Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

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...

85% of People with Expensive Copays Prefer Email Communication

by Vera Gruessner

One study stemming from Kaiser Permanente and published in The American Journal of Managed Care illustrated that one-third of patients who use email communication as their primary method of contacting their doctor reported better health. The...

20% of Insured Americans Struggle with Paying Medical Bills

by Vera Gruessner

A new report from Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation (EHF) shows that 3.8 percent fewer Texans found problems paying their medical bills in September 2015 when compared to the results...

America’s Health Insurance Plans Loses Aetna Membership

by Vera Gruessner

The major health payer Aetna has recently withdrawn its membership from one of the nation’s largest insurance lobbying group America’s Health Insurance Plans (AHIP). The lobbying group is now under new leadership. Former administrator...

Top 4 Factors Necessary for Bundled Payment Model Contract

by Vera Gruessner

In today’s healthcare climate, payers are working to develop value-based reimbursement contracts with their provider network. Lately, payer and provider contract negotiations are often based around alternative payment methods such as the...

Top 4 Predictions for Healthcare Payer Industry in 2016

by Vera Gruessner

As the year comes to a close, while many are off to celebrate the holidays, those within the healthcare payer industry would be wise to look ahead to the New Year and prepare for the coming trends and challenges of 2016. Below we outline four...

Blue Shield, Accountable Care Organization Saved $325 Million

by Vera Gruessner

In recent years, there has been plenty of concern about whether or not Accountable Care Organizations (ACOs) bring significant cost savings to the healthcare industry. However, one health payer and ACO have proven that it is possible to make...

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...

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...

Data Sharing Among Payers Advances Population Health Management

by Vera Gruessner

When it comes to data collection and data sharing, payers should inform beneficiaries exactly how their information is used such as public health reporting requirements or among healthcare providers. The federal government offers a background...

Altering Accountable Care Organizations May Bring More Success

by Vera Gruessner

Despite the fact that Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program was supposed to put a dent in the rising healthcare costs around the country, the latest results show that both in 2013 and 2014, only about 25...

Top 4 Policy Changes Affecting the Health Payer Market in 2015

by Vera Gruessner

The last year has had a huge impact on the health payer market as well as the entire healthcare industry from providers and educational institutions to the federal government and the patient community. Below we will outline the top four policy...

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