Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Policy

Proposed Rule in Oklahoma Impacts Costs of Prescription Drugs

by Vera Gruessner

In recent months, scandals associated with the costs of prescription drugs have made headlines. About seven out of 10 Americans are currently enrolled in a health insurance plan that covers costs of prescription drugs. Prescription drug plans...

CMS Releases Medicare Data for Quality-Based Metrics

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) is further attempting to innovate and improve medicine through quality-based metrics, as the CMS Office of Minority Health has released new data that provides more information on the quality...

64% of Polled Doctors Plagued by Rising Medical Spending

by Vera Gruessner

The health insurance industry needs to continue addressing rising healthcare costs and the increases in spending among hospitals and the pharmaceutical field. Many stakeholders within the healthcare space find that high rates of medical spending...

$120 Million Settlement Ends Medical Claims Processing Failure

by Vera Gruessner

One medical claims processing technological project has been put to rest in the state of California. This project began in 2007 and has still failed to be completed, according to the California Healthline publication. The medical claims processing...

How the Affordable Care Act Strengthened Mental Health Parity

by Vera Gruessner

The Obama administration's Affordable Care Act has brought various benefits to the American people including greater health coverage through the health insurance exchange and Medicaid expansion. Young adults under 26 years of age can now...

How CMS Could Boost Operation of Accountable Care Organizations

by Vera Gruessner

Accountable care organizations (ACOs) have become a more mainstream method for improving care coordination and the quality of medical services while providing an opportunity for reducing wasteful spending. For instance, St. John Health System’s...

CMS Ruling Changes Medicare Advantage and Part D Programs

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced in a press release new changes taking place for the Medicare Advantage and Part D Prescription Drug Program starting in 2017. Essentially, these deviations are meant...

How the Affordable Care Act has Impacted Health Payers

by Vera Gruessner

The Affordable Care Act has  brought a significant reform toward the health insurance industry. This particular legislation has given the majority of American people healthcare coverage, which has put greater strain on health insurers. For...

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...

HHS Issues Medicare Coverage Expansion for Diabetes Prevention

by Vera Gruessner

One of the most common chronic medical conditions found today is that of diabetes. Healthcare providers and payers need to work together to find ways that could help reduce the rates of diabetes nationwide. Recently, the Department of Health...

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...

Medicaid Coverage Expansion Boosts Healthcare Access in Flint

by Vera Gruessner

In April 2014, contamination in drinking water began in Flint, Michigan when the region transitioned its water source to the Flint River from its previous source of Lake Huron and the Detroit River. The problem at hand is that corrosion control...

Open Enrollment Dates Announced for Health Insurance Exchange

by Vera Gruessner

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released its yearly Notice of Benefit and Payment Parameters related to the coverage options on the federal health insurance exchange in 2017. The rulings outline ways...

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...

How New Policies Impact Healthcare Spending and Access

by Vera Gruessner

The Health Care Cost Institute (HCCI) announced today the publication of six different policy briefs entailing how state and federal regulations are affecting healthcare spending and patient services. Independent researchers used HCCI’s...

Healthcare Bundled Payments, Silver Plan Changes Impact Payers

by Vera Gruessner

The federal government especially the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have targeted healthcare payment reform in an effort to reduce rising medical costs around the nation....

Sanders’ Universal Healthcare Coverage May Have Pitfalls

by Vera Gruessner

In the coming Presidential election, health payers have plenty to consider, as most candidates propose significant policy changes from universal healthcare coverage to repealing the Patient Protection and Affordable Care Act. One candidate that...

More Part D Beneficiaries Gain Access to Cost-Sharing Pharmacies

by Vera Gruessner

Healthcare access among Medicare and Medicaid beneficiaries remains a top priority for the Centers for Medicare & Medicaid Services (CMS). In 2015, CMS listened to the concerns of many beneficiaries and discovered that many do not have efficient...

The Affordable Care Act could Decrease Chronic Disease Rates

by Vera Gruessner

Needless to say, healthcare reform and the Affordable Care Act have revolutionized many avenues of the health payer industry. The individual mandate along with Medicaid expansion and federal tax subsidies on the health insurance exchanges have...

HHS Cites Affordable Care Act Led to Prescription Drug Savings

by Vera Gruessner

Yesterday the Department of Health and Human Services (HHS) announced that millions of Medicare beneficiaries continue to see benefits from the Affordable Care Act especially with regard to their savings with prescription drugs. Approximately...

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