Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Insurance

Why are Bundled Payment Systems Difficult to Adopt?

by Vera Gruessner

While bundled payment systems have been advocated as a means to reduce the costs of medical care by the Centers for Medicare & Medicaid Services (CMS), many health insurers and providers are still stuck on fee-for-service payment models....

How Care Management Strategies Could Reduce Medical Costs

by Vera Gruessner

When it comes to managing the treatment and financial implications of complex medical conditions, health payers and providers will need to work together and have effective cross-industry communication. A strong relationship between payers and...

New Framework for MACRA’s Alternative Payment Models Released

by Vera Gruessner

Earlier this year, the federal government passed the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), which reforms the Medicare program by abolishing the Sustainable Growth Rate (SGR) formula, developing a more effective value-based...

75% of Providers Drop Out of CMS Bundled Payments Model

by Vera Gruessner

The Innovation Center belonging to the Centers for Medicare & Medicaid Services (CMS) created the Bundled Payments for Care Improvement (BPCI) program, which consists of setting aside a previously agreed-upon set of funds for several healthcare...

Value-based Care, Member Incentives May be Payers’ ‘Holy Grail’

by Vera Gruessner

The healthcare payer industry is expected to change drastically over the coming years as more insurance companies adopt new business models and focus on value-based care. Moving away from fee-for-service, federal agencies and many payers are...

2016 Premiums on Health Insurance Exchanges Expected to Soar

by Vera Gruessner

Health payers managing plans through the state health insurance exchanges will need to work toward maintaining superior customer relations due to the rise in premium costs expected in 2016. The Robert Wood Johnson Foundation released datasets...

CMS Stresses Informed Decision-Making in Performance Reports

by Vera Gruessner

Since the Affordable Care Act was initially created, the Centers for Medicare & Medicaid Services (CMS) have been focused on improving informed decision-making among payers, providers, the patient community, and other stakeholders. CMS announced...

Value-based Payment Models Pose Challenge to Physicians

by Vera Gruessner

In HealthEdge’s State of the Payer Industry Survey, more than 80 percent of polled health payers are planning to support value-based payment models over the next three years. Additionally, nearly 77 percent of health plans are looking to...

Mergers in Health Insurance Market Don’t Pose ‘Pure Monopoly’

by Vera Gruessner

In recent months, four major players in the health insurance market have come together to form two separate mergers. The Aetna-Humana and Anthem-Cigna mergers have caused significant uproar among medical organizations that fear such a consolidation...

How Payers Can Improve Websites of Health Insurance Exchanges

by Vera Gruessner

In order to better serve their customer base, state health insurance exchanges along with the federal website HealthCare.gov could take a number of steps to improve their web pages and expedite the purchasing of health insurance plans. The Clear...

AMA, AHA Find Health Insurance Mergers Harmful to Consumers

by Vera Gruessner

Many stakeholders are concerned about the potential implications of the Aetna and Humana acquisition along with the Anthem and Cigna merger. Having the top five major health insurers merge into only three payers could block access to affordable...

Vermont’s All-payer Model May Curb Rising Healthcare Costs

by Vera Gruessner

While healthcare reform has been taking place on a national level over the last several years, the state of Vermont is in the process of undergoing its own transformation within the medical industry through a new statewide all-payer model. The...

Health Insurance Mergers Expected to Bring Payer Concentration

by Vera Gruessner

The health insurance industry is experiencing some significant transformations not only due to new policies under the Patient Protection and Affordable Care Act but also because of upcoming health insurance mergers among the nation’s top...

How Physician Home Care Lowers ER Visits and Healthcare Costs

by Vera Gruessner

A common healthcare service provided to many patients with chronic medical conditions is the typical checkup from a visiting home nurse. One medical company called Heal is giving patients a step up from the nurse visit. Heal provides physician...

Top 3 Ways to Meet HEDIS Quality Measures, Improve Performance

by Vera Gruessner

The entire healthcare industry benefits greatly from the quality measurement programs including the Healthcare Effectiveness Data and Information Set (HEDIS) tools developed by the National Committee for Quality Assurance (NCQA). The HEDIS quality...

How Consumer Engagement Brings Better Coverage Decision-Making

by Vera Gruessner

Consumer engagement and awareness is key when payers aim to raise their enrollment rates before the enrollment period rolls around. First, it is vital to improve the health literacy of the everyday consumer so that these individuals understand...

State Health Insurance Exchanges Face Many Challenges

by Vera Gruessner

The creation of health insurance exchanges throughout individual states after the passage of the Affordable Care Act has not been an easy process. Many state health insurance exchanges have experienced a variety of challenges over the last few...

How to Create a Useful Contract for Bundled Payment System

by Vera Gruessner

In 2013, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced that 450 medical providers will take part in a Bundled Payments for Care Improvement initiative. However, more recent results show that healthcare providers...

Insurance Mergers and Acquisitions May Increase Premiums

by Vera Gruessner

Mergers and acquisitions are popping up all over the healthcare industry from drug makers and hospital systems to health insurers. The year 2015 has been a beehive of activity for the consolidation of a large number of medical companies. The...

Aetna’s Humana Acquisition Bringing Strong Opposition

by Vera Gruessner

The complications between the free market of the health insurance industry tied with increasingly complex federal mandates over the last several years is coming to a head with the Humana acquisition by the insurer Aetna. According to a press...

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