Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Spending

Medicaid Can Increase Hospital Revenue Recovery by $500,000

February 14, 2019 - Hospitals could increase their revenue recovery from Medicare bad debt by as much as ten percent per year by identifying insured patients who are also eligible for Medicaid, according to a recent TransUnion Healthcare analysis.   This could translate to more than half a million in recovered revenue tied to both Medicare bad debt and Medicaid Secondary over a three-year period for...


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Medicare, Medicaid Best Private Plans for Containing Health Costs

by Jessica Kent

Medicare and Medicaid contain per enrollee health spending growth better than private insurance which likely indicates that recent policies will be key to sustaining this control, revealed a report conducted by the Urban Institute and...

Single Payer, Public Options Become Focus of Healthcare Debate

by Jennifer Bresnick

As the nation starts to turn its politics-weary eyes towards the 2020 election cycle, a new series of healthcare talking points are emerging, particularly from the left-hand side of the ideological spectrum. Terms like “single...

Payer Investment May Improve Delaware Primary Care Access

by Jessica Kent

Payers can expand primary care access in Delaware by progressively increasing primary care spending until it accounts for 12 percent of all healthcare investment, according to a report from Delaware’s Primary Care...

Verma: Price Transparency Rule a “First Step” for Consumerism

by Jennifer Bresnick

The hospital price transparency mandate that went into effect on January 1 is still ruffling feathers among healthcare providers, leading CMS Administrator Seema Verma to reiterate the importance of giving consumers access to pricing...

DOJ Recovers $2.5B in Healthcare Fraud, False Claims in 2018

by Jennifer Bresnick

2018 was a bad year to be a healthcare fraudster.  The Department of Justice (DOJ) has announced that $2.5 billion of the total $2.8 billion recovered under the False Claims Act can be attributed to fraud and improper claims from...

CVS Health to Begin Important Work of Integrating Aetna

by Kyle Murphy, PhD

On the eve of Christmas, Judge Richard Leon of the United States District Court for the District of Columbia decided against halting the integration of the two companies in a merger valued at $69 billion. “Based on CVS’s...

Does Medicare Advantage Bidding Hold the Key to Reducing Costs?

by Kyle Murphy, PhD

In light of future research on Medicare Advantage spending compared to Medicare fee-for-service, a trio of researchers writing on the Health Affairs blog see the promise in competitive bidding to drive down healthcare...

AHIP, Payer Groups Agree to Focus on Nixing Surprise Billing

by Jennifer Bresnick

Nine of the nation’s most influential payer organizations, including AHIP and the Blue Cross Blue Shield Association (BCBSA), have released a new set of guiding principles aimed at eliminating surprise billing. Unexpected medical...

CMS Reports Slowed Growth of National Health Spending in 2017

by Chuck Green

Last year, healthcare spending in the US jumped at an estimated rate of 3.9 percent to $3.5 trillion – or $10,739 per person, according to a new analysis from the Office of the Actuary at the Centers for Medicare and Medicare...

PBMs, Specialized Formularies Reduce Managed Care Prescription Costs

by Thomas Beaton

Pharmacy benefit managers (PBMs) with specialized drug formularies can help managed care payers significantly reduce prescription drug costs, according to new research published in the Journal of Managed Care and Speciality Pharmacy. The...

Private Insurance Spending Has Outpaced Public Spending Since 2016

by Thomas Beaton

Private insurance spending has grown faster than Medicare and Medicaid spending since 2016, even though national enrollment has plateaued, says a new report from Altarum. The report suggests that higher per-enrollee spending, plus...

How Payers Can Develop a Medication Therapy Management Program

by Thomas Beaton

As the cost of medication non-adherence reaches over $300 billion annually, payers are increasingly challenged to provide new solutions to address the healthcare and economic impacts of non-adherence. Payers could develop a medication...

NYCHH Triples Denials Recovery from UnitedHealthcare to $40.1M

by Thomas Beaton

NYC Health + Hospitals (NYCHH) has more than tripled the amount the health system is seeking in claims recovery from UnitedHealthcare, from $11.1 million to $40.1 million after a comprehensive case-by-case review of high-profile...

Montana Reinsurance Program May Cut Premiums Up to 20%

by Thomas Beaton

Montana is moving ahead with the idea of creating a reinsurance program for the state’s health insurance market.  The program may reduce premiums between 10 and 20 percent, said Governor Steve Bullock and Department of...

Risk Scoring, New Payment Models Can Reduce Medication Non-Adherence

by Thomas Beaton

Adopting new payment models, engaging in targeted risk scoring, and improving prior authorization processes may help payers address medication-non adherence among members with mental health concerns, says a report from the National Council...

Payers Play Crucial Role in Healthcare Quality Transparency

by Thomas Beaton

Payers will need to take the lead in being transparent about healthcare quality and costs in order to improve patient safety and reduce unnecessary spending, experts told the Senate HELP Committee. Payers can take a more proactive role in...

Consumers Struggle with Health Plan Finances, Healthcare Literacy

by Thomas Beaton

The majority of consumers with employer-sponsored health plans lack the necessary financial health literacy to optimally manage their health plan finances, according to a new report from Alegeus. As high-deductible health plans (HDHPs)...

Patient-Centered Medical Home Model Saved BCBS of MI $626M

by Thomas Beaton

BlueCross BlueShield of Michigan has reduced expected spending by $626 million over a nine-year period through a patient-centered medical home (PCMH) model that emphasizes personalized care. The payer found that the PCMH increased rates...

Employers Could See High Financial Returns for Mental Healthcare

by Thomas Beaton

More comprehensive coverage for mental healthcare could bring a financial return of four dollars for every one dollar spent by employers, says a report from the National Alliance of Healthcare Purchaser Coalitions (NAHPC). One in five...

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