Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

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...

Payer Concentration Challenges Health Insurance Exchanges

by Vera Gruessner

More and more research is pointing at the fact that consumers on the health insurance exchanges are being left with fewer health plan issuers. Part of this may be due to health payers such as UnitedHealthcare or Aetna leaving a large percentage...

Lack of Price Transparency Leading Employers to Self-Insure

by Vera Gruessner

Some employers are finding it difficult to keep contracting with their health payers due to continually increasing monthly premium costs and a general lack of price transparency across the health insurance industry. As such, the notion of a company...

7% of Counties Retain One Payer on Health Insurance Exchanges

by Vera Gruessner

With more health payers such as UnitedHealthcare, Humana, and Aetna dropping out of a number of state health insurance exchanges, it is useful to analyze the differences of healthcare coverage between different regions and states around the country....

Public Health Insurance Marketplace Still Benefits Consumers

by Vera Gruessner

The public health insurance marketplace created through the Affordable Care Act (ACA) may have fewer and fewer health plans participating in the coming years since a number of major insurers have dropped out of the exchanges. This would lead...

New York, California Enact Rulings Against Surprise Medical Bills

by Vera Gruessner

Healthcare payers may find that they may no longer have to pass on extraneous costs to their consumers when out-of-network providers send more costly claims their way. New legislation in states like New York and California may soon put an end...

Patient Wait Times Still High at Veterans Health Administration

by Vera Gruessner

While there have been few major problems within the federal Medicare program that have led to any defamation of the federal agency, Veterans Affairs and, specifically, the Veterans Health Administration often has had its fair share of critics....

How Risk Adjustment Challenges the Health Insurance Market

by Vera Gruessner

Ever since the provisions of the Patient Protection and Affordable Care Act came into effect on January 1, 2014, healthcare payers have been unable to deny health insurance or charge larger premium costs to those with pre-existing conditions....

Payers Could Boost HEDIS Quality Measures by Exchanging Data

by Vera Gruessner

HEDIS quality measures are managed by the National Committee for Quality Assurance (NCQA), which allows consumers to compare the quality of health plans among more than 90 percent of health payers around the country. HEDIS quality measures require...

Best Practices to Drive HEDIS Success in 2017

by Brian Drozdowicz of Verisk Health

Achieving success requires plans to adhere to annual changes from the National Committee for Quality Assurance (NCQA) related to HEDIS measurement, reporting requirements, and timelines. In addition, health plans can better position themselves...

Continue to site...