Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Single-Employee Businesses Experience High, Burdensome Premiums

November 16, 2017 - Single-employee businesses paid an average of $500 per month on premiums, experienced high premium payment growth, and experienced polarizing financial burden based on their premium payment amounts, a new report from JPMorgan & Chase reveals. Single-employee health insurance premium payments (HIPP) grew at an average of 8.3 percent in 2016, while multiple employee-sponsored (20 or more...


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Humana Adds Former ONC Chief Karen DeSalvo as Board Member

by Thomas Beaton

Former National Coordinator for Health IT and Assistant HHS Secretary Karen DeSalvo, will join Humana’s board of directors, the payer announced in a press release. Humana believes that the addition of DeSalvo to the board will improve its...

Payer Housing Programs Address Social Determinants of Health

by Thomas Beaton

Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services. A new report from the...

Value-Based Care Outperforms Fee-for-Service Health Plans

by Thomas Beaton

Health plans that include value-based care (VBC) principles are more cost-effective than fee-for-service (FFS) options and are starting to produce better patient outcomes, Humana asserts in a new report. The total healthcare costs associated...

11 Healthcare Payers to Enhance Substance Use Treatment Access

by Thomas Beaton

Executives from 11 healthcare payers have pledged to enhance substance use disorder (SUD) treatment access and offer provider incentives to more effectively address opioid misuse and other substance use issues. In a joint letter, payer executives...

44% of Employees Don’t Know Value of Health Plan Benefits

by Thomas Beaton

Employers must increase their efforts to educate members about the value of their health plan benefits based on recent findings that only 44 percent of employees fully comprehend their benefits. That is the leading takeaway from research published...

Payer Strategies for Improving Member Medication Adherence Rates

by Thomas Beaton

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 adherence. Avoidable healthcare spending totaling between...

Top 4 Consumer Wellness Benefits for Payers to Add to Health Plans

by Thomas Beaton

As payers explore innovative ways to improve beneficiary engagement and satisfaction, they may wish to consider adding enhanced consumer wellness benefits to their health plan offerings. Health plans that take a proactive approach to engaging...

More Choices for Federal Health Plans Doesn’t Spread Market Share

by Thomas Beaton

The federal health plan market contracted under the Office of Personnel Management (OPM) has remained heavily concentrated over the last decade, despite OPM’s efforts to improve health plan choice for employees enrolled in the Federal Employees...

CMS Adjusts Medicaid 1115 State Innovation Waiver Processes

by Thomas Beaton

CMS is attempting to streamline the approval process for Medicaid 1115 state innovation waivers by implementing new policies that prioritize transparency, the agency announced in a bulletin. The agency has adjusted 1115 waiver policies in an...

Why the Generic Drug Market is a Growing Payer Opportunity

by Thomas Beaton

As payers try to ease the rising costs of prescription drugs, which account for 10 percent of national healthcare spending, they may wish to turn to the generic drug market to help curb unnecessary spending and improve profitability.   Generics...

Improving Price Transparency around Generic Drugs for Payers

by Thomas Beaton

Increasing pricing transparency around generic drugs could offer significant advantages to payers, including lower prices and more favorable reimbursement negotiations, according to a report from USC Brookings. Better understanding of contracting...

Reinsurance Changes Payers Can Expect Under the ACA in 2018

by Thomas Beaton

ACA federal reinsurance policies have undergone a transformation since their introduction from four years ago. Payers should continue to prepare for larger changes of federal and state ACA reinsurance in 2018. Reinsurance programs have gone from...

Emergency Response Devices Add Value to Medicare Advantage Plan

by Thomas Beaton

Anthem BlueCross BlueShield plans to add value onto consumer Medicare Advantage (MA) plans by offering personal emergency response systems (PERS) to beneficiaries, the payer announced in a series of press releases. MA beneficiaries in several...

3 Value-Based Pharmaceutical Contracting Options for Payers

by Thomas Beaton

Value-based pharmaceutical contracting offers health payers the option to lower drug prices while improving patient outcomes. These contracts come in several different forms, according to Dr. Surya Singh, Chief Medical Officer of CVS Specialty,...

ACA Open Enrollment Rate Expected to Drop Up to 13% in 2018

by Thomas Beaton

Analysts expect up to a 13 percent drop in open enrollment on the ACA marketplace exchange in 2018,  according to Standard and Poor’s Global (S&P Global). Only 10.1 million to 11.4 million individuals are expected in enroll in...

AHIP Launches Initiative To Combat Nationwide Opioid Crisis

by Thomas Beaton

AHIP launched the Safe, Transparent Opioid Prescribing (STOP) Initiative to support health plans’ widespread adoption of clinical guidelines for pain care and opioid prescribing, and combat the national opioid crisis, the organization announced...

How the Medicare Advantage Market Can Offer Payer Opportunities

by Thomas Beaton

Medicare Advantage (MA) market data from A.M Best and the Kaiser Family Foundation reveals that the MA market has remained profitable and provides financial opportunity, but payers looking to enter into the market should expect to address developing...

Providers Seeing Even Mix of Public, Commercially Insured Patients

by Thomas Beaton

Providers are seeing a fairly even mix of Medicare, Medicaid, and commercially insured patients with fewer uninsured individuals than before the ACA, according to the AMA’s Physician Practice Benchmark Survey. In 2016, forty-three percent...

Before CSR Cuts, ACA Health Plans Expected Stable Premiums

by Thomas Beaton

(CSRs) under the Affordable Care Act, payers were expecting only modest premium increases and some continued profitability, according to a USC Brookings report. However, the uncertainty resulting from federal waffling over the continuation of...

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