Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Payers

Indiana, Florida Approve Anthem, Aetna Health Insurance Mergers

by Vera Gruessner

The major health insurance mergers taking place between Anthem-Cigna and Aetna-Humana have shown some progress of late. Recently, the Indiana Department of Insurance approved the acquisition between Cigna and Anthem, according to a press release...

Payers Adopt Value-Based Care via Health Insurance Marketplace

by Vera Gruessner

The health insurance marketplace created through the Patient Protection and Affordable Care Act has had a variety of success ever since its inception. This new model of healthcare coverage has provided health insurance for an additional 20 million...

Top 6 Factors for Success in Provider-Sponsored Health Plans

by Vera Gruessner

The health insurance industry may have a complete transformation on their hands with regard to hospital and medical practice reimbursement. The number of provider-sponsored health plans is growing among physician groups and hospitals, according...

How State Policymakers Impact the Health Insurance Mergers

by Vera Gruessner

In the state of Missouri, policymakers issued an order that would prevent the Aetna-Humana acquisition from proceeding in post-merger activity within Missouri's Medicare Advantage plans as well as some commercial health plans. The two biggest...

Key Ways Blue Cross Blue Shield Raises its HEDIS Scores

by Vera Gruessner

The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of all health plans situated around the country to compare performance and year-to-year success. HEDIS scores allow health plans to determine where...

Is the Health Insurance Industry Heading on a ‘Death March?’

by Vera Gruessner

The health insurance industry has been undergoing tremendous reforms in recent years due to new federal regulations including the Affordable Care Act. Reimbursement between payers and providers have been changing as well. Coverage for the majority...

Why Payers Need to Address Patient-Centered Medicine

by Vera Gruessner

The healthcare insurance industry needs to meet the demands of consumers looking for quality provider data. Patient-centered medicine is becoming a mainstay throughout the country and cost transparency is a major aspect of this movement. Along...

Pediatric Care Out-of-Pocket Spending Rose 5.5% in 2014

by Vera Gruessner

Both public and private health payers have been searching for ways to reduce healthcare spending as a whole, but rising prices may be making it more difficult to combat medical care expenditure. The Health Care Cost Institute (HCCI) released...

Health Insurance Exchange Consumers Satisfied with Health Plans

by Vera Gruessner

Despite the fact that the House of Representatives and the Senate attempted to repeal the Affordable Care Act at the end of 2015, consumers seem to be satisfied with their healthcare coverage options after purchasing health plans on the health...

Consumer Engagement Vital in Health Insurance Exchanges

by Vera Gruessner

The Patient Protection and Affordable Care Act has brought a variety of changes for both insurers and healthcare providers with the establishment of health insurance exchanges holding a top place in reforming reimbursement between payers and...

Risk Adjustment Affects Plans on Health Insurance Exchanges

by Vera Gruessner

The trade association AMGA, which entails a large membership of medical groups and healthcare delivery systems, submitted comments last week to the Centers for Medicare & Medicaid Services (CMS) regarding its proposal to change risk adjustment...

Why Health Insurance Claims Data Needs Medical Device ID

by Vera Gruessner

If health insurance companies truly want to improve patient health outcomes including the quality of care and boost patient safety in an effort to reduce wasteful spending, it may be beneficial for health insurance claims data to include medical...

Could Electronic Processing Reduce Medical Spending Rates?

by Vera Gruessner

The US healthcare system is one of the most expensive around the world and the rising costs haven't diminished significantly in recent years. Today, health payers and providers have been working together to reduce medical spending around...

Insurer Participation in Health Insurance Exchange Decreases

by Vera Gruessner

Health payers around the country may not be faring as well as hoped within the federal health insurance exchange. The Affordable Care Act may have had a negative impact on health insurance companies, as some are experiencing financial loss when...

California Health Insurance Exchange Targets Costly Hospitals

by Vera Gruessner

The health insurance exchange from the state of California has some news to report. The exchange is considering the elimination of hospitals from its network that have shown subpar performance or had reported rising medical costs, according to...

How One Health Payer Partnership Reduced Hospitalizations

by Vera Gruessner

Recently, the health payer Blue Cross and Blue Shield of Illinois (BCBSIL) announced in a press release that it will be extending its partnership with the American Lung Association of the Upper Midwest over the next two years. The specific partnership...

‘The Future is Accountable Care,’ Population Health Management

by Vera Gruessner

Effective population health management remains a key aspect of running a successful accountable care network. As part of a stronger population health management program, the primary care physician’s referral system must be efficient in...

Should Payers Question ACA’s Health Insurance Exchanges?

by Vera Gruessner

The health insurance exchanges have faced some significant challenges and even some questioning among the payer community, especially after the insurer UnitedHealthcare announced at the end of 2015 that it is considering whether to leave the...

52% of Employers Offer High-Deductible Health Insurance Plans

by Vera Gruessner

Despite the fact that the health insurance exchanges and Medicaid expansion opened up more opportunities for Americans to obtain healthcare coverage without being dependent on employment, the health payer industry is still intertwined with the...

Payers Bear Monetary Losses in Health Insurance Exchanges

by Vera Gruessner

Several medical insurance companies have experienced losses and financial troubles within the federal and state health insurance exchanges. UnitedHealth Group, for example, has considered pulling out of the health insurance exchanges starting...

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