Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Spending

Single-Employee Businesses Experience High, Burdensome Premiums

November 16, 2017 - Single-employee businesses paid an average of $500 per month on premiums, experienced high premium payment growth, and experienced polarizing financial burden based on their premium payment amounts, a new report from JPMorgan & Chase reveals. Single-employee health insurance premium payments (HIPP) grew at an average of 8.3 percent in 2016, while multiple employee-sponsored (20 or more...


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Payer Housing Programs Address Social Determinants of Health

by Thomas Beaton

Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services. A new report from the...

Value-Based Care Outperforms Fee-for-Service Health Plans

by Thomas Beaton

Health plans that include value-based care (VBC) principles are more cost-effective than fee-for-service (FFS) options and are starting to produce better patient outcomes, Humana asserts in a new report. The total healthcare costs associated...

44% of Employees Don’t Know Value of Health Plan Benefits

by Thomas Beaton

Employers must increase their efforts to educate members about the value of their health plan benefits based on recent findings that only 44 percent of employees fully comprehend their benefits. That is the leading takeaway from research published...

Top 4 Consumer Wellness Benefits for Payers to Add to Health Plans

by Thomas Beaton

As payers explore innovative ways to improve beneficiary engagement and satisfaction, they may wish to consider adding enhanced consumer wellness benefits to their health plan offerings. Health plans that take a proactive approach to engaging...

Why the Generic Drug Market is a Growing Payer Opportunity

by Thomas Beaton

As payers try to ease the rising costs of prescription drugs, which account for 10 percent of national healthcare spending, they may wish to turn to the generic drug market to help curb unnecessary spending and improve profitability.   Generics...

How the Medicare Advantage Market Can Offer Payer Opportunities

by Thomas Beaton

Medicare Advantage (MA) market data from A.M Best and the Kaiser Family Foundation reveals that the MA market has remained profitable and provides financial opportunity, but payers looking to enter into the market should expect to address developing...

Only 30% of Employers Get Pharmacy Benefit Manager Contracts

by Thomas Beaton

Only 30 percent of employers have a complete understanding of their pharmacy benefit manager (PBM) contracts, according to a new survey from the National Pharmaceutical Council (NPC). Just 40 percent of the 88 employers participating in the survey...

AMA: Payers Operate in Extremely High Concentrated Markets

by Thomas Beaton

Payers have significant control of their respective healthcare markets as 69 percent of payers offering HMO, PPO, POS, and public health exchanges operate in very high concentrated markets, AMA found in a study of national insurance markets....

Medicare Consumers Prefer Phone Calls from Health Plans

by Thomas Beaton

Medicare consumers tend to prefer traditional phone calls or mailings over digital engagement strategies such as text messaging or using a member portal, according to a new Healthmine survey. Forty-eight percent of Medicare consumers aged 65...

What are the Pros and Cons of Consumer Directed Health Plans?

by Thomas Beaton

In recent years, payers have been extending their consumer-directed health plan (CDHP) offerings as a way to encourage health plan enrollment and save on healthcare costs. Many healthcare stakeholders see CDHPs as products that create mutual...

Anthem Adds Home Meal Delivery to Medicare Advantage Plans

by Thomas Beaton

Anthem is offering home meal delivery service to its post-discharge Medicare Advantage plan members in  in several states including Georgia, Kentucky, Missouri, and Wisconsin the payer announced. Anthem is partnering with GA foods to provide...

Payer Strategies for Boosting Consumer Engagement, Satisfaction

by Thomas Beaton

In an increasingly competitive health insurance environment, payers that can successfully increase consumer engagement and beneficiary satisfaction will be best positioned for success. David Biel, the US Leader for Health Plans consulting at...

Quality Measures Challenging in Pharmaceutical Value-Based Contracts

by Thomas Beaton

Healthcare payers may find it difficult to establish value-based contracts (VBCs) with pharmaceutical companies due to the challenges of creating meaningful, workable quality measures.   Pharmaceutical companies are generally reluctant to...

How to Create Balanced Risk Pools that Lower Premiums

by Thomas Beaton

Payers have been increasingly challenged to manage the high cost of healthcare while lowering the premiums their beneficiaries pay.  Creating balanced risk pools that benefit medically complex individuals while also serving healthier consumers...

Employer Insurance Enrollment, Member Engagement Stagnated in 2016

by Thomas Beaton

Growth in employer-sponsored insurance enrollment and certain measures of member engagement did not significantly increase in 2015 and 2016, according to the Medical Expenditure Panel Survey (MEPS) released by AHRQ. There was no significant change...

High-Deductible Health Plans Reduce Care Costs, Needed Services

by Thomas Beaton

High-deductible health plans (HDHPs) may reduce spending, but are also prone to preventing health care consumers from accessing necessary services and recommended preventive care, according to a study published in Health Affairs. High-deductible...

80% of Payers Investing in Member Engagement, Satisfaction

by Thomas Beaton

Eighty percent of health plans are focusing on improving member engagement and consumer satisfaction, according to a survey by Change Healthcare.   Member engagement is a growing opportunity for payers because of the potential improvements...

Medical Device Data, UDIs on Claims Impact Costs, Patient Safety

by Thomas Beaton

Adding medical device data and unique device identifiers (UDIs) to insurance claims could have a significant positive impact on healthcare spending and patient safety, according to reports from Pew Charitable Trusts, Brigham and Women’s...

Beneficiary Segmentation, Spending by Healthcare Payer Type

by Thomas Beaton

Healthcare spending in the US continues to grow steadily across all beneficiary segments and healthcare payers. 2015 data from CMS, the CDC, and the Kaiser Family Foundation (KFF) indicates that payers and individuals sponsoring their own healthcare...

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