Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Spending

Pharmaceutical Industry Slow to Embrace Value-Based Contracts

September 21, 2017 - Sixty-one percent of pharmaceutical companies are not yet participating in value-based contracts due largely to the belief that current policies make it too difficult to negotiate with payers and see a return on investment, according to a PricewaterhouseCoopers report. Only 25 percent of pharmaceutical companies are participating in these contracts, and another 14 percent weren’t sure...


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Top 10 Healthcare Spending Categories in the United States

by Thomas Beaton

The upward trajectory of US healthcare spending doesn’t seem to be slowing down anytime soon, leaving payers, providers, and beneficiaries wondering how to control costs while maintaining a high level of quality. Value-based contracting...

More Payers, More Providers Increase Price Negotiation Power

by Thomas Beaton

Payers that operate within healthcare markets with a high concentration of payers and providers prices can negotiate the price of services up to 19 percent lower than those operating in low-concentration payer-provider markets, found a new study...

Pharmacy Benefit Manager Accountability is Key for Employers

by Thomas Beaton

As prescription drug costs continue to rise employers should ensure that they have strong pharmacy benefit manager (PBM) accountability measures in place to maximize cost-savings and plan efficiency, according to a report from the Midwest Business...

Cost of Implementing Quality Measures Key for Value-Based Care

by Thomas Beaton

Healthcare payers and providers must develop a better sense of the costs and burdens of implementing quality measures if they are to succeed with value-based care, according to the authors of a recent commentary in JAMA. Leaders from Boston Children’s...

How Preventive Healthcare Services Reduce Spending for Payers

by Thomas Beaton

Reducing healthcare spending is a multi-faceted challenge for payers that requires creative and innovative strategies like offering a wide range of preventive healthcare services in health plans. Payers that encourage beneficiaries to take advantage...

Small Employer Health Plan Quality on Par with Larger Groups

by Thomas Beaton

Small employer health plans can deliver similar levels of quality with many of the same cost controls as larger employers, according to new research from United Benefits Advisors (UBA). A “less is more” approach can provide significant...

Stop-Loss Insurance a Growing Market Opportunity for Healthcare

by Thomas Beaton

Even though payers may experience higher total revenues on commercial self-insurance, stop-loss and third-party protected insurance revenues have been growing at a higher rate with stronger market stability according to market research from AM...

Are Health Insurance Subsidies Enough for Low-Income Patients?

by Jesse Migneault

Despite financial penalties designed to prompt consumers to keep their health insurance, current efforts to subsidize care for low-income individuals may not be enough to incentivize patients, according to a recent study by economists at MIT...

Minn. Healthcare Payers Reported $687M in Financial Losses

by Thomas Beaton

Local healthcare payers in Minnesota reported financial losses of $687 million due to the rising gaps in premiums and healthcare spending. The Minnesota Council of Health Plans gathered statewide data from insurance companies and HMOs, and found...

Prescription Drugs Account for 22% of Payer Premium Spending

by Thomas Beaton

Prescription drug costs consume the largest proportion of dollars spent on healthcare premiums, with 22 cents out of every dollar going to medication costs, says AHIP in a new data brief. Eighty percent of every dollar is spent on medical expenses,...

Out-Of-Pocket Healthcare Spending on the Decline Since 2000

by Thomas Beaton

The Agency for Healthcare Research and Quality (AHRQ) reported that out-of-pocket healthcare spending decreased for all age groups between 2000 and 2014. A statistical brief of the report presents data from the Household Component of the Medical...

Impact of Wage Level Variation on Employer-Sponsored Plans

by Thomas Beaton

Findings from a recent study of healthcare utilization and spending by four self-insured employers show a correlation between wage levels and the types of services received. Based on data on 42,936 employees at four self-insured employers that...

Aetna, Humana, Harvard Pilgrim Target Patient Health Outcomes

by Vera Gruessner

Commercial health insurance companies have pursued a number of different approaches to improve patient health outcomes and reduce wasteful medical spending. The payers Aetna, Humana, and Harvard Pilgrim conducted some key collaborations to achieve...

How Healthcare Payers Could Reduce Wasteful Spending

by Vera Gruessner

For many years, the health insurance industry has been working to address wasteful spending among hospitals and medical practices. Some of the areas of wasteful spending relate to duplicative medical testing, unnecessary diagnostics, and excessive...

CMS Cuts Wasteful Medical Spending, FFS Improper Payments

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has reduced the Medicare fee-for-service improper payment rate from last year’s 12.1 percent to 11 percent in 2016, The CMS Blog reports. CMS has dedicated itself in recent years to...

Deductibles, Out-of-Pocket Healthcare Spending Rose 3% in 2015

by Vera Gruessner

Healthcare spending within the private health insurance market has grown 4.6 percent in 2015, according to a press release from the Health Care Cost Institute (HCCI). This type of growth in spending is higher than in recent years. For instance,...

How Investing in Social Services Could Cut Healthcare Spending

by Vera Gruessner

While healthcare spending is continually increasing, patient outcomes and overall health has not necessarily improved greatly, according to a report from Leavitt Partners and the Robert Wood Johnson Foundation. However, the study also...

4 Ways Health Payers Could Decrease Medical Spending Growth

by Vera Gruessner

Health insurance companies are often looking for key methods and best practices to reduce rising healthcare costs. Payers could avoid the continual increase in medical spending by reducing the rates of unnecessary and duplicative services, adopt...

Affordable Care Act Payment Program Boosts Care, Cuts Costs

by Vera Gruessner

The Patient Protection and Affordable Care Act has a wide variety of reforms that have been implemented to improve care for American citizens. One of these reforms includes a payment model called the Independence at Home Demonstration operated...

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