Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Executive Order Eases ACA Rules on Association Health Plans

by Thomas Beaton

An executive order signed by President Trump will lighten rules on association health plans (AHPs), which could allow groups of businesses to provide lower cost insurance without essential health benefits (EHBs), as reported by multiple news...

How to Create Balanced Risk Pools that Lower Premiums

by Thomas Beaton

Payers have been increasingly challenged to manage the high cost of healthcare while lowering the premiums their beneficiaries pay.  Creating balanced risk pools that benefit medically complex individuals while also serving healthier consumers...

CMS Releases 2018 Medicare Advantage Star Ratings for Health Plans

by Thomas Beaton

CMS has updated the 2018 Medicare Advantage star ratings on health plans, allowing consumers to explore options that will best suit their individual needs.   The star ratings are based on several consumer engagement and care quality criteria,...

Employer Insurance Enrollment, Member Engagement Stagnated in 2016

by Thomas Beaton

Growth in employer-sponsored insurance enrollment and certain measures of member engagement did not significantly increase in 2015 and 2016, according to the Medical Expenditure Panel Survey (MEPS) released by AHRQ. There was no significant change...

High-Deductible Health Plans Reduce Care Costs, Needed Services

by Thomas Beaton

High-deductible health plans (HDHPs) may reduce spending, but are also prone to preventing health care consumers from accessing necessary services and recommended preventive care, according to a study published in Health Affairs. High-deductible...

Health Plan Consumers Report Insufficient Payer Communications

by Thomas Beaton

Health plans may not be effectively communicating with consumers about member  benefits and largely fail to understand their members’ health and financial needs, a survey from Healthmine found. A sample of 750 consumers enrolled in...

80% of Payers Investing in Member Engagement, Satisfaction

by Thomas Beaton

Eighty percent of health plans are focusing on improving member engagement and consumer satisfaction, according to a survey by Change Healthcare.   Member engagement is a growing opportunity for payers because of the potential improvements...

Medicaid Drug Pricing Rule May Inhibit Value-Based Contracts

by Thomas Beaton

A Medicaid drug pricing rule which safeguards deep discounts for the public program can potentially inhibit value-based contracts agreements between payers and pharmaceutical companies, according to research from the Journal of Health Politics,...

Blue Shield of CA to Offer Statewide Healthcare Provider Directory

by Thomas Beaton

Blue Shield of California plans to develop a statewide healthcare provider directory, with the help of Integrated Healthcare Association (IHA), that gives members access to current information on providers, the payer announced in a press release....

Beneficiary Segmentation, Spending by Healthcare Payer Type

by Thomas Beaton

Healthcare spending in the US continues to grow steadily across all beneficiary segments and healthcare payers. 2015 data from CMS, the CDC, and the Kaiser Family Foundation (KFF) indicates that payers and individuals sponsoring their own healthcare...

Pediatric Data Reveals Private Payer, Medicaid Spending Gaps

by Thomas Beaton

Private payers spend close to twice as much on pediatric services as Medicaid, according to a statistical brief from AHRQ, highlighting significant disparities in cost related to visit type and geographical region. Data from the 2015 Household...

Payer Pricing, Partnership Strategies for Population Health

by Thomas Beaton

Effective population health management and comprehensive preventive care open the door to new opportunities that maximize payer spending, raise care quality, and slow the progression of costly chronic conditions such as diabetes and cardiovascular...

90% Medicare Supplemental Plan Members Report Satisfaction

by Thomas Beaton

Over 90 percent of Medicare supplemental plan beneficiaries cited satisfaction with their healthcare coverage, according to a recent AHIP study. Findings point out ways for payers to provide consumer-friendly health plans to a growing senior...

NB and IA Offer New Individual Market Plan For Open Enrollment

by Thomas Beaton

An new individual market plan created out of Medica and CHI Health will be available to consumers during the open enrollment period in Nebraska and Iowa, the health networks announced in a press release. The Medica with CHI Health plan offers...

Payers Driving Value by Promoting Connected Care Models

by Thomas Beaton

As payers vie to remain competitive in commercial insurance markets, they must be able to effectively manage consumer costs while providing beneficiaries the best possible healthcare experience now and in the future. Rising healthcare costs are...

Nevada Blue to Offer Supplemental Medicare Coverage to Members

by Thomas Beaton

On October 1, Blue Cross Blue Shield (BCBS) of Nevada members can enroll in Medicare Supplemental Innovation Plans F, G, or N that provide preventative care services and extended benefits, the payer announced earlier this week. The plans will...

Large Variations Seen in Consumer Healthcare Spending

by Thomas Beaton

As healthcare costs rise, beneficiaries will be more responsible for out-of-pocket healthcare expenses not covered by their health plans. But those costs drastically vary by state, family size and income, and other variables, according to a report...

6 Ways VA Can Improve Administrative Management of Care Delivery

by Thomas Beaton

Even though VA has taken steps to improve administration and management of its healthcare delivery systems, the Government Accountability Office (GAO) found six action items that allows the VA to adjust policies that improve data sharing and...

Planning for Individual Insurance Exchange Stabilization in WA

by Thomas Beaton

State health insurance markets and their individual insurance exchanges have faced regular instability in the form of payer exits, imbalanced risk pools, and rising premiums that push out new and returning insurance consumers. As premiums go...

AHIP: Graham-Cassidy Bill a Poor Choice for Payers, Patients

by Thomas Beaton

AHIP believes that passage of the Graham-Cassidy Bill making the rounds in the Senate would adversely affect payer market through policies that destabilize the health insurance markets, reduce patient access to healthcare, and fail to meet the...

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