Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Why the Generic Drug Market is a Growing Payer Opportunity

by Thomas Beaton

As payers try to ease the rising costs of prescription drugs, which account for 10 percent of national healthcare spending, they may wish to turn to the generic drug market to help curb unnecessary spending and improve profitability.   Generics...

Improving Price Transparency around Generic Drugs for Payers

by Thomas Beaton

Increasing pricing transparency around generic drugs could offer significant advantages to payers, including lower prices and more favorable reimbursement negotiations, according to a report from USC Brookings. Better understanding of contracting...

Reinsurance Changes Payers Can Expect Under the ACA in 2018

by Thomas Beaton

ACA federal reinsurance policies have undergone a transformation since their introduction from four years ago. Payers should continue to prepare for larger changes of federal and state ACA reinsurance in 2018. Reinsurance programs have gone from...

Emergency Response Devices Add Value to Medicare Advantage Plan

by Thomas Beaton

Anthem BlueCross BlueShield plans to add value onto consumer Medicare Advantage (MA) plans by offering personal emergency response systems (PERS) to beneficiaries, the payer announced in a series of press releases. MA beneficiaries in several...

3 Value-Based Pharmaceutical Contracting Options for Payers

by Thomas Beaton

Value-based pharmaceutical contracting offers health payers the option to lower drug prices while improving patient outcomes. These contracts come in several different forms, according to Dr. Surya Singh, Chief Medical Officer of CVS Specialty,...

ACA Open Enrollment Rate Expected to Drop Up to 13% in 2018

by Thomas Beaton

Analysts expect up to a 13 percent drop in open enrollment on the ACA marketplace exchange in 2018,  according to Standard and Poor’s Global (S&P Global). Only 10.1 million to 11.4 million individuals are expected in enroll in...

AHIP Launches Initiative To Combat Nationwide Opioid Crisis

by Thomas Beaton

AHIP launched the Safe, Transparent Opioid Prescribing (STOP) Initiative to support health plans’ widespread adoption of clinical guidelines for pain care and opioid prescribing, and combat the national opioid crisis, the organization announced...

How the Medicare Advantage Market Can Offer Payer Opportunities

by Thomas Beaton

Medicare Advantage (MA) market data from A.M Best and the Kaiser Family Foundation reveals that the MA market has remained profitable and provides financial opportunity, but payers looking to enter into the market should expect to address developing...

Providers Seeing Even Mix of Public, Commercially Insured Patients

by Thomas Beaton

Providers are seeing a fairly even mix of Medicare, Medicaid, and commercially insured patients with fewer uninsured individuals than before the ACA, according to the AMA’s Physician Practice Benchmark Survey. In 2016, forty-three percent...

Before CSR Cuts, ACA Health Plans Expected Stable Premiums

by Thomas Beaton

Had cost-sharing reductions (CSRs) under the Affordable Care Act remained in place payers would only expect modest premium increases with some continued profitability, a USC Brookings report found. However, the uncertainty resulting...

Mercy Health, Centene Form Medicaid Accountable Care Organization

by Thomas Beaton

Mercy Health of Arkansas and the Centene Corporation have received approval to operate an accountable care organization within the state focusing on Medicaid beneficiaries, the organizations announced in a press release. Centene subsidiaries...

AMA: Payers Operate in Extremely High Concentrated Markets

by Thomas Beaton

Payers have significant control of their respective healthcare markets as 69 percent of payers offering HMO, PPO, POS, and public health exchanges operate in very high concentrated markets, AMA found in a study of national insurance markets....

Medicare Consumers Prefer Phone Calls from Health Plans

by Thomas Beaton

Medicare consumers tend to prefer traditional phone calls or mailings over digital engagement strategies such as text messaging or using a member portal, according to a new Healthmine survey. Forty-eight percent of Medicare consumers aged 65...

What are the Pros and Cons of Consumer Directed Health Plans?

by Thomas Beaton

In recent years, payers have been extending their consumer-directed health plan (CDHP) offerings as a way to encourage health plan enrollment and save on healthcare costs. Many healthcare stakeholders see CDHPs as products that create mutual...

Anthem Adds Home Meal Delivery to Medicare Advantage Plans

by Thomas Beaton

Anthem is offering home meal delivery service to its post-discharge Medicare Advantage plan members in  in several states including Georgia, Kentucky, Missouri, and Wisconsin the payer announced. Anthem is partnering with GA foods to provide...

Payer Strategies for Boosting Consumer Engagement, Satisfaction

by Thomas Beaton

In an increasingly competitive health insurance environment, payers that can successfully increase consumer engagement and beneficiary satisfaction will be best positioned for success. David Biel, the US Leader for Health Plans consulting at...

Michigan MSSP Accountable Care Org Saves $8M for Medicare

by Thomas Beaton

The Physician Organization of Michigan Accountable Care Organization (POM ACO), a Medicare Shared Savings Program (MSSP) ACO, helped the state save $8 million dollars on Medicare expenses by reducing unnecessary ED utilization, preventing unneeded...

Top Commercial Payers Offering Medigap, MA, and Medicaid Plans

by Thomas Beaton

The top payers with the highest enrollment numbers for Medigap, Medicaid, and Medicare Advantage (MA) are a unique mix of some of the largest commercial payers as well as smaller to mid-size insurers, a new report from AHIP reveals. These three...

Quality Measures Challenging in Pharmaceutical Value-Based Contracts

by Thomas Beaton

Healthcare payers may find it difficult to establish value-based contracts (VBCs) with pharmaceutical companies due to the challenges of creating meaningful, workable quality measures.   Pharmaceutical companies are generally reluctant to...

Trump Plans to End Cost Sharing Reduction Subsidies for Payers

by Jennifer Bresnick

The White House has announced plans to scrap the Affordable Care Act cost sharing reduction subsidies for health insurers that have helped to keep premiums low and stabilize markets subject to the individual mandate. The announcement came just...

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