Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

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...

Aetna Cancels its Expansion in Health Insurance Exchange

by Vera Gruessner

The national health payer Aetna continues to make headlines in the month of August after the public learned last month about the Department of Justice’s move to block Aetna’s major health insurance merger with Humana. On August 2,...

Why Provider-Sponsored Health Plans are Gaining Ground

by Vera Gruessner

There are a number of reasons why provider-sponsored health plans are growing and more hospitals are considering investing in their own health plans instead of partnering with health payers, says Paul Keckley, Ph.D., a healthcare industry expert...

Aetna, UnitedHealth Take On California’s Medicaid Program

by Vera Gruessner

The two major health payers UnitedHealth and Aetna plan to join California’s Medicaid program called Medi-Cal managed care, according to Kaiser Health News. Aetna and UnitedHealth will serve residents of the San Diego and Sacramento counties....

Does Reference Pricing Reduce Costs of Diagnostics for Payers?

by Vera Gruessner

Health insurers and consumers can benefit from seeking reference pricing when it comes to choosing specific diagnostic tests among a set of different laboratories. Researchers from the University of Southern California and the Brookings Institution...

Payers’ Perspective: Insurance Mergers Benefit Consumers

by Vera Gruessner

As previously reported, the Department of Justice (DOJ) has announced that it will be blocking the Anthem-Cigna and Aetna-Humana insurance mergers due to the potential harm it may bring to consumers along with employers, hospitals and providers....

NCQA Proposes New Changes to HEDIS Quality Measures in 2017

by Vera Gruessner

The National Committee for Quality Assurance (NCQA) is looking to broaden a number of HEDIS quality measures for the 2017 edition, according to a news release from NCQA. These changes include the addition of four new HEDIS quality measures and...

Health Insurance Mergers May Harm Consumer Interests

by Vera Gruessner

What does the future hold for the Cigna-Anthem and Aetna-Humana health insurance mergers? Currently, many experts point at the possibility that these health insurance mergers will face regulatory blockage and won’t continue. A large number...

Minnesota’s Biggest Payer Leaves Health Insurance Exchanges

by Vera Gruessner

State health insurance exchanges are likely to see more disruption in the health insurance market with some payers either leaving the individual consumer marketplace or limiting their offerings in the coming year. The health payer UnitedHealthcare...

Major Health Insurance Mergers May Leave Consumers “Worse Off”

by Vera Gruessner

Four of the top five major payers in the nation are looking to consolidate into two combined health insurance companies. The Anthem-Cigna and Aetna-Humana health insurance mergers could lead to a complete transformation of the market and impact...

29% of Doctors Have Tools Needed for Value-Based Care Payments

by Vera Gruessner

While value-based care payments are making headway across the country, there are still barriers that stand in the way of payers and providers fully embracing these alternative payment models. A report from Quest Diagnostics and Inovalon found...

Why Payers Should Adhere to Patient Engagement, Consumer Choice

by Vera Gruessner

Consumer choice in health plans and provider networks is becoming a more popular topic of late among payers looking to increase patient engagement. There is a growing movement around the nation aimed at improving consumer satisfaction and healthcare...

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