Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Health Plan Member Engagement

Strategies for Designing Consumer-Centric Health Plans

November 12, 2018 - The Health Care Transformation Task Force recently released a new set of guiding principles to help healthcare industry leaders and policymakers better integrate consumer needs into benefit design. The goal of the task force, a consortium of leading healthcare payers, providers, purchasers and patient organizations, is to accelerate the industry’s move to...


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Employer-Sponsored Medicare Advantage Enrollment Up 12% for 2019

by Thomas Beaton

Employer-sponsored Medicare Advantage (MA) enrollment for plan year 2019 increased by 12 percent, representing a bump of more than 443,000 individual members, according to a new analysis by Mark Farrah Associates. Individual Medicare...

BCBSAZ Shared Savings Program Reduces Hospital Readmissions by 26%

by Thomas Beaton

BlueCross BlueShield of Arizona’s (BCBSAZ) shared savings program has reduced 30-day hospital readmission rates by 26.3 percent while generating shared savings for providers.. BCBSAZ also reported 15.2 percent fewer ED visits per...

Consumer Demand for High-Deductible Health Plans Dwindles

by Thomas Beaton

Consumer demand for high-deductible health plans (HDHPs) is expected to decline in 2019 as more beneficiaries look for health plans with customized benefits instead, according to a new survey from Oliver Wyman. Half of consumers surveyed...

60% of Employers Fail to Address Healthcare Spending Waste

by Thomas Beaton

Sixty percent of employers don’t capitalize on opportunities to address healthcare spending waste, even though they say wasteful spending is a key concern, according to a new survey from the National Alliance of Healthcare Purchaser...

Venture-Funded Medicare Advantage Plans Launch into 2019 Market

by Thomas Beaton

Several Medicare Advantage (MA) plans entering the market for the 2019 plan year are backed by millions in venture capital funding and are planning to compete with established payers by promoting new health plan solutions. The recent...

Engagement, Data Analytics Cut Opioid Dependency in Managed Care

by Thomas Beaton

AmeriHealth Caritas has successfully reduced opioid dependency rates among managed care beneficiaries through member engagement and data analytics techniques that promote alternatives to opioid treatments. The payer’s Opioid...

Employer Wellness Programs Reduce Costs by Targeting Chronic Diseases

by Thomas Beaton

In order to reduce overall spending, employers should focus on designing wellness programs that target chronic diseases and address other clinical factors impacting employee health, says a new research paper from Transamerica. The...

Physical Therapy, Chiropractic Back Care Cut Opioid Use, Costs

by Thomas Beaton

Payers could improve outcomes, increase cost-effectiveness, and reduce opioid use for lower back pain by expanding non-pharmacological coverage such as physical therapy and chiropractic care, according to a new study published in JAMA...

Insured Critical Illness Beneficiaries Face High Treatment Costs

by Thomas Beaton

Health plan members with critical illnesses face high treatment costs and other financial issues even with comprehensive health insurance, said a new survey conducted by the Harvard T. Chan School of Public Health, New York Times, and...

Administrative Plan Costs for Managed Care Payers Jumped 5.7% in 2017

by Thomas Beaton

Managed care payers experienced a 5.7 percent increase in administrative plan costs in 2017, for items such as staffing and customer service support, according to an analysis from the Sherlock Company. Spikes in Medicaid enrollment...

Medicare Diabetes Prevention Program May Have Cost Concerns

by Thomas Beaton

The Medicare Diabetes Prevention Program (MDPP) may not fully cover provider costs needed to administer classes and other programs to prevent diabetes among Medicare members, says a new report from the University of Colorado (UC) School of...

Medicaid Beneficiaries Face Significant Food Insecurity Challenges

by Thomas Beaton

Medicaid beneficiaries face significant food insecurity challenges and may require additional healthcare programs to reduce food insecurity risks, according to new research from the Root Cause Coalition. Many Medicaid beneficiaries...

CMS Releases 2019 Medicare Advantage Health Plan Star Ratings

by Thomas Beaton

CMS has released its 2019 star ratings for Medicare Advantage (MA) health plans, noting that the Medicare Advantage market continues to grow in affordability and access for consumers. CMS estimates that 74 percent of MA beneficiaries will...

Payers Partner with Trade Orgs to Roll Out Association Health Plans

by Thomas Beaton

Healthcare payers are beginning to launch partnerships with trade organizations and chambers of commerce to provide association health plans (AHPs) to small businesses and contractors. The roll out of AHPs follows federal and state...

How Payers Can Develop a Medication Therapy Management Program

by Thomas Beaton

As the cost of medication non-adherence reaches over $300 billion annually, payers are increasingly challenged to provide new solutions to address the healthcare and economic impacts of non-adherence. Payers could develop a medication...

Cigna’s Digital Diabetes Prevention Program Cuts Costs, Ups Outcomes

by Thomas Beaton

With more than one out of every three Americans living with prediabetes, payers are actively seeking out innovative strategies for preventing progression of the costly and life-changing disease.   Most payers offer clinical benefits...

How Managed Care Payers Can Improve Substance Use Treatment

by Thomas Beaton

Managed care payers can use data analytics, case management strategies, and patient engagement tools to address the needs of high-risk individuals with substance use disorders (SUDs), states a new report from the Association for Community...

Medicare Advantage Premiums to Decrease by 6% in 2019

by Thomas Beaton

CMS officially announced a six-percent decrease in Medicare Advantage premiums in 2019 as the result of MA enrollment, health plan options, and benefits increase. All signs point to the MA marketplace continuing to be a lucrative...

Consumer Engagement Tools Prep Members for Open Enrollment

by Thomas Beaton

Mobile apps, enrollment platforms, and search engines help the majority of consumers prepare for open enrollment and make informed healthcare choices, says a new survey from UnitedHealthcare. Thirty-six percent of consumers said they used...

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