Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Humana Expands Bundled Payment Model for Medicare Advantage

by Thomas Beaton

Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations. The payer has teamed up with orthopedic specialists to expand its Total Joint...

CVS Health Offers New Tools for Lowering Prescription Drug Costs

by Thomas Beaton

CVS Health has launched new cost-saving initiatives that aim to lower beneficiary prescription drug costs through co-pay adjustments, pricing transparency technology, and increased promotion of generic drugs. The initiatives follow a CVS...

How Payers Address the Nation’s Opioid Crisis, Patient Safety

by Thomas Beaton

Commercial payers leverage community financing and engagement techniques to limit patient safety risks related to the nation’s opioid crisis. Payers find that contributing information to datasets can help stakeholders detect opioid...

Payers Add Preventive Care, Wellness to Holistic Health Solutions

by Thomas Beaton

Payers have developed several initiatives to incorporate preventive care and wellness as part of their larger holistic health solutions. Adding wellness and preventive care can help payers keep their beneficiaries from developing costly...

11.8M Members Bought Health Plans Via Affordable Care Act Exchanges

by Thomas Beaton

Nearly 11.8 million beneficiaries have enrolled or re-enrolled in a health plan through the Affordable Care Act exchanges, reaching close to 2017 enrollment totals (12.2 million) despite federal changes in how the exchanges are funded and...

Rising Medical Costs Created Health Plan Enrollment Shifts in MN

by Thomas Beaton

The Minnesota of Council of Health Plans (MCHP) associated rising beneficiary medical costs in 2017 to irregular health plan enrollment shifts in both the private and public market. The Council said in a press release that a three percent...

BCBS Association: Use Alternative Pain Therapies Before Opioids

by Thomas Beaton

The BlueCross BlueShield Association (BCBSA) has announced a new professional standard that removes opioid prescriptions as a primary pain treatment in a majority of clinical situations. The payer’s National Council of Physician and...

Rumors Swirl of Possible Walmart Acquisition of Humana

by Jennifer Bresnick

Walmart may be making a move to acquire Humana, one of the nation’s biggest health payers, according to The Wall Street Journal. Citing sources familiar with the matter – but without comment from Humana or Walmart – the...

CVS, Aetna Merger May Face Antitrust, Consumer Protection Issues

by Thomas Beaton

The American Antitrust Institute (AAI) has warned the Department of Justice (DoJ) that the proposed CVS and Aetna merger would violate consumer protections and damage competition in the healthcare industry. AAI believes that the merger of...

Payers Form Coalition to Address Social Determinants of Health

by Thomas Beaton

A group of commercial payers and other healthcare organizations have formed a coalition to explore how addressing the social determinants of health can lower care costs and improve outcomes. A number of large payer companies have joined...

Humana Bold Goal Targets Members’ Social Determinants of Health

by Thomas Beaton

Humana is improving the overall physical and mental health of its Medicare members by addressing social determinants of health and targeting problematic community health behaviors under its Bold Goal initiative. The Bold Goal 2018...

Policy, Market Changes May Harm Employer-Sponsored Insurance

by Thomas Beaton

Significant changes to the employer-sponsored insurance market, such as increasing medical costs, policy changes, and improvements in other payer markets may cause employers to stop providing health insurance An analysis from the American...

Urgent Care Center Utilization Skyrocketed by 1725% in Last Decade

by Thomas Beaton

Healthcare payers saw urgent care center utilization grow by 1725 percent from 2007 to 2016, indicating that urgent care may the one of the fastest-growing choices for receiving healthcare. A white paper from FAIR Health found that...

BCBS of MI Launches Bundled Payments for Hip, Knee Replacements

by Thomas Beaton

BlueCross BlueShield of Michigan has launched a pilot program that will use bundled payments for knee and hip replacements in order to manage costs and improve member outcomes. BCBS data estimates that knee and hip replacements can cost...

Member Engagement is Key for High-Deductible Health Plan Success

by Thomas Beaton

Payers and employers who offer high-deductible health plans (HDHPs) to attract low-cost members may need member engagement strategies to generate higher value for these beneficiaries. Member engagement is critical for HDHP success because...

Payers Enter New Value-Based Care Agreements with Providers

by Thomas Beaton

Commercial payers including Aetna, Cigna, and Tufts Health are launching new value-based care agreements with providers to reduce healthcare costs and increase care quality for beneficiaries. Many payers are acting on the need to...

Prior Authorization Issues Contribute to 92% of Care Delays

by Thomas Beaton

Prior authorization issues are associated with 92 percent of care delays and may contribute to patient safety concerns as well as administrative inefficiencies, according to a new survey from AMA. Payers should work to change their prior...

Payment Cuts Drive Medicare Advantage Plans to Contain Costs

by Thomas Beaton

Medicare Advantage (MA) plans contained beneficiary costs and remained profitable despite reductions to federal MA payments from 2009 to 2014, according to new research from the Commonwealth Fund. The report found that as Medicare reduced...

Patient, Provider Engagement Drives High Health Plan Performance

by Thomas Beaton

Health plan performance, and how to improve it, is always an issue at the forefront of payers’ minds.  While payers have engaged in several strategies in the past aimed at improving clinical quality, reducing costs, and boosting...

BCBS Launches Institute to Address Social Determinants of Health

by Thomas Beaton

The BlueCross BlueShield Association has created a new subsidiary called the BlueCross BlueShield Institute to help identify and address the social determinants of health (SDOH) for its beneficiaries. BCBS credits the Institute as the...

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