Both private payers and public payers like the Centers for Medicare & Medicaid Services (CMS) have a long road ahead of them in supporting healthcare providers and consumers with the transition to...
Health insurers and consumers can benefit from seeking reference pricing when it comes to choosing specific diagnostic tests among a set of different laboratories. Researchers from the University of...
While the Centers for Medicare & Medicaid Services (CMS) was first to implement bundled payments in one of its many programs meant to renovate provider reimbursement processes, private health...
There is still more work that needs to be done to ensure all American citizens have access to healthcare coverage. The Episcopal Health Foundation and Rice University’s Baker Institute for Public...
The number of employees who have gained healthcare coverage through employer-sponsored health plans has been rising in recent years as the economy recovered and more Americans gained a foothold in the...
Last month, the Center for American Progress (CAP) issued a statement urging the Department of Health & Human Services (HHS) to expand their work in bundled payment programs so that medical costs...
The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of health payers to assess and collect data on the performance of providers. HEDIS consists of a number of...
Accountable care organizations (ACOs) have taken on a larger role in delivering services throughout the continuum of care. Initially, these establishments were created under the Medicare Shared Savings...
In order to ensure that the health insurance exchange successfully reduces healthcare spending, it may be necessary to strengthen consumer engagement and education so that policyholders continually...
Accountable care organizations (ACOs) continue to gain greater acknowledgement within the healthcare industry as the field transitions to value-based care reimbursement and moves away from the...
Health insurance is no longer primarily a business-to-business transaction between payer organizations and employers. Today, payers must be prepared to holistically meet the needs of millions of...
From a health insurance perspective, more analysis needs to be taken into account when attempting to reduce healthcare spending. For instance, health payers may be interested in learning that pharmacy...
Last week, the Centers for Medicare & Medicaid Services (CMS) issued a request for information called Modular Solutions for Medicaid IT Enterprise and Pre-certification of Solutions. Essentially,...
Health payers are often looking for ways to reduce healthcare spending, especially with regard to the costs of covering medical claims. Many have focused on implementing value-based care reimbursement...
Bundled payment models are a form of reimbursement between payers and providers that adheres to an episode of care instead of payment for a particular medical service. This reimbursement system was created to transition healthcare...
While the Patient Protection and Affordable Care Act was passed into law six years ago, there is still plenty of controversy that surrounds this landmark legislation. For instance, the Senate and House...
Consumer choice in health plans and provider networks is becoming a more popular topic of late among payers looking to increase patient engagement. There is a growing movement around the nation aimed...
Is lower healthcare spending truly tied to improved quality of care among hospitals? New research published in Health Affairs begs to differ when it comes to rewarding lower quality hospitals that...
Episode-based bundled payments are becoming a sought-after reimbursement model throughout the healthcare industry. Along with the Centers for Medicare & Medicaid Services and its focus on...
The health insurance industry may have a complete transformation on their hands with regard to hospital and medical practice reimbursement. The number of provider-sponsored health plans is growing...
