Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Costs

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...

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...

NYCHH Triples Denials Recovery from UnitedHealthcare to $40.1M

by Thomas Beaton

NYC Health + Hospitals (NYCHH) has more than tripled the amount the health system is seeking in claims recovery from UnitedHealthcare, from $11.1 million to $40.1 million after a comprehensive case-by-case review of high-profile...

Employers are Experimenting with Innovative Health Plan Designs

by Thomas Beaton

Just under half of employers participating in a survey from the National Business Group on Health (NBGH) are actively experimenting with innovative health plan designs that aim to foster new approaches to care delivery. NBGH found that...

31% of Beneficiaries Face Social Isolation, More Health Risks

by Thomas Beaton

A new survey of Humana’s commercial population has found that almost one-third of members over 65 years old experience social isolation. The survey reveals that payers could benefit by addressing social isolation among their elderly...

Montana Reinsurance Program May Cut Premiums Up to 20%

by Thomas Beaton

Montana is moving ahead with the idea of creating a reinsurance program for the state’s health insurance market.  The program may reduce premiums between 10 and 20 percent, said Governor Steve Bullock and Department of...

Risk Scoring, New Payment Models Can Reduce Medication Non-Adherence

by Thomas Beaton

Adopting new payment models, engaging in targeted risk scoring, and improving prior authorization processes may help payers address medication-non adherence among members with mental health concerns, says a report from the National Council...

Senators Propose Limits on Surprise Healthcare Billing

by Thomas Beaton

A bipartisan group of Senators has introduced legislation that aims to end surprise healthcare billing, a practice which can lead to extremely high out-of-pocket costs for consumers. The Protecting Patients from Surprise Medical Bills Act...

Payers Play Crucial Role in Healthcare Quality Transparency

by Thomas Beaton

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...

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...

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