from 2016 that encompass payer involvement with value-based care reimbursement.
What Are the Benefits of Accountable Care Organizations?
One of the biggest challenges payers face when partnering with an accountable care organization is the potential for low reimbursement rates among their provider network and hospitals’ inability to function at low revenue levels. Accountable care organizations and payers will need to put in the time and resources necessary to share in cost savings. To read this resource, click here.
Patients Need More Guidance on Medicare Prescription Drug Plans
A survey from Walgreens indicates that Medicare beneficiaries are not taking the time to review their Medicare Advantage drug plan before renewing during open enrollment periods. To learn more, click here.
Population Health Vital for Medicare ACO Models to Succeed
With some providers dropping out of the Medicare Shared Savings Program, a report from the National Association of ACOs (NAACOS) emphasized the need to implement new policies in order to strengthen the effectiveness of accountable care organizations. NAACOS recommends CMS to prioritize population-based payments across various Medicare programs. To read more about this report, click here.
Why HEDIS Quality Measures Matter for Value-Based Care
A number of health payers such as Humana and Blue Cross Blue Shield of Rhode Island have focused on improving their HEDIS quality scores while adhering to value-based care protocols. Raising HEDIS scores often involves increasing preventive screening and reducing readmission rates, which are key aspects of value-based care. Click here to read more.
How Payers Should Prepare for Value-Based Reimbursement
The Centers for Medicare & Medicaid Services (CMS) have created a number of different value-based care programs in recent years as the agency attempts to transition half of Medicare claims to be paid through a value-based, alternative payment model by the end of 2018. These innovations from CMS include the Medicare Shared Savings Program and the Medicare Bundled Payment for Care Improvement (BPCI) program. To learn more, click here.
Private Payers Follow CMS Lead, Adopt Value-Based Care Payment
The fee-for-service payment system has brought continually rising healthcare prices for the past several decades. The payment model incentivizes physicians to offer more services instead of quality, coordinated care. This may lead to wasteful spending and redundant medical testing. This is why CMS and the private health insurance market have been transitioning to value-based care such as bundled payment models and shared savings programs. To read more, click here.
Value-based Care Reimbursement Makes Strides in Health Plans
Karen Ignani, President of EmblemHealth, discussed in an editorial how EmblemHealth serves more than 60 percent of their HMO health plan members through a value-based care program. Ignani is looking to further expand the use of alternative payment models at the organization. For more information, click here.
Time, Commitment Required for ACO, Value-Based Care Success
In order to be a successful accountable care organization, providers and payers will need to commit for a long-term endeavour. For example, Pioneer Accountable Care Organizations gained greater cost savings during their third year than the first year they operated. To read our feature, click here.
17 Health Payers Participating in CMS Oncology Care Model
This past summer, CMS adopted a new payment and healthcare delivery structure called the Oncology Care Model. The program was created to decrease the costs of cancer treatment and improve care coordination. As many as 200 physician groups and 17 health plans are participating in the Oncology Care Model. For more information about the CMS program, click here.
Cigna Boosts Outcomes Despite Affordable Care Act Obstacles
A number of healthcare payers, such as UnitedHealthcare and Humana, have had difficulty operating through the health insurance exchanges and faced significant financial losses. Cigna, however, adopted various strategies to improve revenue such as incorporating new data analytics platforms to reduce wasteful spending. Provider engagement was another key way Cigna ensured greater success operating on the health insurance exchanges. To read more, click here.