Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Costs

Payers Play Crucial Role in Healthcare Quality Transparency

September 19, 2018 - Payers will need to take the lead in being transparent about healthcare quality and costs in order to improve patient safety and reduce unnecessary spending, experts told the Senate HELP Committee. Payers can take a more proactive role in addressing patient safety and improving healthcare utilization, agreed four policy and provider groups. Expanding public availability of patient...


More Articles

Consumers Struggle with Health Plan Finances, Healthcare Literacy

by Thomas Beaton

The majority of consumers with employer-sponsored health plans lack the necessary financial health literacy to optimally manage their health plan finances, according to a new report from Alegeus. As high-deductible health plans (HDHPs)...

Earning Top Medicare Advantage Ratings Requires Data, Ambitious Goals

by Thomas Beaton

Succeeding in the highly competitive Medicare Advantage (MA) market requires more than just a sense that there are financial gains to be had in this growing health insurance segment. Payers that wish to reap some of the many financial...

Reference Pricing Models for Prescription Drugs May Contain Costs

by Thomas Beaton

Reference pricing models for prescription drugs may help to contain spending and reduce high costs for beneficiaries, says a new report from the Commonwealth Fund. Currently, most payers use tiered drug formularies to manage drug costs,...

Patient-Centered Medical Home Model Saved BCBS of MI $626M

by Thomas Beaton

BlueCross BlueShield of Michigan has reduced expected spending by $626 million over a nine-year period through a patient-centered medical home (PCMH) model that emphasizes personalized care. The payer found that the PCMH increased rates...

Employers Could See High Financial Returns for Mental Healthcare

by Thomas Beaton

More comprehensive coverage for mental healthcare could bring a financial return of four dollars for every one dollar spent by employers, says a report from the National Alliance of Healthcare Purchaser Coalitions (NAHPC). One in five...

Poor Healthcare Literacy Leads to $4.8B in Administrative Costs

by Thomas Beaton

Widespread rates of poor consumer literacy within the healthcare industry creates administrative burdens for payers and contributes to an additional $4.8 billion in health plan costs, according to a new Accenture report. Fifty-two percent...

Cigna Launches $250M Venture Fund for Analytics, Digital Health

by Thomas Beaton

Cigna will invest $250 million in the new Cigna Ventures fund, which will invest in healthcare startups specializing in analytics, digital health, retail, care management, and other business opportunities related to value-based...

MedPAC to Explore if Hospital Consolidation Impacts Medicare Costs

by Thomas Beaton

The House Committee on Energy and Commerce has asked the Medicare Payment Advisory Commission (MedPAC) to investigate whether or not hospital consolidation increases Medicare spending. In a letter to MedPAC, Representatives Greg Walden...

86% of Consumers Blame Insurers for Surprise Healthcare Bills

by Thomas Beaton

Eighty-six percent of health plan beneficiaries primarily blame payers for surprise medical bills, according to a survey from NORC at the University of Chicago, indicating that insurers may wish to improve their financial education...

ACA Health Insurance Tax to Cost $16B, Lead to Higher Premiums

by Thomas Beaton

The Affordable Care Act’s health insurance tax (HIT) is expected to levy $16 billion in fees for health insurers by 2020, leading payers to increase premiums by an anticipated 2.2 percent, according to a Oliver-Wyman report...

How Capitated Payments Prompt Payer, Provider Innovation

by Thomas Beaton

The challenges of lowering care costs and improving healthcare quality may lead payers to consider the use of capitated payments as part of their value-based payment model strategies. Capitated payments are pre-arranged payments for...

Payers See Cost, Quality Gains with Value-Based Payment Models

by Thomas Beaton

Payers and providers participating in value-based payment models are seeing reduced costs and improvements in care quality.   Value-based payment, which is expected to account for 59 percent of all healthcare payments by 2020, helps...

CMS Tells States to Curb Silver-Loading with Off-Exchange Plans

by Thomas Beaton

CMS is asking state insurance departments to offer more off-exchange health plans in order to reduce silver-loading of qualified health plans (QHP). Silver-loading is the practice of raising premiums so that payers can earn larger federal...

Google Invests $375M in Oscar Health for Medicare Advantage

by Thomas Beaton

Google’s parent company, Alphabet, has invested $375 million in Oscar Health to help the tech-focused payer enter into Medicare Advantage markets by 2020, according to multiple news outlets, including Reuters. Oscar Health said in...

Nearly 20% of Employees Have Inpatient Out-of-Network Claims

by Thomas Beaton

Approximately twenty percent of employees with insurance had at least one out-of-network claim for inpatient care, according to a Peterson-Kaiser Tracker analysis. Employees with out-of-network provider bills may experience increased...

Managed Care Accounted for 38% of Medicaid Spending in 2012

by Thomas Beaton

Medicaid managed care accounted for 38 percent of total Medicaid spending in 2012, according to a Congressional Budget Office analysis. The report found that the majority of states in the US have implemented some form of a managed care...

Provider Market Concentration Outweighs Payer Concentration

by Thomas Beaton

Healthcare provider systems tend to be bigger, more consolidated, and have more market share than payers in the same metropolitan areas, leaving some payers with less power to negotiate pricing and other contracts, according to the...

Insurance Coverage Rates Dip by 12% Due to High Premium Costs

by Thomas Beaton

Individual health plan enrollment between 2017 and 2018 fell by 12 percent as high premiums and a scarcity of subsidy assistance force consumers out of the market, according to an analysis from the Kaiser Family Foundation (KFF). Health...

How to Improve Cost Sharing to Enhance Chronic Disease Management

by Thomas Beaton

A tailored cost sharing program that helps beneficiaries pay for chronic disease care can reduce wasteful spending and increase access to chronic disease management services. However, relying on one-size-fits all cost-sharing plans can...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...