Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Costs

CVS Unveils New Pricing Tool for Pharmacy Benefit Management

by Chuck Green

CVS Health has introduced a new approach to the pricing of pharmacy benefit management services, the company announced. The Guaranteed Net Cost model simplifies the financial arrangements underlying pharmacy benefit management (PBM)...

Consumers Maintaining Positive Health Savings Accounts

by Chuck Green

Today, there are more than 23.4 million health savings accounts (HSAs) across the country, with assets of more than $51 billion, according to the 2018 Midyear Devenir Report. “We are continuing to see a growing market for HSAs, and...

Aetna Joins Healthcare Blockchain Alliance, Pilot Project

by Kyle Murphy, PhD

Not long after closing its deal to be acquired by CVS Health, health payer Aetna has signed on to pilot the use of blockchain technology as part of the Synaptic Health Alliance. In a statement with new fellow participants Ascension, the...

AMA Study Finds Lack of Health Payer Competition Across US

by Kyle Murphy, PhD

Decreased competition in health insurance is likely to do more harm than good, new AMA study concludes. The America Medical Association released its most recent study of health payer competition, and the results fail to indicate the...

Health Payers Contend for Share of SMB Health Insurance Market

by Chuck Green

Changing government regulations and demands for benefits in the small to medium business market is likely to lead to consolidation and place a growing emphasis on creating innovative health plans, according to a recent Edifecs...

High-Deductible Plans Lead Diabetics to Forgo, Delay Treatment

by Chuck Green

Workers with diabetes who switched to high-deductible health plans requiring additional out-of-pocket expenses are more apt to put off necessary check-ups, a new Annals of Internal Medicine study finds. A growing proportion of Americans...

Proposed Rule Seeks Lower Medicare Advantage, Part D Drug Prices

by Kyle Murphy, PhD

CMS has opened comments on a proposed rule with the purpose of lowering the cost of prescription drugs and out-of-pocket expenses under Medicare Part C (Medicare Advantage) and Part D. The proposed rule aligns with the Trump...

AHIP Eyes Solutions to Assist Consumers Shopping for Health Plans

by Chuck Green

American Health Insurance Plans (AHIP) recently issued a dozen solutions aimed at assisting families with an income over 400 percent of the federal poverty level afford comprehensive coverage covering their pre-existing conditions. Last...

Insured Consumers Struggling With Prescription Drug Costs

by Kyle Murphy, PhD

Despite having access to health benefits, 40 percent or more of United States citizens have difficulty affording their prescription drugs. A GoodRx survey of 1,060 respondents about their prescriptions between October 29 and November 2...

Data from Health Plans, PBMs Helps Lower Prescription Drug Costs

by Chuck Green

The health information network Surescripts is using data from both payers and PBMs to give prescribers access to patient-specific and formulary-based benefit and cost information for nearly three-quarters of all covered lives in the...

CMS Demonstrations Target Mental Health Services Under Medicaid

by Chuck Green

Medicaid beneficiaries with serious mental illness (SMI) or serious emotional disturbance (SED) are the targets of recent CMS efforts to improve health outcomes. In a letter to Medicaid directors across the country, the federal agency...

Addressing Healthcare Literacy Key to Health Plans Reducing Costs

by Chuck Green

The inability of consumers to successfully navigate the healthcare system, which costs employers and health plans billions in administrative costs. In a recent article in the Harvard Business Review, members of Accenture’s...

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...

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...

BCBS of TN Defrauded $2M in $2B Telemedicine Insurance Scheme

by Thomas Beaton

BlueCross BlueShield (BCBS) of Tennessee has been named a damaged party after it was defrauded $2 million as part of a larger $2 billion telemedicine insurance scheme, according to the Department of Justice (DOJ). The District Court for...

Spending, Prescription Histories Identify Future High Cost Members

by Thomas Beaton

An individual’s healthcare spending and prescription drug histories are among the most accurate predictors of future high costs, according to a new Society of Actuaries (SOA) report. SOA used claims data collected by the Health Care...

Private Insurance Spending Has Outpaced Public Spending Since 2016

by Thomas Beaton

Private insurance spending has grown faster than Medicare and Medicaid spending since 2016, even though national enrollment has plateaued, says a new report from Altarum. The report suggests that higher per-enrollee spending, plus...

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