Best Practices

Payer Provides Homebound COVID-19 Vaccine Access, Best Practices

April 2, 2021 - To ensure COVID-19 vaccine access for homebound individuals, the Commonwealth of Massachusetts has partnered with the Commonwealth Care Alliance (CCA), a health plan that says it has proven best practices for vaccinating this population. CCA, an integrated care system that serves individuals with significant social and health needs, was the first...


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Best Practices to Address Opioid Use Disorder for Medicaid Directors

by Emily Sokol, MPH

The overdose death rate from prescription opioids rose by 12 percent from 2016 to 2017, urging states to address opioid use disorders. As the opioid epidemic shows no signs of slowing, healthcare...

Building Cross-Sector Partnerships to Address Food Insecurity

by Emily Sokol, MPH

Food insecurity is one of the biggest social determinants of health. It affects over 19 percent of United States adults, according to data from the Centers for Disease Control and Prevention. The...

5 Strategies for 5 Stars: Cigna’s Approach to CMS Star Ratings

by Emily Sokol, MPH

Achieving five stars in all three domains – Medicare Advantage, Part D, and overall - is difficult. The work of Cigna’s HealthSpring of Florida plan in 2018 earned them five-stars across the board, making them one of only two...

State Medicaid Programs Invest in Accountable Care Organizations

by Vera Gruessner

Last month, the Center for Health Care Strategies released a fact sheet outlining the growth of state Medicaid programs operating accountable care organizations (ACOs). Right now, there are...

Top 4 Ways Payers Could Improve Patient Health Outcomes

by Vera Gruessner

Health insurance companies have been putting more focus on preventive care, a reduction in unnecessary medical testing, and better patient health outcomes by transitioning to value-based care...

How to Develop HEDIS Quality Measures for Pediatric Care

by Vera Gruessner

The American Academy of Pediatrics (AAP) announced yesterday on its website that it will be partnering with the National Quality Forum (NQF) to connect quality metrics to the interests of children and...

Are Bundled Payment Models or Capitation the Better Choice?

by Vera Gruessner

  Today, healthcare payers have multiple ways to reimburse providers for performing medical services that move away from the traditional and more costly fee-for-service reimbursement system. Two...

Should Accountable Care Organizations Include Social Services?

by Vera Gruessner

While government agencies, healthcare payers, and medical organizations put their efforts and hopes in advancing accountable care organizations (ACOs), these healthcare delivery reforms lack...

Vermont Blue Cross Plan Reaches Highest Member Satisfaction

by Vera Gruessner

Blue Cross and Blue Shield of Vermont (BCBSVT) announced in a company press release this month that the payer has achieved the highest scores for member satisfaction and efficiency rankings for the...

Key Best Practices for Success on the Health Insurance Exchanges

by Vera Gruessner

Which healthcare insurers are succeeding in the health insurance exchanges? What best practices can be taken from these payers? The weekly newsletter Washington Health Policy Week in Review published...

How Payers Could Assist Primary Care Docs with Value-Based Care

by Vera Gruessner

How can health insurance companies improve their relationship with primary care practices? How can payers work with primary care providers to expand value-based care reimbursement?  For answers...

84% of Physicians Unsure of Quality Payment Program Conditions

by Vera Gruessner

As many as 84 percent of polled independent physicians and medical staff are unaware of how to meet the requirements of MACRA’s Quality Payment Program, according to a survey from Kareo. The...

Key Challenges and Solutions of Healthcare Payment Reform

by Vera Gruessner

Healthcare payment reform is becoming more common across payers and providers with many stakeholders transitioning from the traditional fee-for-service reimbursement system to value-based care...

Value-Based Care Drives Progress in Population Health Management

by Vera Gruessner

Population health management is becoming a more prominent topic of interest among healthcare payers as they strive to transition to value-based care reimbursement and improve patient outcomes. A report...

Why Payers Should Reduce Cost Sharing for High-Value Care

by Vera Gruessner

Today, more healthcare payers are positioning greater cost-sharing onto the consumers to keep from raising premium rates, according to commentary published in JAMA Internal Medicine. The 2016 National...

Prospective vs. Retrospective Healthcare Bundled Payment Models

by Vera Gruessner

When implementing healthcare bundled payment models, providers and payers have two main strategies to choose from: prospective or retrospective bundles. A prospective healthcare bundled payment model...

5 Best Practices to Advance Value-Based Care Reimbursement

by Vera Gruessner

When payers begin to transition to value-based care reimbursement from the more traditional fee-for-service payment system, company executives and financial experts may find it takes longer than...

Key Steps for Payers to Improve Population Health Management

by Vera Gruessner

In recent years, population health management has become a larger factor in the success of a health insurance company. With more payers transitioning to value-based care reimbursement platforms, the...

Medical Organizations Advise Changes for Quality Payment Program

by Vera Gruessner

The healthcare provider community has shown some concern about MACRA implementation and the quality payment program. The Advisory Board released a survey last month showing that 70 percent of 30...