Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Affordable Care Act

Medicaid Managed Care Spending Rose to $107 Billion in 2014

by Vera Gruessner

One area in which the federal government has put in excessive amounts of funds is the managed care arena. The reasoning may be due to the growing elderly population of baby boomers. The US Government Accountability Office released a report...

How Presidential Nominees May Change World of the Health Payer

by Vera Gruessner

The future of the healthcare industry hangs in the balance as the presidential nominees within the United States have their own plans for how to improve the consumer experience and the world of the health payer. Some of the most...

Guaranteed Renewability Key to Replacing Affordable Care Act

by Vera Gruessner

Even though President Barack Obama vetoed the Budget Reconciliation bill aimed at repealing the Affordable Care Act, there is still the potential that, if a Republican nominee wins the presidential election by the end of the year, new...

Top 3 Difficulties Facing State Health Insurance Exchanges

by Vera Gruessner

Once the Patient Protection and Affordable Care Act was passed into law, a tide of legal challenges came crashing against the legislation. In particular, the state and federal health insurance exchanges faced several differing...

UPDATE: House Passes Bill to Repeal Obama’s Affordable Care Act

by Vera Gruessner

The House of Representatives voted 240 to 181 in favor of the Budget Reconciliation bill, which would repeal large parts of the Patient Protection and Affordable Care Act as well as take away funding from Planned Parenthood for one year,...

3 Policy Challenges Health Insurance Exchanges Face

by Vera Gruessner

Health insurance exchanges have faced a number of legal challenges in recent months, as some key provisions of the Patient Protection and Affordable Care Act have found opposition. Last June, the Supreme Court ruled on the King v. Burwell...

Why State Medicaid Expansion May be Worthwhile for All

by Vera Gruessner

When the Supreme Court ruled that Medicaid expansion under the Patient Protection and Affordable Care Act is voluntary among the states, this set a precedence that allowed individual states to play partisan politics and withhold from...

The Impact of Medicare Advantage Plans, ACOs, Payment Reform

by Vera Gruessner

Now that the New Year is upon us, the Medicare program may be undergoing some significant changes that could affect patients and healthcare services. One ongoing transformative characteristic is the rise in enrollment in Medicare Advantage...

8.2 Million Applied for Coverage on Health Insurance Exchanges

by Vera Gruessner

Open enrollment via the health insurance exchanges has seen a dramatic rise in popularity since the starting date of November 1, as more than 8.2 million consumers signed up for health coverage on HealthCare.gov or had their plans renewed,...

Medicaid Expansion Brought More Cancer Screenings among Women

by Vera Gruessner

Several years ago, the Supreme Court ruled that state Medicaid expansion under the Patient Protection and Affordable Care Act is to be optional for each region. This led a large number of states to forego expanding their Medicaid program...

Top 3 Recent Outcomes of the Affordable Care Act in 2015

by Vera Gruessner

The Obama administration’s Patient Protection and Affordable Care Act has dealt with a multitude of opposition since its passage and this past year has been no different. There are still partisan politics at play when it comes to the...

Top 4 Factors Necessary for Bundled Payment Model Contract

by Vera Gruessner

In today’s healthcare climate, payers are working to develop value-based reimbursement contracts with their provider network. Lately, payer and provider contract negotiations are often based around alternative payment methods such as...

Will the US Embrace the Affordable Care Act in Future Years?

by Vera Gruessner

The Patient Protection and Affordable Care Act has had many obstacles in the way when revolutionizing the healthcare insurance field and broadening access to medical care for the US population. What does the future hold for the Affordable...

Blue Shield, Accountable Care Organization Saved $325 Million

by Vera Gruessner

In recent years, there has been plenty of concern about whether or not Accountable Care Organizations (ACOs) bring significant cost savings to the healthcare industry. However, one health payer and ACO have proven that it is possible to...

2016 Premiums on Health Insurance Exchanges Expected to Soar

by Vera Gruessner

Health payers managing plans through the state health insurance exchanges will need to work toward maintaining superior customer relations due to the rise in premium costs expected in 2016. The Robert Wood Johnson Foundation released...

CMS Stresses Informed Decision-Making in Performance Reports

by Vera Gruessner

Since the Affordable Care Act was initially created, the Centers for Medicare & Medicaid Services (CMS) have been focused on improving informed decision-making among payers, providers, the patient community, and other stakeholders. CMS...

Is Employer Mandate in Affordable Care Act Constitutional?

by Vera Gruessner

On Monday, the Association of American Physicians and Surgeons (AAPS) filed an amicus brief with the US Supreme Court that asks the justices to provide a writ of certiorari in a court case that claims the employer insurance mandate of the...

Will Health Insurance Exchange Remain Intact Despite Hurdles?

by Vera Gruessner

What will happen to the health insurance exchange created by the Patient Protection and Affordable Care Act? Will it continue on as originally planned by the Obama administration? Or will new legislation and the decisions of insurance...

The Senate Passes Bill to Repeal Chunks of Affordable Care Act

by Vera Gruessner

On Thursday, the United States Senate voted 52 to 47 in passing a legislation that would gut major provisions within the Patient Protection and Affordable Care Act. This is the first time the Senate has approved such a bill and has the...

Is UnitedHealthcare Leaving a ‘Death Spiral’ for Exchanges?

by Vera Gruessner

The insurer UnitedHealthcare has recently announced that it would consider moving away from the Affordable Care Act’s health insurance exchanges due to significant profit losses. The actions of this large health payer could be an...

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