Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Aetna, Humana, Harvard Pilgrim Target Patient Health Outcomes

by Vera Gruessner

Commercial health insurance companies have pursued a number of different approaches to improve patient health outcomes and reduce wasteful medical spending. The payers Aetna, Humana, and Harvard Pilgrim conducted some key collaborations to achieve...

Why Payers Should Reduce Cost Sharing for High-Value Care

by Vera Gruessner

Today, more healthcare payers are positioning greater cost-sharing onto the consumers to keep from raising premium rates, according to commentary published in JAMA Internal Medicine. The 2016 National Health Insurance Survey discovered that 40...

Humana, Aetna, Cigna Invest in Value-Based Care Payment Models

by Vera Gruessner

Value-based care payment models are continuing to make headlines among major health insurance companies around the nation. Last month, Humana entered into a value-based care arrangement with the population health management company Fullwell,...

Payers See High Financial Losses on Health Insurance Exchanges

by Vera Gruessner

Healthcare payers have been facing significant financial losses on the health insurance exchanges in recent years. UnitedHealth Group lost $475 million in 2015 and was predicting a loss of $650 million in 2016, according to Kaiser Health News....

How the 21st Century Cures Act will Impact Healthcare Payers

by Vera Gruessner

Last week, the House of Representatives passed the 21st Century Cures Act by 392-26 votes. The 21st Century Cures Act affects the health insurance market through a provision that establishes small business health reimbursement arrangements (HRAs),...

Payers Continue to Drop Out of the Health Insurance Exchanges

by Vera Gruessner

Healthcare payers have seen significant obstacles when it comes to operating on the public health insurance exchanges with large, national insurance companies losing money through this marketplace. Below we outline some key insurers that have...

Health Payer Solutions for Improving HEDIS Quality Scores

by Vera Gruessner

Payers and providers transitioning to value-based care reimbursement need to commit to meeting and improving their HEDIS quality scores. However, the documentation involved in reporting HEDIS quality scores tends to become complex. Johns...

Healthcare Insurance Literacy Vital for Higher Coverage Rate

by Vera Gruessner

New research from the RAND Corporation shows that uninsured Americans who have better healthcare insurance literacy were more likely to purchase coverage when the Affordable Care Act’s health insurance exchanges opened in 2014, according...

Humana’s Value-Based Care Platform Decreased Costs by 20%

by Vera Gruessner

The health payer Humana released positive results within its Medicare Advantage program for the third year in a row, according to a company press release. The value-based care platform used at Humana indicated 19 percent higher HEDIS scores among...

Vermont’s All-Payer Model Limits Medical Spending Growth

by Vera Gruessner

Vermont has been working on regulatory actions that would reform healthcare payment throughout the state specifically through an all-payer model. Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a press release the...

Healthcare Payers Struggle with Price Transparency, Technology

by Vera Gruessner

Health insurance companies are still struggling with improving price transparency in order to gain greater trust from their consumer base. One survey has shown low customer service satisfaction and a need for payers to inform consumers on their...

Private Payers Face Challenges on Health Insurance Exchanges

by Vera Gruessner

The health insurance exchanges created after passage of the Affordable Care Act may not serve as a truly effective marketplace for commercial payers since some national insurers like Aetna and UnitedHealthcare have been dropping out of operating...

How Investing in Social Services Could Cut Healthcare Spending

by Vera Gruessner

While healthcare spending is continually increasing, patient outcomes and overall health has not necessarily improved greatly, according to a report from Leavitt Partners and the Robert Wood Johnson Foundation. However, the study also...

Misalignment of Healthcare Quality Measures Impacts Payers

by Vera Gruessner

In the healthcare industry’s move toward value-based care reimbursement, public and private payers create healthcare quality measures meant to align with how providers are paid and what type of financial penalties will be instituted for...

MA Proposed Rule May Cut Savings from Ambulatory Surgery Centers

by Vera Gruessner

New proposed changes to current legislation from the Massachusetts Department of Public Health may either decrease the use of or potentially eliminate ambulatory surgery centers, according to a press release from Healthcare Bluebook. The reason...

How Provider-Sponsored Health Plans Can Compete for Consumers

by Ross Erlebacher and Warren Suh

Provider organizations that take the leap to develop their own health plans compete in a highly competitive healthcare environment with established national, regional and local plans, and in some markets, new non-traditional entrants in the health...

VT All-Payer Model Aligns Costs for Public, Private Insurers

by Vera Gruessner

The state of Vermont is moving forward with establishing an all-payer model that uses accountable care organizations and ensures a provider is reimbursed by an equal amount among all healthcare payers for a particular service. The Vermont government...

49M Americans Risk Losing Fixed Indemnity Health Insurance

by Vera Gruessner

A new proposed rule called Expatriate Health Plans, Expatriate Health Plan Issuers, and Qualified Expatriates; Excepted Benefits; Lifetime and Annual Limits; and Short-Term, Limited-Duration Insurance may negatively impact access to fixed indemnity...

Comprehensive Primary Care Plus Program Selects Anthem BCBS

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has selected Anthem Blue Cross and Blue Shield in Colorado as a participant for their Comprehensive Primary Care Plus (CPC+) initiative, according to a company press release. The Comprehensive...

Consumer-Driven Health Plans Reduce Medical Care Utilization

by Vera Gruessner

The Health Care Cost Institute released new findings that show consumer-driven health plans are leading individuals to utilize less medical care as well as spending more on out-of-pocket costs. Among consumer-driven health plans, enrollees spend...

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