Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Best Practices

4 Major Ways to Succeed in Value-Based Care Payment Strategies

by Vera Gruessner

What areas should payers and providers focus on when contracting through a value-based care payment strategy? In order to succeed in value-based care payment models, insurers and practitioners may need to focus on population health management,...

4 Key Ways Payers Could Reach HEDIS Score Thresholds

by Vera Gruessner

Health payers looking to increase consumer satisfaction and member retention may need to reach care quality metrics and HEDIS measures. The National Committee for Quality Assurance (NCQA) is responsible for many aspects of HEDIS measures and...

Population Health Management Helps ACOs Earn Shared Savings

by Vera Gruessner

Continually rising medical costs without significant benefits to patient care have led both public and private payers to invest in value-based care payment structures such as accountable care organizations (ACOs). However, when payers and providers...

How Healthcare Payers Could Reduce Wasteful Spending

by Vera Gruessner

For many years, the health insurance industry has been working to address wasteful spending among hospitals and medical practices. Some of the areas of wasteful spending relate to duplicative medical testing, unnecessary diagnostics, and excessive...

Humana Standardizes Healthcare Quality Measures for Physicians

by Vera Gruessner

Last week, Humana announced in a company press release the development of a Clinical Quality Metrics Alignment (CQMA) program meant to simplify and regulate healthcare quality measures. The new strategy will be used specifically among doctors...

Top Ways Payers Integrate Patient Engagement Strategies

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced last week the creation of the CMS Person and Family Engagement Strategy, The CMS Blog states. This CMS initiative is meant to stimulate patient engagement and bring the patients...

4 Ways Payers Could Improve Healthcare Price Transparency

by Vera Gruessner

Healthcare price transparency remains a key issue for health payers across the country. In order to strengthen member retention efforts especially during open enrollment periods, payers will need to boost price transparency to improve consumer...

Key Ways Payers Could Improve Medical Claims Management

by Vera Gruessner

Medical claims management is a key aspect of the payer-provider relationship. However, medical claims management tends to include multiple challenges for both payers and providers. Some of the problems stem from a lack of training in medical...

UnitedHealthcare Cut Costs through Value-Based Care Programs

by Vera Gruessner

Last month, UnitedHealthcare released a report outlining the benefits of value-based care programs. The report called Collaborative and Coordinated: How Value-Based Care Programs are Driving Improvements in Quality and People’s Health began...

Patient Engagement Helps Payers on Affordable Care Act Exchanges

by Vera Gruessner

Many health insurance companies selling health plans through the Affordable Care Act exchanges have been seeing higher and higher rates of financial losses. Some payers such as Aetna, Humana, and UnitedHealth Group have even pulled back from...

Premier Offers Healthcare Policy Improvements for ACOs, Payers

by Vera Gruessner

Earlier this year, the provider alliance organization Premier Inc. announced in a company press release a number of recommendations meant to improve the framework of healthcare policy. The key points meant to improve the creation of healthcare...

Health Payer Solutions for Improving HEDIS Quality Scores

by Vera Gruessner

Payers and providers transitioning to value-based care reimbursement need to commit to meeting and improving their HEDIS quality scores. However, the documentation involved in reporting HEDIS quality scores tends to become complex. Johns...

How Health Payers Could Help Reduce High Out-of-Pocket Costs

by Vera Gruessner

A major problem still impacting consumers within the health insurance market is the potential for seeing high out-of-pocket costs. Many individuals are still underinsured despite the significant decrease in the uninsured rate around the country...

How Payers Could Gain Success in Value-Based Care Models

by Vera Gruessner

Value-based care models are on their way to becoming the main form of reimbursement between payers and providers especially when considering the goals of the Centers for Medicare & Medicaid Services (CMS) to position 50 percent of Medicare...

CMS Cuts Wasteful Medical Spending, FFS Improper Payments

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has reduced the Medicare fee-for-service improper payment rate from last year’s 12.1 percent to 11 percent in 2016, The CMS Blog reports. CMS has dedicated itself in recent years to...

Deductibles, Out-of-Pocket Healthcare Spending Rose 3% in 2015

by Vera Gruessner

Healthcare spending within the private health insurance market has grown 4.6 percent in 2015, according to a press release from the Health Care Cost Institute (HCCI). This type of growth in spending is higher than in recent years. For instance,...

Healthcare Insurance Literacy Vital for Higher Coverage Rate

by Vera Gruessner

New research from the RAND Corporation shows that uninsured Americans who have better healthcare insurance literacy were more likely to purchase coverage when the Affordable Care Act’s health insurance exchanges opened in 2014, according...

Top 5 Ways Commercial Payers Could Boost Consumer Engagement

by Vera Gruessner

Consumer engagement is an important factor that commercial healthcare payers may need to address in order to keep a loyal customer base throughout future open enrollment periods. Some health insurance companies have worked to address consumer...

Care Coordination Vital in Accountable Care Organizations

by Vera Gruessner

Healthcare payers looking to transition to new payment systems and better coordinate care across multiple facilities would benefit from working within accountable care organizations (ACOs). Within ACOs, payment is linked to quality performance...

How Payers Could Use Price Transparency to Boost Satisfaction

by Vera Gruessner

In order to reduce ever rising healthcare costs, health insurance companies will need to improve price transparency among their health plans as well as within their provider networks. The Robert Wood Johnson Foundation released a report showing...

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