Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Consumer Engagement Vital in Health Insurance Exchanges

by Vera Gruessner

The Patient Protection and Affordable Care Act has brought a variety of changes for both insurers and healthcare providers with the establishment of health insurance exchanges holding a top place in reforming reimbursement between payers and...

Risk Adjustment Affects Plans on Health Insurance Exchanges

by Vera Gruessner

The trade association AMGA, which entails a large membership of medical groups and healthcare delivery systems, submitted comments last week to the Centers for Medicare & Medicaid Services (CMS) regarding its proposal to change risk adjustment...

Why Health Insurance Claims Data Needs Medical Device ID

by Vera Gruessner

If health insurance companies truly want to improve patient health outcomes including the quality of care and boost patient safety in an effort to reduce wasteful spending, it may be beneficial for health insurance claims data to include medical...

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...

Insurer Participation in Health Insurance Exchange Decreases

by Vera Gruessner

Health payers around the country may not be faring as well as hoped within the federal health insurance exchange. The Affordable Care Act may have had a negative impact on health insurance companies, as some are experiencing financial loss when...

California Health Insurance Exchange Targets Costly Hospitals

by Vera Gruessner

The health insurance exchange from the state of California has some news to report. The exchange is considering the elimination of hospitals from its network that have shown subpar performance or had reported rising medical costs, according to...

How One Health Payer Partnership Reduced Hospitalizations

by Vera Gruessner

Recently, the health payer Blue Cross and Blue Shield of Illinois (BCBSIL) announced in a press release that it will be extending its partnership with the American Lung Association of the Upper Midwest over the next two years. The specific partnership...

‘The Future is Accountable Care,’ Population Health Management

by Vera Gruessner

Effective population health management remains a key aspect of running a successful accountable care network. As part of a stronger population health management program, the primary care physician’s referral system must be efficient in...

Should Payers Question ACA’s Health Insurance Exchanges?

by Vera Gruessner

The health insurance exchanges have faced some significant challenges and even some questioning among the payer community, especially after the insurer UnitedHealthcare announced at the end of 2015 that it is considering whether to leave the...

52% of Employers Offer High-Deductible Health Insurance Plans

by Vera Gruessner

Despite the fact that the health insurance exchanges and Medicaid expansion opened up more opportunities for Americans to obtain healthcare coverage without being dependent on employment, the health payer industry is still intertwined with the...

Payers Bear Monetary Losses in Health Insurance Exchanges

by Vera Gruessner

Several medical insurance companies have experienced losses and financial troubles within the federal and state health insurance exchanges. UnitedHealth Group, for example, has considered pulling out of the health insurance exchanges starting...

Do Provider Reimbursement Pathways Need Oncologist Perspective?

by Vera Gruessner

When it comes to oncologists following a set protocol for cancer care, should health payers have a say in the type of pathways these physicians need to follow? An opinion piece from JAMA Oncology seems to say otherwise. The issue at hand is that,...

Payers and CMS Seek to Join Accountable Care Organizations

by Vera Gruessner

Healthcare payers seeking to reduce costs of medical services would benefit from partnering with accountable care organizations, which essentially seek high quality care in value-based payment arrangements. With a stronger focus on population...

Why Payers Need Robust Health Information Technology

by Vera Gruessner

Health information technology continues to be an elusive field for the payer industry, as some insurers still have difficulty with adhering to key technological advancements and data security protocols. For example, the health insurer Centene...

Patient Engagement Cuts Healthcare Spending among Payers

by Vera Gruessner

Within both federal and state health insurance exchanges, payers are seeking methods for reducing cost in order to avoid profit loss and dropping out of the exchanges much like UnitedHealthcare’s move away from the marketplace. One method...

Health Insurance Company Couldn’t Lay Claim to Personal Assets

by Vera Gruessner

The health payer industry has seen its share of legal battles when it comes to keeping businesses afloat financially. One particular health insurance company – the National Elevator Industry Health Benefit Plan – paid $120,000 in...

‘Patient Voice’ Missing from Healthcare Spending Conversation

by Vera Gruessner

Chronic disease continues to lead to heavy healthcare spending and health payers have aimed their sights on better understanding methods for preventing and addressing chronic medical conditions. Both private and public payers such as the Medicaid...

How Presidential Nominees May Change World of the Health Payer

by Vera Gruessner

The future of the healthcare industry hangs in the balance as the presidential nominees within the United States have their own plans for how to improve the consumer experience and the world of the health payer. Some of the most transformative...

Why a Competitive Health Insurance Plan Matters to Employees

by Vera Gruessner

It seems that benefits and a health insurance plan majorly influence employment decisions of many Americans. An online survey completed by Harris Poll on behalf of the software company Collective Health shows that more than 75 percent of US citizens...

AAI Asks DOJ to “Just Say No” to Health Insurance Mergers

by Vera Gruessner

The latest news regarding the Aetna-Humana and Anthem-Cigna mergers revolves around a new letter sent to the Department of Justice Antitrust Division by the American Antitrust Institute. The letter states it concerns about the impending mergers...

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