Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Insurance

Payers Leaving Affordable Care Act Insurance Exchanges in 2017

June 9, 2017 - Questions over the future of the Affordable Care Act (ACA) and its cost-sharing reduction (CSR) payments have prompted many payers to abandon ACA state health insurance exchanges in part or entirely in 2017.  Insurers cited the usual suspects as reasons for their marketplace withdrawal, which will take effect in 2018: regulatory instability, lower-than-expected enrollment numbers, large...


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BCBS Georgia Plan to Charge for Unnecessary ER Visits Draws Ire

by Jesse Migneault

Blue Cross of Georgia is facing criticism from the American College of Emergency Physicians (ACEP) for a policy directive that would charge members for emergency department visits that result in a non-emergency diagnosis. The policy, which Blue...

Single-Payer Healthcare Plan May Cost California $400 Billion

by Jesse Migneault

California’s proposed single-payer healthcare system would come with a $400 billion price tag, says a report from the state Senate on bill SB 562. The goal of the universal healthcare bill is two-fold: to tackle the issue of runaway premiums...

Kaiser Permanente Will Stay in ACA Health Insurance Exchange

by Jesse Migneault

Kaiser Permanente will continue to offer coverage options through the ACA health insurance exchanges during 2018, the payer and provider announced this week. “Kaiser Permanente will continue to offer coverage -- including access to our...

CMS Offers Resources for High-Risk Pools, Reinsurance Waivers

by Jesse Migneault

The Centers for Medicare and Medicaid Services (CMS) has just released a checklist for states to use on applications for Section 1332 waivers.    The waivers are specifically targeted at helping states establish high-risk pools...

AHIP Sees 28% Increase in Medigap Enrollment Among Seniors

by Jesse Migneault

AHIP has released data showing that enrollment in the Medicare Supplement, Medigap, has seen a steady increase from 2014 to December 2015.   The data represents statistics from 11.8 million enrollees with policies from 305 separate...

Medicaid Expansion Boosts Coverage, Quality at Health Centers

by Jacqueline Belliveau

Federally funded health centers in states that underwent Medicaid expansion through the Affordable Care Act faced higher levels of insured patients and improved care quality compared to their peers in non-expansion states, a recent Health Affairs...

ACA Health Insurance Exchanges Bring Challenges for 2017

by Vera Gruessner

The Affordable Care Act (ACA) health insurance exchanges will have some key differences next year. Health insurance companies have faced various obstacles when selling health plans through the exchanges. These challenges include a higher risk...

How a Public Option May Preserve Health Insurance Exchanges

by Vera Gruessner

Multiple healthcare payers have been struggling with operating successfully on the Affordable Care Act’s health insurance exchanges. Some experts and lawmakers suggest that establishing a public option on the health insurance exchanges...

Health Insurance Acquisitions Impede Competition in 24 States

by Vera Gruessner

The American Medical Association (AMA) announced today in a press release the results of a new study show that the health insurance acquisitions between Anthem-Cigna and Aetna-Humana would obstruct competition in the health insurance market throughout...

4 Motives Why Hospitals Adopt Provider-Sponsored Health Plans

by Vera Gruessner

Due to the many new transformations taking place within the healthcare industry today such as the transition from fee-for-service reimbursement to value-based care payments, the potential for creating provider-sponsored health plans has grown...

How the Affordable Care Act Impacts First Quarter Earnings

by Vera Gruessner

The health insurance industry has had a topsy turvy time learning how to function effectively in the new landscape the Affordable Care Act has brought to the medical field. When it comes to the financial well-being of top payers, the Affordable...

Is Rising US Healthcare Spending Burdening the Economy?

by Vera Gruessner

Is healthcare spending in the United States too high? Are the financial aspects of running the medical system around the country burdening the US economy? The National Center for Policy Analysis insists that the viewpoint claiming that healthcare...

Why Payers Should Improve Cost Transparency for Consumers

by Vera Gruessner

The health insurance industry could benefit from greater cost transparency, as it could bring new methods for lowering healthcare spending and create a more competitive market among providers. Federal and state regulators aiming at reducing healthcare...

Consumer Education Key for Health Insurance Marketplace Success

by Vera Gruessner

It seems that those residing in Texas who have purchased their healthcare coverage through the health insurance marketplace do not have as much understanding of certain terms as those who have medical insurance through their employer or via Medicaid...

How the Affordable Care Act has Impacted Health Payers

by Vera Gruessner

The Affordable Care Act has  brought a significant reform toward the health insurance industry. This particular legislation has given the majority of American people healthcare coverage, which has put greater strain on health insurers. For...

Could Electronic Processing Reduce Medical Spending Rates?

by Vera Gruessner

The US healthcare system is one of the most expensive around the world and the rising costs haven't diminished significantly in recent years. Today, health payers and providers have been working together to reduce medical spending around...

Plan Member Satisfaction Reduced in Less Competitive Markets

by Vera Gruessner

Due to the value-based care initiatives taking place at the Centers of Medicare and Medicaid Services (CMS), patient engagement and patient satisfaction have become imperative for the health payer industry. A report from J.D. Power called the...

How Data, Value-Based Care Drives Down Health Insurance Costs

by Vera Gruessner

In today’s world, the average employee and business owner are seeing a rise in health insurance costs. Even through the health insurance exchange, premium prices are expected to rise this year while high-deductible plans are becoming more...

Bundled Payment Models Need to Align Payer, Provider Incentives

by Vera Gruessner

Bundled payment models are growing in popularity throughout the health insurance industry partially due to the Centers for Medicare & Medicaid Services (CMS) pushing forth alternative payment structures as well as the general goal of reducing...

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