Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Policy

Department of Justice Argues Against ACA Essential Health Benefits

by Thomas Beaton

The Department of Justice (DoJ) has argued against the Affordable Care Act’s essential health benefits (EHBs) and the law’s individual mandate by supporting a lawsuit that argues the constitutionality of both laws,...

President Trump Signs Bill to Expand Privatization of VA Healthcare

by Thomas Beaton

President Trump signed the Veterans Affairs’ Mission Act into law midweek which will provide over $50 billion in federal investments to privatize a portion of the VA’s healthcare system and improve historical...

Medicare Bundled Payment Programs Primed to Produce Savings

by Thomas Beaton

Medicare’s bundled payment programs are in an opportune position to produce additional savings and create a more cost-effective public payer program with certain revisions, a new white paper from USC Brookings explains. CMS’s...

Maine Court to Force Medicaid Expansion Past LePage’s Block

by Thomas Beaton

A state-level court in Maine has forced Governor Paul LePage (R) and the Maine Department of Health and Human Services (DHHS) to uphold a ballot initiative that implements Medicaid expansion under the Affordable Care Act...

ACA’s Individual Mandate Boosted High-Income Enrollment Totals

by Thomas Beaton

The Affordable Care Act’s (ACA) individual mandate spurred greater high-income enrollment in health plans and is a key component of increasing enrollment and stability in the nation’s individual insurance markets, according to...

CMS Medicaid Scorecards Increase Transparency, Accountability

by Thomas Beaton

CMS has released new Medicaid scorecards that contain care quality data on a state-by-state basis in order to improve transparency and accountability across the Medicaid program. CMS Administrator Seema Verma emphasized a need for...

HHS Made Nearly $90B in Improper Payments to Medicaid, Medicare

by Thomas Beaton

HHS made approximately $90 billion in improper payments to Medicaid and Medicare programs during 2017 and may require updated payment evaluation procedures to address improper payments, a new Government Accountability Office (GAO) report...

Early Health Insurance Premium Proposals Indicate Hikes for 2019

by Thomas Beaton

Significant increases to health insurance premiums are on the horizon for beneficiaries in multiple states as payers begin to share their 2019 rate plans.   A challenging regulatory landscape, complicated by policy changes that have...

Virginia Legislature Approves Medicaid Expansion

by Thomas Beaton

The Virginia General Assembly has passed Medicaid expansion as part of a two-year budget bill that could provide coverage to 400,000 newly eligible residents. The action would make Virginia the 33rd state in the US to expand Medicaid...

MSSP ACOs Taking on Downside Risk See Smaller Savings

by Thomas Beaton

Medicare Shared Savings Program (MSSP) ACOs that take on downside risk generate smaller savings than upside risk ACOs, according a Center for Healthcare Quality and Payment Reform (CHQPR) analysis. In 2016, the average annual cost of care...

GAO Appoints Public Policy, Payment Experts to MedPAC

by Thomas Beaton

The Government Accountability Office (GAO) has appointed five new public policy and healthcare payment experts to the Medicare Payment Advisory Commission (MedPAC). GAO chief Gene L. Dodaro, Comptroller General of the United States, is...

Medicaid Plans More Cost Effective, Stable than Exchange Plans

by Thomas Beaton

Medicaid health plans are more cost effective than federal exchange plans and could offer beneficiaries more affordable coverage options, according to a UnitedHealth Group analysis. UnitedHealth Group said that federal healthcare agencies...

GAO: Medicare DME Prior Authorization Programs are Effective

by Thomas Beaton

CMS’s prior authorization programs for durable medical equipment (DME) and mobility devices created between $1.1 and $1.9 billion in Medicare savings from 2012 to 2017 by controlling unnecessary spending, according to a new...

MN Law Allows Some Patients to Override Payers on Step Therapy

by Thomas Beaton

Minnesota Governor Mark Dayton has signed a bill into law that allows patients and providers to execute overrides on payer step therapy programs for prescription drug treatments in certain clinical situations. HF 3196 requires payers to...

CMS: Medicare Part D Gag Clauses are “Unacceptable”

by Thomas Beaton

CMS Administrator Seema Verma has stated in a letter to health plan sponsors that CMS will no longer tolerate Medicare Part D gag clauses as the federal agency continues to promote prescription drug price transparency for...

MD Extends All-Payer Model, Targets $1B in Medicare Savings

by Thomas Beaton

Maryland Governor Larry Hogan and CMS have announced a five year extension of the state’s All-Payer Model, targeting an additional $1 billion in Medicare savings over the coming years, according to a public statement from...

Payers Express Enthusiasm for Prescription Drug Pricing Reforms

by Thomas Beaton

Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.   A number of influential organizations have offered commentary on the plan, including...

More Competition May Benefit Medicare Advantage Bidding Process

by Thomas Beaton

The Medicare Advantage (MA) bidding process requires more competition to increase the availability of high quality MA plans for beneficiaries and reduce federal spending, according to a new Brookings Institute report. Brookings analysts...

Managing Payer Challenges in the ACA Risk Adjustment Program

by Thomas Beaton

The implementation of the Affordable Care Act risk adjustment program has created a number of challenges - as well as some promising opportunities - for payers participating in the ACA marketplaces.   Under the ACA, payers can only...

CMS Approves Medicaid Work Requirements in New Hampshire

by Thomas Beaton

CMS Administrator Seema Verma has approved New Hampshire's request to implement Medicaid work requirements and change additional Medicaid rules related to member eligibility.  The approval makes New Hampshire the fourth state to...

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