Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

NQF Aims to Improve Medicaid Use of Social Determinants Data

by Thomas Beaton

Collaborating with public health and community organizations to foster informed decision-making can help Medicaid entities better address the social determinants of health (SDOHs), says new guidance issued by the National Quality Forum...

2018 Best in KLAS Taps Vendors for Claims Admin, Price Transparency

by Thomas Beaton

The 2018 Best in KLAS report ranked the best vendor solutions for payer claims administration, care management, price transparency, and payer analytics based on five industry performance criteria.    KLAS ranked vendor solutions...

Member Incentives for Lower Cost Health Services Saved Payer $3.2M

by Thomas Beaton

Commercial payers struggling to curb costs and encourage their members to make smarter financial choices may be able to save millions of dollars each year by investing in modest member incentives. Offering small financial rewards for...

Amazon, JP Morgan, Berkshire Hathaway Form Healthcare Company

by Thomas Beaton

Amazon, JP Morgan Chase & Co., and Berkshire Hathaway have announced a long-term partnership to form an independent company that focuses on cost-effective healthcare for employees. The company will aim to remove profit-making...

Consumer-Directed Care, High Deductibles Popular for Employees

by Thomas Beaton

Consumer-directed care, high-deductible health plans (HDHPs), and financial benefits related to healthcare spending have increased in popularity and demand by employees from 2017 to 2018, according to a new report from Benefitfocus. The...

DE Shifts Managed Medicaid Contracts to Value-Based Agreements

by Thomas Beaton

Delaware’s Department of Health and Social Services (DHSS) announced it is translating the state’s managed Medicaid Contracts into value-based agreements to improve the outcomes and costs of the state’s public healthcare...

Health Insurance Costs Placing Stress on Majority of Americans

by Thomas Beaton

Sixty-nine percent of Americans with an income of $50,000 a year or more cited the cost of health insurance as a major stressor and 63 percent of Americans with incomes less than $50,000 per year cited insurance costs as a major life...

Academy of Actuaries Reaffirms Association Health Plan Risks

by Thomas Beaton

The American Academy of Actuaries released a statement reaffirming its concerns with expanding association health plan (AHPs) availability in light of perceived risks to the individual insurance marketplace. The statement precedes...

ACA Implementation Led to Varied Out-of-Pocket, Premium Spending

by Thomas Beaton

Affordable Care Act (ACA) implementation led to an 11.9-percent decrease in out-of-pocket spending but also a 12.1-percent increase in premium spending totals, according to a study published in JAMA Internal Medicine. The landmark...

High Care Costs Driving Employer-Sponsored Insurance Spending

by Thomas Beaton

The Health Care Cost Institute (HCCI) found that high care costs were the primary driver of increased employer-sponsored insurance spending in 2016, which grew by 4.6 percent and exceeded any rate between 2012 and 2015. A HCCI report of...

VA Awards Accenture $62M Benefits IT Infrastructure Contract

by Thomas Beaton

Accenture received a one-year, $62 million contract by the VA’s Veterans Benefit Administration (VBA) division to improve the VBA’s technology infrastructure for delivering member benefits. Accenture Federal Services (AFS)...

Humana Expands Long-Term Social Health Determinant Investments

by Thomas Beaton

Humana, and its philanthropic arm the Humana Foundation, announced changes to their grant making processes that provide long-term investments into community programs that address the social determinants of health (SDOH). The new...

Aetna Agrees to $17M Settlement in HIV Privacy Data Breach

by Thomas Beaton

Aetna has agreed to pay $17,161,200 in a settlement involving allegations that the payer exposed private HIV information for more than 12,000 beneficiaries. The final terms of the settlement require Aetna to break up the total settlement...

AHA Makes Suggestions for In-State Insurance Market Stabilization

by Thomas Beaton

In order to stabilize in-state insurance markets, stakeholders should consider strategies including reinsurance, Medicaid-sponsored health plans, and high-risk pools, according to the AHA. Several factors are contributing to unstable...

Payers, Providers Pledge to Improve Prior Authorizations

by Thomas Beaton

AHIP, BCBSA, AHA, and other leading payer and provider organizations announced an industry pledge to improve the efficiency of prior authorizations while reducing administrative burden. Leaders of organizations participating in the pledge...

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

by Thomas Beaton

Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in...

Payers Support Integrated Care Services for NC Medicaid Patients

by Thomas Beaton

Payers and provider organizations that support integrated care systems can help lower healthcare costs by addressing the healthcare concerns of vulnerable patient populations, including Medicaid beneficiaries. Several commercial payers...

Humana Becomes Latest Payer to End AHIP Membership

by Thomas Beaton

Humana is the latest commercial payer to end its membership in AHIP, the nation’s largest health insurance trade organization. “Humana has not actively participated in AHIP since early 2017,” a Humana spokesperson told...

Outcomes-Based Contracts Offer Payers New Pharmaceutical Options

by Thomas Beaton

Payers may be more willing to provide their beneficiaries with genetic drug therapies that costs hundreds of thousands of dollars if they enter into outcomes-based pharmaceutical contracts that lessen financial risks. An outcomes-based...

Top 10 Highest Performing Commercial Health Plans

by Thomas Beaton

The top performing commercial health plans in the US for 2017-18 exceeded expectations for customer satisfaction, preventive care, and outcomes of their beneficiaries, according to the National Committee for Quality Assurance (NCQA). NCQA...

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