Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

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...

Will Health Insurance Exchange Remain Intact Despite Hurdles?

by Vera Gruessner

What will happen to the health insurance exchange created by the Patient Protection and Affordable Care Act? Will it continue on as originally planned by the Obama administration? Or will new legislation and the decisions of insurance companies...

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...

Could New Legislation Stop the Hikes in Generic Drug Prices?

by Vera Gruessner

When it comes to containing healthcare costs, one of the biggest culprits of rising prices is the pharmaceutical industry, which has recently exhibited spikes in generic drug prices, according to a press release from the Healthcare Supply Chain...

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...

Medical Loss Ratio Provision Led to $2.4 Billion in Rebates

by Vera Gruessner

A new report shows that consumers have received more than $2.4 billion in premium rebates since 2011 because of the passage of the Patient Protection and Affordable Care Act. The Medical Loss Ratio provision under the Affordable Care Act gives...

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...

How Value-Based Care Payment Models Could Reduce Costs

by Vera Gruessner

Did you know that 8 million people gained private insurance through the health insurance exchange and 3 million young adults gained coverage since the Affordable Care Act was passed? In recent years, the health insurance market and the medical...

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...

Does Blocking State Medicaid Expansion Create a Coverage Gap?

by Vera Gruessner

The most recent data on state Medicaid expansion shows that a total of 20 states are declining to broaden Medicaid coverage among those living below poverty level. One of the provisions under the Patient Protection and Affordable Care Act meant...

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...

Top 3 Ways to Reduce Healthcare Spending Across Industry

by Vera Gruessner

What new innovations and healthcare reforms are making a real benefit to cutting unnecessary healthcare spending associated with duplicative tests, hospital-acquired infections, and medical errors? While there are a wide number of transformations...

Maryland’s All-Payer Model Shows Promising First Year Results

by Vera Gruessner

Last week, the Department of Health and Human Services (HHS) announced the state of Maryland’s first year results from its All-Payer Model. Maryland has implemented a global budget payment system in which insurers are required to pay hospitals...

Medicare Shared Savings Program Seeks High ACO Performance

by Vera Gruessner

As part of the Patient Protection and Affordable Care Act, goals of improving the quality of healthcare services and reducing costs led to the creation of Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program. Both quality...

How MACRA Affects Future of Healthcare Payment Models

by Vera Gruessner

Earlier this year, the federal government repealed the Medicare Sustainable Growth Rate (SGR) Formula, which affected the future of healthcare payment models all across the board. Recently, the Centers for Medicare & Medicaid Services (CMS)...

Accountable Care Organizations, Technology Cut Medical Costs

by Vera Gruessner

The healthcare system has a multitude of gaps that cause spending to continue rising without an effective method to reign in these high costs. For example, a major problem has been ongoing redundant tests and unnecessary, expensive procedures...

OPA Report Cards Let CA Healthcare Consumers Compare Choices

by Jacqueline DiChiara

The California Office of the Patient Advocate (OPA) has released the latest edition of online quality Report Cards intended to help healthcare consumers better compare care quality with the mere click of a mouse or finger swipe across a mobile...

What to Consider During Medicare Open Enrollment Period

by Vera Gruessner

Health payers and consumers need to be aware that the Medicare open enrollment period begins this week on Thursday, October 15. This means that individuals aged 65 years old and older who have health insurance through Medicare will have the chance...

Poor Consumer Decision-Making in Health Insurance Marketplace

by Vera Gruessner

The health insurance exchange set up by more recent healthcare reforms including the Affordable Care Act was established in order to give consumers more choice in their medical coverage options. This was essentially expected to provide more competition...

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