Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Reform

Payers Express Enthusiasm for Prescription Drug Pricing Reforms

May 15, 2018 - 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 some of their own suggestions for how to best address the skyrocketing prices of prescription drugs.   In a document called “America’s Patients...


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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 believe...

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 integrate...

Verma: Patient Care, Payment Design Need Value-Based Reforms

by Thomas Beaton

Changes to patient care and payment design are required to further the progress of value-based care reforms within the healthcare industry, said CMS Administrator Seema Verma in a speech to the American Hospital Association (AHA). During the...

Uninsured Rate among Working Adults Rises to 15.5% in 2018

by Thomas Beaton

The uninsured rate of working adults ages 19 to 64 rose by more than 3 percent between 2016 and 2018, according to the Commonwealth Fund’s ACA Tracking Survey. In 2016, 12.2 percent of working adults lacked health insurance.  During...

CMS Proposes Value-Based Payment for Skilled Nursing Facilities

by Thomas Beaton

CMS has proposed to implement value-based payment reforms for skilled nursing facilities (SNFs) and other Medicare inpatient facilities in order to reduce fraud and create higher quality healthcare experiences for beneficiaries. The proposed...

CMS Releases Medicare Advantage Encounter Data to the Public

by Thomas Beaton

CMS has planned to release Medicare Advantage encounter data so that researchers and consumers have the ability to make informed opinions about the cost and healthcare outcomes of the MA program. The agency will allow researchers to access 2015...

CMS Aims to Catalyze Advancements in Consumer Price Transparency

by Thomas Beaton

A proposed rule that requires hospitals to post their standard service rates online is only the start of CMS efforts to advance consumer price transparency across the entire agency, according to CMS Administrator Seema Verma. Verma explained...

CMS Rule Ups Medicare Hospital Payments, Cuts Quality Measures

by Thomas Beaton

CMS has proposed a new federal rule that increases overall Medicare hospital payments while removing 19 quality measures in efforts to lower administrative burden to Medicare providers. The rule would also increase price transparency and provider...

AHIP Calls for Changes in Proposed Association Health Plan Policy

by Thomas Beaton

AHIP has issued a statement to CMS that calls for changes in the agency’s proposed rule on association health plan (AHP) and short-term plan policy to avoid unintentional disparities in health insurance access for individuals with pre-existing...

Payers, Orgs Provide Feedback on CMS Value-Based Care Reform

by Thomas Beaton

CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider accountability, chronic disease management, and...

Senate Bill Proposes Medicare Health Plan for All Ages

by Thomas Beaton

Senator Jeff Merkley (D-OR), with sponsorship from 11 other Democrats, has introduced a bill to create a Medicare health plan for all ages that would be offered in state and federal health exchanges, as well as the employer-sponsored market....

HHS Appoints James Parker to Address Health Insurance Costs

by Thomas Beaton

HHS Secretary Alex Azar has appointed James Parker as Senior Advisor to the Secretary of the Office of Health Reform to address healthcare challenges related to health insurance costs and health plan availability. Parker previously served as...

Health Plan Variety Does Not Boost Managed Medicaid Performance

by Thomas Beaton

Managed Medicaid performance does not increase as state Medicaid programs introduce more health plan variety, but a single health plan with value-based characteristics may be more effective in improving performance, a new JAMA commentary...

How Payers Can Succeed in Association Health Plan Markets

by Thomas Beaton

Association health plans (AHPs) may completely alter the nation’s health insurance markets with increasing support from federal entities and a handful of state insurance commissions. An expansion of the AHP market may materialize based...

Humana Expands Bundled Payment Model for Medicare Advantage

by Thomas Beaton

Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations. The payer has teamed up with orthopedic specialists to expand its Total Joint Replacement...

Experts Support Medicaid Work Requirements Lawsuit Against KY

by Thomas Beaton

A lawsuit that contends the legality of Medicaid work requirements in Kentucky has received support from 43 public health experts and 8 medical school deans who say the work requirements directly violate the Medicaid program. In an amicus brief,...

Policy, Market Changes May Harm Employer-Sponsored Insurance

by Thomas Beaton

Significant changes to the employer-sponsored insurance market, such as increasing medical costs, policy changes, and improvements in other payer markets may cause employers to stop providing health insurance An analysis from the American Health...

Proposed Rule Deregulates Medicaid Managed Care, Fee-for-Service

by Thomas Beaton

CMS has proposed a new rule that deregulates certain aspects of Medicaid managed care and Medicaid fee-for-service (FFS) programs in order to reduce regulatory burdens at the state level. The rule would exempt managed care programs from certain...

AL Medicaid Work Requirements Linked to Health Equity Challenges

by Thomas Beaton

Alabama’s proposed Medicaid work requirements are likely to lead to health equity challenges by inadvertently creating eligibility barriers for vulnerable populations, according to research from the Georgetown Health Policy Institute. Alabama...

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