Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Value-Based Care Key to Bipartisan Healthcare System Reform

by Thomas Beaton

A group of five governors developed a bipartisan plan to reform the US healthcare system by using value-based care strategies such as quality reporting, insurance stabilization policies, and encouraging consumers to have a more proactive...

Aetna Highlights Emerging Drivers of Value-Based Care

by Thomas Beaton

Payer-provider collaboration, holistic healthcare approaches that address the social determinants of health (SDOH), and the use of health IT tools will be among the most important drivers of value-based care, Aetna says in a new report....

Apple to Launch Healthcare, Wellness Clinics for Employees

by Thomas Beaton

Apple is launching a new healthcare venture, called AC Wellness, that will deliver healthcare and wellness services to the company’s employees, according to major news outlets. The health and wellness clinics will primarily serve...

Payers Address Opioid Safety Via Education, $0 Narcan Co-Pays

by Thomas Beaton

Commercial payers are addressing the nation’s opioid crisis and promoting opioid safety by funding patient education programs and waiving Narcan co-pays to reduce barriers to access. Patient-centered strategies have allowed payers...

UnitedHealth Offers Data Analytics to CMS Bundled Payment Program

by Thomas Beaton

UnitedHealth Group will help support a new Medicare bundled payment program by offering data and analytics services to participating providers. The payer announced in a press release that it will contribute data and analytics, technology,...

Medicare Advantage Evaluation Requires Transparent Claims Data

by Thomas Beaton

The growth of the Medicare Advantage (MA)  market requires the release of more claims data to evaluate the commercial and government impact of the program, according to a recent JAMA commentary from the Health Care Cost Institute,...

Employers, Employees Face Disconnect Over Wellness Programming

by Thomas Beaton

More than half of employers believe that their wellness programming is effective for improving health and reducing spending, but only a third of their employees think the same thing, according to a new Willis Watson Towers...

96% of Payers Are Committed to Electronic Prior Authorization

by Thomas Beaton

The vast majority of payers are committed to implementing electronic prior authorization solutions as a way to address administrative problems with prior authorization procedures, according to research published through the ePA National...

Idaho Prepares to Offer Association Health Plans to Consumers

by Thomas Beaton

Idaho will allow payers to offer association health plans (AHPs) that are not required to meet all of the consumer protections or benefits criteria included in the Affordable Care Act.   Governor C.L. “Butch” Otter...

Payer Housing Partnership Addresses Social Determinants of Health

by Thomas Beaton

Health Partners Plans (HPP) and two community programs in Philadelphia announced a partnership to address housing-related social determinants of health by connecting homeless individuals to healthcare services, free clinics, free meals,...

Ongoing Payer Consolidation Leads to Consumer Premium Hikes

by Thomas Beaton

The four largest payers in the US have continued to get bigger over the past few years, said Leemore S. Dafny, a professor of the Bruce V. Rauner Professor of Business Administration at Harvard Business School, during a House Energy and...

70% of Providers See Data Sharing as Key to Value-Based Care

by Thomas Beaton

Seventy percent of executives participating in a survey conducted by Humana and HFMA believe that the need for interoperability and seamless data sharing will be required for payers and providers to succeed with value-based care. The...

80% of Payers Aim to Address Social Determinants of Health

by Thomas Beaton

Eighty percent of payers believe that addressing the social determinants of health (SDOH) of their beneficiary populations will be a key way to improve their population health programs, according to a new Change Healthcare survey. The...

CA to Investigate Aetna after Insurance Claim Review Admission

by Thomas Beaton

The California Insurance Commission has opened an investigation into Aetna’s medical practices after a former medical director for the company testified in court that he did not review patient records before approving or denying...

IN Medicaid Waiver Uses Work Requirements, Tobacco Penalties

by Thomas Beaton

Indiana is the second state to receive approval for a 1115 Medicaid demonstration that adds work requirements as a condition of beneficiary eligibility.  The demonstration also adds premium penalties for tobacco use as well as...

Lawmakers Propose HDHP Coverage for Chronic Disease Prevention

by Thomas Beaton

A new bill introduced into the House and Senate would allow high-deductible health plans (HDHPs) to provide chronic disease prevention services before a patient meets his or her deductible, which could help to accelerate a growing HDHP...

Employer Guide Offers Strategies for Wellness Program Success

by Thomas Beaton

An employer guide developed by The Transamerica Center for Health Studies (TCHS) and the Interdisciplinary Center for Healthy Workplaces (ICHW) determined that employers may need a better understanding of the factors that inhibit wellness...

71% of Workers Satisfied with Employer-Sponsored Health Plans

by Thomas Beaton

Over 70 percent of employees are generally satisfied with their employer-sponsored health plans, but are concerned with rising health plan costs, an AHIP study found. Employer sponsored health plans have provided fair premium and...

AHIP: 25% of Opioid Prescriptions Top CDC Dosage Guidelines

by Thomas Beaton

An AHIP retrospective analysis of claims data found that 25 percent of opioid prescriptions were above CDC dosage recommendation and provides a basic snapshot of problematic areas where payers could minimize patient safety risks related to...

Merger Impacts, Medicaid Growth Drove 2017 Earnings for Payers

by Thomas Beaton

Aetna experienced a 4 percent drop in year-to-year earnings because of fallout from its proposed Humana merger, while other payers increased revenues by taking advantage of growing Medicaid, Medicare, and ACA-compliant business...

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