Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Health Insurance Exchange

Anthem-Cigna Health Insurance Merger Suit Starts on November 21

by Vera Gruessner

The lawsuit against the Anthem-Cigna health insurance merger had its first pretrial conference this past Monday, according to The Coalition to Protect Patient Choice. Judge Amy Berman Jackson said that the two parties met to have a discussion...

Health Insurance Exchanges Require Engagement, Narrow Networks

by Vera Gruessner

Since some private health payers are struggling with enrollment and the ability to make a profit on the health insurance exchanges, engaging consumers, reducing the administrative burden, and creating a narrow provider network will become an...

Blue Cross to Expand Value-Based Care Reimbursement in 2017

by Vera Gruessner

The coming years will further position the medical industry including payers to adopt value-based care reimbursement models and new healthcare delivery systems partially due to the reforms that came about from the Patient Protection and Affordable...

How Payers Could Compete in Midst of Health Insurance Mergers

by Vera Gruessner

Among the payers facing a Department of Justice lawsuit against their health insurance mergers, Aetna and Humana have requested sanctions due to the government allegedly delaying the release of documents the two insurers need. The Motion for...

High-Deductible Health Plan Consumers Seek Price Transparency

by Vera Gruessner

Families and individuals who have purchased healthcare coverage on the ACA health insurance exchanges may have seen that monthly premium rates are expected to rise 25 percent in 2017, but should be aware that those eligible for tax subsidies...

Premium Rates on Affordable Care Act Exchanges Rise 25% in 2017

by Vera Gruessner

Monthly premium costs on the Affordable Care Act exchanges is expected to rise an average of 25 percent in 2017, according to a report from the Department of Health & Human Services (HHS). This percentage is based solely on the premiums for...

Private Payers Face Challenges on Health Insurance Exchanges

by Vera Gruessner

The health insurance exchanges created after passage of the Affordable Care Act may not serve as a truly effective marketplace for commercial payers since some national insurers like Aetna and UnitedHealthcare have been dropping out of operating...

How a Public Option May Preserve Health Insurance Exchanges

by Vera Gruessner

Multiple healthcare payers have been struggling with operating successfully on the Affordable Care Act’s health insurance exchanges. Some experts and lawmakers suggest that establishing a public option on the health insurance exchanges...

Revisions to Affordable Care Act May Improve Payer Performance

by Vera Gruessner

Health insurance executives have faced various regulatory challenges since the Patient Protection and Affordable Care Act was passed in 2010. Payers have had to participate in new health insurance marketplaces and face different restrictions...

Health Insurance Marketplaces Call for Plan Standardization

by Vera Gruessner

Healthcare payers are being instructed to offer standardized plan and benefit designs as the  federally facilitated health insurance marketplace is working to improve consumers’ ability to compare varying health plans during the next...

Marketplace Instability May Cause Affordable Care Act Reforms

by Vera Gruessner

While the Patient Protection and Affordable Care Act has decreased uninsurance rates to historically low levels, the healthcare law also led to higher premium costs and insurance rates among health plans sold on the health insurance exchanges....

Why Strengthening Affordable Care Act Could Cut Disparities

by Vera Gruessner

The Patient Protection and Affordable Care Act has significantly improved healthcare coverage and access throughout the country, but there are still some obstacles remaining to ensuring that every American has access to health insurance. While...

Merger Suit Led Aetna to Drop out of Health Insurance Exchanges

by Vera Gruessner

The national health payer Aetna may have chosen to reduce its participation in the Affordable Care Act’s health insurance exchanges due to the Department of Justice’s decision to pursue a lawsuit against the merger between Aetna and...

VT Agency Wrongly Allotted $13M for Health Insurance Marketplace

by Vera Gruessner

The Department of Vermont Health Access went against federal laws when it failed to allocate funds to establishment grants in order to create a public health insurance marketplace, the Office of the Inspector General (OIG) found in a new report....

Lawmakers Push for Public Option on Health Insurance Exchanges

by Vera Gruessner

A total of five senators and multiple organizations are looking to create a public option for healthcare coverage to be available among all Americans purchasing insurance through the Affordable Care Act’s health insurance exchanges. Senators...

CMS Grants Navigators $63M to Boost Health Insurance Marketplace

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced in a press release earlier this week that it will be providing $63 million in grants to both new and older organizations returning to offer health plans through the public health...

Payer Concentration Challenges Health Insurance Exchanges

by Vera Gruessner

More and more research is pointing at the fact that consumers on the health insurance exchanges are being left with fewer health plan issuers. Part of this may be due to health payers such as UnitedHealthcare or Aetna leaving a large percentage...

Affordable Care Act Marketplace Consumers Face Fewer Choices

by Vera Gruessner

A hefty number of health insurance companies have been dropping out of the Affordable Care Act’s state exchanges in recent months including Humana, Aetna, and UnitedHealthcare. These actions would leave fewer health plans to choose from...

7% of Counties Retain One Payer on Health Insurance Exchanges

by Vera Gruessner

With more health payers such as UnitedHealthcare, Humana, and Aetna dropping out of a number of state health insurance exchanges, it is useful to analyze the differences of healthcare coverage between different regions and states around the country....

Public Health Insurance Marketplace Still Benefits Consumers

by Vera Gruessner

The public health insurance marketplace created through the Affordable Care Act (ACA) may have fewer and fewer health plans participating in the coming years since a number of major insurers have dropped out of the exchanges. This would lead...

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