Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Cigna Files with SEC to Begin $67B Express Scripts Acquisition

by Thomas Beaton

Cigna has submitted a filing to the Securities and Exchange Commission (SEC) to complete a $67 billion acquisition of the pharmacy benefit manager (PBM) Express Scripts. The payer filed the merger agreement under a temporary parent...

Adding Telehealth, Remote Care Benefits into Health Plan Options

by Thomas Beaton

Payers that include telehealth and remote care benefits in their health plan options could position themselves as leaders in health plan value, convenience, and innovation. Health plans are challenged to improve customer service and...

More Competition May Benefit Medicare Advantage Bidding Process

by Thomas Beaton

The Medicare Advantage (MA) bidding process requires more competition to increase the availability of high quality MA plans for beneficiaries and reduce federal spending, according to a new Brookings Institute report. Brookings analysts...

Commercial Health Plan Customer Satisfaction Remains Steady

by Thomas Beaton

Commercial health plan customer satisfaction rates remained stable from 2017 to 2018, but payers still have a number of opportunities to improve their customer service and beneficiary education, according to a new JD Power consumer...

CMS Increases Payments for Durable Medical Equipment

by Thomas Beaton

CMS has issued an interim final rule that raises Medicare payments for durable medical equipment (DME) to ensure Medicare beneficiaries have access to critical medical devices. The rule will raise DME payments to Medicare providers from...

Improving Health Plan Customer Service Through Technology

by Thomas Beaton

High quality health plan customer service is critical for payers who want to create meaningful, positive beneficiary interactions. Customer service plays several important roles for health plans.  In addition to the stand-alone goal...

How Payers Can Address Food Insecurity among Plan Beneficiaries

by Thomas Beaton

Payers are constantly challenged to provide their health plan beneficiaries the best possible healthcare experiences, but may have trouble doing that if members experience food insecurity. Food security is just one lifestyle need that...

Harvard Pilgrim, Partners HealthCare Discuss Possible Merger

by Thomas Beaton

Harvard Pilgrim and Partners HealthCare are engaging in discussion of a possible merger.  A deal would combine Massachusetts’s largest payer organization with the state’s largest provider group and may create a dominant...

Supplemental Insurance is a Value-Add Opportunity for Employers

by Thomas Beaton

Employers may have a prime opportunity to add value to their health plan options by offering supplemental insurance, according to a recent AHIP survey. The survey found that 95 percent of employees are satisfied with supplemental plan...

How Payers Can Effectively Scale Value-Based Care Networks

by Thomas Beaton

Value-based care networks are a promising opportunity for payers that want to manage costs and improve outcomes of beneficiaries.  But effectively scaling collaborative, risk-based reimbursement networks for millions of beneficiaries...

Uninsured Rate among Working Adults Rises to 15.5% in 2018

by Thomas Beaton

The uninsured rate of working adults ages 19 to 64 rose by more than 3 percent between 2016 and 2018, according to the Commonwealth Fund’s ACA Tracking Survey. In 2016, 12.2 percent of working adults lacked health insurance....

CMS Proposes Value-Based Payment for Skilled Nursing Facilities

by Thomas Beaton

CMS has proposed to implement value-based payment reforms for skilled nursing facilities (SNFs) and other Medicare inpatient facilities in order to reduce fraud and create higher quality healthcare experiences for beneficiaries. The...

Payers, Orgs Provide Feedback on CMS Value-Based Care Reform

by Thomas Beaton

CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider accountability, chronic disease management,...

How Payers Address Deep-Rooted Social Determinants of Health

by Thomas Beaton

The social determinants of health (SDOH) have gained traction in payer discussions and are driving payers to take a thoughtful look into factors that create long-lasting effects on healthcare costs and outcomes. Payers recently have...

Senate Bill Proposes Medicare Health Plan for All Ages

by Thomas Beaton

Senator Jeff Merkley (D-OR), with sponsorship from 11 other Democrats, has introduced a bill to create a Medicare health plan for all ages that would be offered in state and federal health exchanges, as well as the employer-sponsored...

Humana Launches Bundled Payment Model for Maternity Care

by Thomas Beaton

Humana has launched a bundled payment model to improve outcomes and lower costs of maternity by partnering with OBG-YNs across the country. Humana’s Maternity Episode-Based Model bundles payments that covers the cost of a...

HHS Must Address Adverse Selection in Medicaid, Medicare Renal Care

by Thomas Beaton

AHIP is urging HHS secretary Alex Azar to address adverse selection related to Medicaid or Medicare end stage renal disease (ESRD) in order to ensure that vulnerable beneficiaries continue to receive appropriate healthcare services. AHIP...

AMA Promotes Alternative Payment Model for Opioid-Use Disorder

by Thomas Beaton

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) have announced plans to promote an alternative payment model to address opioid use disorder. Leaders at ASAM and AMA are encouraging payer and...

How Payers Can Add More Value to Medicare Advantage Health Plans

by Thomas Beaton

Payers striving to compete in the Medicare Advantage (MA) market can add more value to their health plans by taking advantage of regulatory changes established under a new final rule. Starting in plan year 2019, payers can offer a greater...

High-Deductible Health Plan, HSA Enrollment Reached 21M in 2017

by Thomas Beaton

High-deductible health plan (HDHP) and health savings account (HSA) enrollment reached 21 million members in 2017, according to new research from AHIP.  These health plan options are expected to see continued growth in the near...

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