Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Best Practices

Is the Medicare Part B Proposed Rule ‘Bad Medicine’?

by Vera Gruessner

Two months ago, the Centers for Medicare & Medicaid Services (CMS) announced a new proposed rule that would create new payment models meant to reimburse providers for assigning prescription drugs. This would change the payment structure of...

How CMCS Improved Managed Care in State Medicaid Programs

by Vera Gruessner

Earlier this week, the Centers for Medicaid and CHIP Services (CMCS) finalized its ruling on the managed care Medicaid reimbursement regulations. Soon afterward, the National Association of Medicaid Directors (NAMD) released a statement regarding...

Risk Adjustment Affects Plans on Health Insurance Exchanges

by Vera Gruessner

The trade association AMGA, which entails a large membership of medical groups and healthcare delivery systems, submitted comments last week to the Centers for Medicare & Medicaid Services (CMS) regarding its proposal to change risk adjustment...

Medicare Must Remain Cautious with Alternative Payment Models

by Vera Gruessner

The federal government has brought a tremendous amount of focus on reforming provider-payer reimbursement in order to reduce the rising healthcare expenditure around the country. New regulations have been implemented to improve medical care as...

How CMS Could Boost Operation of Accountable Care Organizations

by Vera Gruessner

Accountable care organizations (ACOs) have become a more mainstream method for improving care coordination and the quality of medical services while providing an opportunity for reducing wasteful spending. For instance, St. John Health System’s...

Why Payers Need Robust Health Information Technology

by Vera Gruessner

Health information technology continues to be an elusive field for the payer industry, as some insurers still have difficulty with adhering to key technological advancements and data security protocols. For example, the health insurer Centene...

Why a Competitive Health Insurance Plan Matters to Employees

by Vera Gruessner

It seems that benefits and a health insurance plan majorly influence employment decisions of many Americans. An online survey completed by Harris Poll on behalf of the software company Collective Health shows that more than 75 percent of US citizens...

How to Design and Support an Accountable Care Organization

by Vera Gruessner

When a large establishment wants to bring more care coordination and greater organization among multiple medical facilities including primary care offices, hospitals, and specialty entities, there are specific steps to take and certain aspects...

Why Health IT is Critical for an Accountable Care Organization

by Vera Gruessner

In order to provide medical services under an Accountable Care Organization (ACO), a network of medical practices, specialty healthcare offices, and hospitals must contract with a health payer such as Medicare, Medicaid, commercial health plans,...

How to Create a Useful Contract for Bundled Payment System

by Vera Gruessner

In 2013, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced that 450 medical providers will take part in a Bundled Payments for Care Improvement initiative. However, more recent results show that healthcare providers...


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