Payers that include telehealth and remote care benefits in their health plan options could position themselves as leaders in health plan value, convenience, and innovation.
Health plans are challenged...
The implementation of the Affordable Care Act risk adjustment program has created a number of challenges - as well as some promising opportunities - for payers participating in the ACA marketplaces....
High quality health plan customer service is critical for payers who want to create meaningful, positive beneficiary interactions.
Customer service plays several important roles for health plans....
Payers are constantly challenged to provide their health plan beneficiaries the best possible healthcare experiences, but may have trouble doing that if members experience food insecurity.
Food...
Expanding Medicare Advantage data transparency may allow researchers to gain more comprehensive insights into cost and quality within the popular MA program.
Healthcare experts and academic...
Payers striving to compete in the Medicare Advantage (MA) market can add more value to their health plans by taking advantage of regulatory changes established under a new final rule.
Starting in plan...
The top performing commercial health plans in the US for 2017-18 exceeded expectations for customer satisfaction, preventive care, and outcomes of their beneficiaries, according to the National...
Bundled payment models are a popular reimbursement option for payers because they present an opportunity to improve healthcare quality, lower costs, and participate in value-based agreements with...
2017 was a turbulent year for the Affordable Care Act. Legislative battles in Congress, fluctuating support from healthcare stakeholders, and threats of repeal have left many payers facing an...
All-payer claims databases (APCDs) allow payers, providers, and regulators to analyze claims from millions of beneficiaries to learn where spending is directed and whether or not spending on certain...
Prior authorization may allow payers to limit unnecessary spending on high-cost prescription drugs, but leading provider experts suggest that payers could do more to boost the efficiency of prior...
Payers rely on process and outcome quality measures to communicate healthcare performance to new and current beneficiaries.
Quality measurements such as HEDIS, CMS Star Ratings, and standardized core...
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...
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...
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...
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...
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...
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...
Healthcare provider fraud is extraordinarily common and can be conducted at a shockingly large scale. The largest healthcare provider fraud takedown in US history was announced just recently,...
Payers are spending billions of dollars annually on medications that aren’t improving the health outcomes, with financial and health literacy proving to be the most common barriers to...
