Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Costs

Payers Support Integrated Care Services for NC Medicaid Patients

January 15, 2018 - Payers and provider organizations that support integrated care systems can help lower healthcare costs by addressing the healthcare concerns of vulnerable patient populations, including Medicaid beneficiaries. Several commercial payers have recently announced agreements to work with Community Care of North Carolina (CCNC), a leader in data-driven population health, towards developing integrated...


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Considerations for Designing Consumer-Directed Health Plans

by Thomas Beaton

Employers and health plans are rapidly adopting consumer-directed health plans (CDHPs) as a way to lower benefit costs and encourage cost-effective care utilization among beneficiaries. CDHPs are becoming part of many US employers’ efforts...

Expanding Air Ambulance Service May Help Payers Control Costs

by Thomas Beaton

Expanding air ambulance benefits may help payers lower beneficiary premiums and help beneficiaries avoid several thousand dollars in out-of-pocket healthcare spending. An air ambulance costs between $12,000 to $25,000 per flight to account for...

Wellness, Preventive Care to Drive Employer Health Plans in 2018

by Thomas Beaton

Employer-sponsored health plans are expected to widely embrace value-based purchasing agreements and patient engagement technologies that improve employee wellness programs and preventive care, according to the National Business Group on Health...

Healthcare Insurance Market Profits May Hold Steady in 2018

by Thomas Beaton

Certain segments of the healthcare insurance market, including employer-sponsored insurance and Medicare Advantage (MA), will help to stabilize payer profitability in 2018, predicts a report by A.M. Best. The gains from these sectors are expected...

Member Engagement, Medicare Advantage Growth Top 2018 Payer Trends

by Thomas Beaton

2018 is a year in which payers are likely to implement strategies aimed at improving growth in Medicare Advantage markets, increasing the use of the social determinants of health  to improve outcomes, and expanding member engagement with...

Medicare Advantage Cost Benchmarks Create Plan Inefficiencies

by Thomas Beaton

New research from the Commonwealth Fund found that the Medicare Advantage (MA) benchmark bidding system, which was intended to reduce plan inefficiencies, has allowed health plans to benefit financially while remaining cost inefficient. Since...

CMS Asked to Bolster Value-Based Payment Models for Providers

by Thomas Beaton

The American Academy of Physicians, Aledade, the Texas Medical Association, Iora Health, and the Medical Group Management Association (MGMA) are among provider advocates urging CMS to create more opportunities for providers interested in value-based...

BCBS Ohio Plans for Upping Patient ED Visit Costs Raise Concerns

by Thomas Beaton

BCBS of Ohio plans to charge beneficiaries the total cost of their emergency department visits  if a diagnosis suggests the visit wasn’t emergency-based, a policy which has been met with extensive concern from The American College...

ACA Cost Concerns Offer Payers a Member Engagement Opportunity

by Thomas Beaton

Consumers purchasing health insurance through the ACA exchanges are likely to actively seek out lower-cost options when enrolling or re-enrolling in individual health plans, says new data from GAO, giving payers a chance to practice their member...

Senate Hearing Opens Policy Discussion on Prescription Drug Costs

by Thomas Beaton

At a Senate HELP Committee hearing this month, policy experts and advocacy groups suggested several strategies that could lower prescription drug costs, including removing Medicare Part D cost-sharing, increasing federal oversight of the pharmaceutical...

UnitedHealthcare Assists Phoenix Children’s Value-Based Care Goals

by Thomas Beaton

UnitedHealthcare and Phoenix Children’s Care Network (PCCN) have launched an accountable care program aimed at a lowering costs and improving care quality. UnitedHealthcare will share data with PCCN to inform providers of a patient’s...

Medicare Advantage, Consumer Engagement Top Payer Trends for 2018

by Thomas Beaton

Payers will face a number of industry challenges in 2018, including improving Medicare Advantage (MA) member satisfaction, expanding access to community outreach programs for individuals, and creating more drug pricing transparency for consumers,...

Why Bundled Payments Are a Popular Option for Healthcare Payers

by Thomas Beaton

Bundled payments are ideal for payers that want to participate in value-based care. Bundled payments tend to have lower financial risks than other payment models for payers and are beneficial to providers as well as payers. In a bundled payment...

Member Engagement, Payer Spending Lead Top 10 Stories of 2017

by Thomas Beaton

The 2017 news cycle was a constant flurry of political and financial developments for payers. From the turbulent efforts to repeal and replace the ACA in the House and Senate to challenges with member engagement, population health, and cost cutting,...

Prescription Drug Spending Cuts Require Payer Policy Changes

by Thomas Beaton

The US’s current prescription drug policies require updates that cut prescription drug spending while increasing competition in the market, a new report from the National Academies of Sciences, Engineering, and Medicine (NASEM) found. A...

How Provider-Sponsored Health Plans Can Find Consumer Success

by Thomas Beaton

Provider-sponsored health plans (PSHPs) are seen as a way for provider organizations to compete with commercial payers while lowering their own costs and improving care quality, because provider organizations can manage the cost of healthcare...

Ridesharing Benefit May Help Payers Improve Patient Engagement

by Thomas Beaton

Payers looking to help members overcome negative social determinants of health, such as transportation issues, may be able to offer beneficiaries a ridesharing benefit to improve patient engagement. The emergence of healthcare partnerships and...

Most High-Deductible Health Plan Consumers Lack Financial Management

by Thomas Beaton

Less than half of high-deductible health plan (HDHP) consumers engage in positive financial management tasks such as negotiating costs for healthcare services or saving for future healthcare expenses, says a research letter published in JAMA...

CVS Caremark Provides Real-Time Benefits Data to Pharmacies

by Thomas Beaton

CVS Caremark, the pharmacy benefit manager (PBM) of CVS Health, will provide pharmacies and prescribers with real-time benefits data on patients as a way to reduce payer and patient drug costs, the organization announced in a press release. The...

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