Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Costs

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...

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...

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...

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...

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...

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...

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...

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...

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...

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)...

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...

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...

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...

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...

The Pros and Cons of Pharmacy Benefits Managers for Payers

by Thomas Beaton

Prescription drug spending is a billion-dollar problem for the payer industry. While pharmacy benefit managers (PBMs) are often a positive way for payers to manage prescription drug benefits for their members, savings for payers can be...

How Payers Can Improve the Value of Small Business Health Plans

by Thomas Beaton

Payers offering insurance plans for the employer market need to provide flexible benefits and cost-saving strategies that create value for small businesses. Small businesses are an excellent market opportunity for payers because health...

Ensuring High Out-of-Pocket Spending Won’t Lead to Negative Outcomes

by Thomas Beaton

High deductible health plans (HDHPs) are intended to reduce payer and beneficiary spending on healthcare services, but untenable out-of-pocket spending for beneficiaries could lead to patients letting preventable conditions develop into...

Medicare Advantage Consumers Seek New Plans as Risk Scores Rise

by Thomas Beaton

Medicare Advantage (MA) consumers who switch to new health plans may have higher risk scores than beneficiaries who are content with their current options, indicates a Congressional Budget Office (CBO) report.   Payers who are...

Single-Employee Businesses Experience High, Burdensome Premiums

by Thomas Beaton

Single-employee businesses paid an average of $500 per month on premiums, experienced high premium payment growth, and experienced polarizing financial burden based on their premium payment amounts, a new report from JPMorgan & Chase...

Payer Housing Programs Address Social Determinants of Health

by Thomas Beaton

Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services. A new report...

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