Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Payers May Be Neglecting a Growing Medicare Advantage Market

by Thomas Beaton

Payers may be able to secure more of the growing Medicare Advantage (MA) marketplace by expanding their member messaging efforts and improving consumer education about what the supplementary plan has to offer, according to a new J.D. Power survey....

Can Healthcare Price Transparency Tools Cut Costs for Payers?

by Thomas Beaton

As out-of-pocket costs for patients continue to rise alongside payer spending on services, many health insurance companies are turning to online price transparency tools to help beneficiaries decide how to purchase low cost, high quality care....

BCBS Minnesota Launches Prediabetes Prevention Campaign

by Thomas Beaton

Blue Cross Blue Shield (BCBS) of Minnesota is launching a prediabetes prevention campaign to lessen the rate of diabetes in local communities, the payer announced in a press release. Titled “Reverse It,” the campaign focuses on helping individuals...

Anthem to Withdraw from ACA Individual Market Exchanges in NV

by Thomas Beaton

Anthem BlueCross BlueShield (BCBS) will completely withdraw from Nevada’s ACA exchange for individual health plans in 2018, the health payer announced on Monday. The payer’s decision follows discussion with state leaders and regulators....

Payers, Providers Highlight the Pros of Cost-Sharing Reductions

by Thomas Beaton

A joint group of America’s Health Insurance Plans (AHIP) and provider organizations came together to promote the benefits of cost-sharing reductions (CSRs) on consumer and payer healthcare costs, the group announced in a joint statement....

Latest Earnings Reports Show State of Health Payers in 2017

by Thomas Beaton

At the half-year mark, payers have a good sense of how well their efforts to promote value-based care have fared and the opportunity to make the necessary adjusts where they have not. As part of the business-facing side of value-based care, payers...

Socioeconomic Data Improves Public Health, Payer Programs

by Thomas Beaton

CMS programs recognize that the social determinants of health (SDOH) play a large role in the health of their beneficiaries and, when neglected, can create negative health implications for beneficiaries covered by Medicare, Medicaid, and CHIP....

Payer Collaboration Can Address Social Determinants of Health

by Thomas Beaton

Billions in overspending on medical costs are attributed to social determinants of health (SDOH), and SDOH can identify if beneficiaries covered by insurance plans are at risk for adverse health conditions outside their coverage. SDOH include...

KPMG: Cybersecurity Breaches on the Rise for Healthcare Payers

by Jennifer Bresnick

Healthcare payers are increasingly becoming targets of cybersecurity breaches, both malicious and accidental, according to a new survey from KPMG.  Cybersecurity incidents resulting in compromised data and HIPAA violations affected 47 percent...

Effective Steps for Health Insurance Marketing, Consumer Engagement

by Thomas Beaton

Creating and deploying effective health insurance marketing and consumer engagement plans can be difficult for payers in today’s complex purchasing landscape.   Payers must focus on building strong brands, clear messaging, and effective...

How Can Health Savings Accounts Help, Hinder Patients and Payers?

by Thomas Beaton

Health savings accounts (HSAs) have been widely discussed as lawmakers consider policy reforms, at the federal level, and have become a fixture in conversations about healthcare spending among payers and patients alike.   HSAs are consumer...

ACA “Skinny Repeal” Dies in Senate, Leaving Next Steps Uncertain

by Jennifer Bresnick

In the early hours of Friday morning, the Senate failed to pass its attempt at a “skinny repeal” of the Affordable Care Act, which would have eliminated the tax penalties associated with the individual mandate for insurance coverage...

Large Employers Aim to DRIVE the Expansion of Value-Based Care

by Thomas Beaton

Large employers are deeply invested in bringing down healthcare spending rates, and have embraced value-based care strategies for ensuring that their employees stay as healthy and productive as possible. As care costs continue to rise across...

Can Healthcare Payers Inspire ACOs to Take on Two-Sided Risk?

by Jennifer Bresnick

While two-sided risk arrangements are attractive for healthcare payers, even experienced accountable care organizations (ACOs) are wary of jumping into contracts which make them financially responsible for falling short of their quality benchmarks. ...

Senate Nixes Better Care Reconciliation Act, But Isn’t Done Yet

by Jennifer Bresnick

After a nail-biting procedural vote on Tuesday afternoon that required Vice President Mike Pence to break the tie, the Senate continued its tumultuous afternoon by voting down the Better Care Reconciliation Act, which included deep cuts to Medicaid...

Opioid Use Fell 32% in CA BCBS Prescription Drug Safety Program

by Thomas Beaton

The Blue Shield of California Health Plan, an independent member of Blue Cross Blue Shield (BCBS), successfully lowered overall opioid use by 32 percent during the first two years of its Narcotic Safety Initiative (NSI).   The NSI leveraged...

CMS to Host Summit on Behavioral Health Payment, Care Delivery

by Thomas Beaton

CMS has opened registration for a one-day summit where healthcare experts can discuss ideas about innovative behavioral health payment models and related care delivery systems. The Behavioral Health Payment and Care Delivery Summit will take...

UnitedHealthcare of WI Grants $100K to Community Disability Groups

by Thomas Beaton

UnitedHealthcare Community Plan of Wisconsin awarded four non-profit community health organizations a total of $100,000 to enhance healthcare access and resources for individuals with disabilities. Lt. Gov. Rebecca Kleefisch of Wisconsin joined...

Humana Foundation Awards $735K To Improve Community Health

by Thomas Beaton

The Humana Foundation announced awards totaling $735,000 to help South Florida nonprofits to help improve community health. As part of the payer’s philanthropic pursuits, the grants are being awarded during their 2017 donation cycle to...

Humana, Oscar Health to Deliver Small Business Insurance

by Thomas Beaton

Humana and startup insurance provider Oscar Health have entered into a strategic partnership that aims to provide commercial small business insurance to consumers in a nine-county area surrounding Nashville, TN. The partnership merges Humana’s...

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