Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

31% of Beneficiaries Face Social Isolation, More Health Risks

by Thomas Beaton

A new survey of Humana’s commercial population has found that almost one-third of members over 65 years old experience social isolation. The survey reveals that payers could benefit by addressing social isolation among their elderly...

Top Health Plans Excel in Preventive Care, Chronic Disease Management

by Thomas Beaton

Health plans that offered high-quality preventive care and comprehensive chronic disease management received top marks in the latest health plan rankings from the National Committee on Quality Assurance (NCQA). NCQA ranks health plans in...

Medicare-Medicaid Dual Eligible Care Models Aim to Coordinate Care

by Thomas Beaton

Medicare and Medicaid dual-eligible care models provide extensive care coordination to ensure beneficiaries with multiple chronic conditions can access healthcare services, according to a new AHIP report.   Twelve million Americans...

Reference Pricing Models for Prescription Drugs May Contain Costs

by Thomas Beaton

Reference pricing models for prescription drugs may help to contain spending and reduce high costs for beneficiaries, says a new report from the Commonwealth Fund. Currently, most payers use tiered drug formularies to manage drug costs,...

Poor Healthcare Literacy Leads to $4.8B in Administrative Costs

by Thomas Beaton

Widespread rates of poor consumer literacy within the healthcare industry creates administrative burdens for payers and contributes to an additional $4.8 billion in health plan costs, according to a new Accenture report. Fifty-two percent...

Cigna Launches $250M Venture Fund for Analytics, Digital Health

by Thomas Beaton

Cigna will invest $250 million in the new Cigna Ventures fund, which will invest in healthcare startups specializing in analytics, digital health, retail, care management, and other business opportunities related to value-based...

FDA Recruits Payers to Submit Quality Feedback on Medical Devices

by Thomas Beaton

FDA has launched a new quality assurance program that leverages feedback from commercial payers about medical device coverage requirements in order to expedite approvals. The Private Payor Program (PPP) is a voluntary program for medical...

Da Vinci Project Connects Payers, Providers, FHIR for Value-Based Care

by Thomas Beaton

Payer and provider members of the Da Vinci Project are undertaking a series of pilot projects exploring how to best leverage FHIR for data exchange to enhance value-based care. “Da Vinci is a collective initiative of concerned,...

Handful of States Propose Lower ACA Premium Rates for 2019

by Thomas Beaton

Several states have announced lower ACA premium rates for 2019, bucking a national trend brought on by unstable markets and regulatory changes.   While early proposals from a number of states, including Virginia, Maryland, and...

Payers Sue to Collect 2017 Cost Sharing Reduction Payments

by Thomas Beaton

Payer organizations are exercising their right to use the court system to collect cost sharing reduction (CSR) payments that were not provided in the last quarter of 2017. A number of lawsuits are challenging the government’s...

CPC+ Model Offers Payers Insight into Population Health Management

by Thomas Beaton

CMS’s Comprehensive Primary Care Plus (CPC+) model may offer lessons and strategies for payers that want to increase primary care efficiency with population health management strategies. The CPC+ model is the nation’s largest...

How to Curb Adverse Selection in the Individual Health Plan Market

by Thomas Beaton

Maintaining a profitable individual health plan product is already challenging, but adverse selection can create additional problems that impede a payer’s ability to control health plan costs. Policies within the Affordable Care...

How Can Accreditation Programs Promote Health Plan Value?

by Thomas Beaton

Health plan accreditation programs can help payers highlight offerings that deliver on key quality, efficiency, and beneficiary satisfaction measures. Many health plans currently participate in the HEDIS performance set and receive...

How Capitated Payments Prompt Payer, Provider Innovation

by Thomas Beaton

The challenges of lowering care costs and improving healthcare quality may lead payers to consider the use of capitated payments as part of their value-based payment model strategies. Capitated payments are pre-arranged payments for...

Next Generation ACO Model Saved Medicare $62M in 2016

by Thomas Beaton

Next Generation Accountable Care Organizations (ACO) saved the Medicare program $62 million during their first year of operation in 2016, encouraging CMS to expand downside risk models across Medicare. Next Generation ACOs accept the...

Value-Based Care Slashes Per Member Per Month Costs in Kansas

by Thomas Beaton

BlueCross BlueShield of Kansas has seen significantly lower per member per month costs for beneficiaries participating in value-based care arrangements, including accountable care organizations (ACOs) and patient-centered medical homes...

Payers, Providers Create New Medicare Advantage Partnerships

by Thomas Beaton

New Medicare Advantage plans, many born of innovative partnerships between payers and providers, are creating more options for beneficiaries to supplement their existing coverage with high-value offerings. Commercial payers operating in...

Anthem, Walmart Partner for Over-the-Counter Drug Allowance

by Thomas Beaton

A new partnership between Anthem and Walmart will allow Medicare Advantage beneficiaries to purchase over-the-counter drugs and other drug store necessities with a plan allowance. Starting in January of 2019, Anthem beneficiaries will be...

CMS Tells States to Curb Silver-Loading with Off-Exchange Plans

by Thomas Beaton

CMS is asking state insurance departments to offer more off-exchange health plans in order to reduce silver-loading of qualified health plans (QHP). Silver-loading is the practice of raising premiums so that payers can earn larger federal...

CMS Processes State Medicaid Requests, Approvals 23% Faster

by Thomas Beaton

CMS has announced that an agency initiative to streamline state Medicaid approvals and state plan amendments (SPAs) has increased approval processing speed by 23 percent. In 2017, CMS sent a bulletin to state Medicaid programs informing...

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