Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

PA Attorney General Intervenes in UPMC, Highmark Health Dispute

February 15, 2019 - Pennsylvania Attorney General Josh Shapiro has filed a petition in Commonwealth Court to modify the consent decrees that govern the relationship between UPMC and Highmark Health, two of western Pennsylvania’s largest provider and payer entities. The petition asks that the Court implement modifications to protect the public interest by ensuring that UPMC is abiding by its...


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Medicaid Can Increase Hospital Revenue Recovery by $500,000

by Jessica Kent

Hospitals could increase their revenue recovery from Medicare bad debt by as much as ten percent per year by identifying insured patients who are also eligible for Medicaid, according to a recent TransUnion Healthcare analysis....

Senators Request Payer, Provider Data on Surprise Medical Billing

by Jessica Kent

Senators from both sides of the aisle have requested information from providers and payers regarding surprise medical billing. In a recently released letter, Senators Bill Cassidy (R-LA), Michael Bennet (D-CO), Todd Young (R-IN), Tom...

Medicare, Medicaid Best Private Plans for Containing Health Costs

by Jessica Kent

Medicare and Medicaid contain per enrollee health spending growth better than private insurance which likely indicates that recent policies will be key to sustaining this control, revealed a report conducted by the Urban Institute and...

Humana, Aledade Bring Value-Based Care to Medicare Advantage Members

by Jessica Kent

Humana and Aledade have announced a value-based care agreement that will increase access to value-based care for Medicare Advantage members. The partnership will enable physicians in Aledade’s accountable care organizations (ACOs)...

Cigna Value-Based Care Participation Tops 50%, Saving $600M

by Jennifer Bresnick

Cigna has surpassed its goal of having 50 percent of its Medicare and commercial health reimbursements tied to value-based care models in top markets by the end of 2018, the payer announced. Between 2013 and 2017, value-based care...

91% of Physicians Say Prior Authorizations Negatively Impact Care

by Jennifer Bresnick

Prior authorizations (PAs) are causing significant delays in care and adding unsustainably to the administrative burdens of physicians, according to a new survey published by the American Medical Association (AMA). The majority of...

Single Payer, Public Options Become Focus of Healthcare Debate

by Jennifer Bresnick

As the nation starts to turn its politics-weary eyes towards the 2020 election cycle, a new series of healthcare talking points are emerging, particularly from the left-hand side of the ideological spectrum. Terms like “single...

2019 Best in KLAS Taps Payer Price Transparency, Claims Solutions

by Jessica Kent

Change Healthcare, Health Solutions Plus (HSP), and Casenet were among the top-ranked solutions in the 2019 Best in KLAS report for price transparency, payer claims and administration, and payer quality analytics. MedInsight and Activate...

HHS Proposes Eliminating Drug Rebates to Cut Prescription Costs

by Jennifer Bresnick

HHS has announced a proposal that would essentially eliminate the existing drug rebate process and instead encourage direct discounts to patients in an effort to control the costs of prescription drugs. The proposal would exclude drug...

Payers to Focus on Price Transparency, Data Exchange at HIMSS19

by Jessica Kent

Price transparency, data exchange strategies, and the challenges of addressing administrative burdens will be among the key discussion topics for payers at this year’s HIMSS Global Conference and Exhibition in Orlando, Florida. Over...

UPMC, AstraZeneca Enter Value-Based Pharmaceutical Contract

by Jennifer Bresnick

UPMC Health Plan and AstraZeneca are taking on the challenge of a value-based pharmaceutical contract for one of the manufacturer’s cardiovascular medications. Reimbursement for prescriptions of BRILINTA, a drug intended to help...

Apple, Aetna Create Wellness Program Based on Apple Watch

by Jennifer Bresnick

Apple and Aetna, newly acquired by CVS Health, have announced a new collaboration that will offer wearable-based wellness services to members.  The new program, called “Attain,” will leverage the Apple Watch to offer...

Optum Sues Over Alleged Trade Secrets Brought to Amazon

by Jennifer Bresnick

Optum is suing former employee David Smith over allegations that Smith has shared Optum’s trade secrets with his new employer, the as-yet-unnamed collaboration between Amazon, JP Morgan Chase, and Berkshire Hathaway. Optum is...

86% of Payers Fail to Deliver Readable Medicare Communications

by Jennifer Bresnick

Most documents intended for Medicare and Medicare Advantage members do not meet accessibility standards for the average reader, according to a new report from VisibleThread, a text analysis company. More than 86 percent of payers offering...

Bipartisan Bill Suggests Another Health Insurance Tax Delay

by Jennifer Bresnick

Senators from both sides of the aisle have sponsored a bill that would delay implementation of the ACA’s health insurance tax (HIT) once again, this time for two years. The $16 billion tax, designed to be levied on payers, would...

Walmart, CVS Health Agree on PBM Pharmacy Network Rates

by Jennifer Bresnick

Walmart and CVS Health have signed a multi-year agreement to keep Walmart participating in the CVS Caremark pharmacy benefit management (PBM) commercial and Managed Medicaid pharmacy networks. Walmart will continue to offer services to...

CMS Mulls End of Auto-Reenrollment, Silver Loading in ACA Market

by Jennifer Bresnick

CMS has issued its proposed Payment Notice for the 2020 plan year, which contains provisions that would significantly alter the operations and structure of the ACA individual marketplace. Continuing a pattern of using CMS regulatory...

Payer Investment May Improve Delaware Primary Care Access

by Jessica Kent

Payers can expand primary care access in Delaware by progressively increasing primary care spending until it accounts for 12 percent of all healthcare investment, according to a report from Delaware’s Primary Care...

Blue Cross of NC, Major Health Systems Partner for Value-Based Care

by Jennifer Bresnick

Blue Cross and Blue Shield of North Carolina has launched Blue Premier, a new value-based care model that increases accountability for participating providers and their accountable care organizations (ACOs). Beginning in January of 2019,...

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