Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Spending

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

January 16, 2018 - Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in 2017. In 2016, opioid abuse was responsible for 42,000 deaths. Forty-percent of all deaths from an opioid overdose were from either a legally or illegally obtained...


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Considerations for Designing Consumer-Directed Health Plans

by Thomas Beaton

Employers and health plans are rapidly adopting consumer-directed health plans (CDHPs) as a way to lower benefit costs and encourage cost-effective care utilization among beneficiaries. CDHPs are becoming part of many US employers’ efforts...

Expanding Air Ambulance Service May Help Payers Control Costs

by Thomas Beaton

Expanding air ambulance benefits may help payers lower beneficiary premiums and help beneficiaries avoid several thousand dollars in out-of-pocket healthcare spending. An air ambulance costs between $12,000 to $25,000 per flight to account for...

Healthcare Insurance Market Profits May Hold Steady in 2018

by Thomas Beaton

Certain segments of the healthcare insurance market, including employer-sponsored insurance and Medicare Advantage (MA), will help to stabilize payer profitability in 2018, predicts a report by A.M. Best. The gains from these sectors are expected...

All-Payer Claims Databases Offer Insights into Healthcare Spending

by Thomas Beaton

All-payer claims databases (APCDs) allow payers, providers, and regulators to analyze claims from millions of beneficiaries to learn where spending is directed and whether or not spending on certain healthcare services is avoidable. State-level...

Member Engagement, Medicare Advantage Growth Top 2018 Payer Trends

by Thomas Beaton

2018 is a year in which payers are likely to implement strategies aimed at improving growth in Medicare Advantage markets, increasing the use of the social determinants of health  to improve outcomes, and expanding member engagement with...

CMS Asked to Bolster Value-Based Payment Models for Providers

by Thomas Beaton

The American Academy of Physicians, Aledade, the Texas Medical Association, Iora Health, and the Medical Group Management Association (MGMA) are among provider advocates urging CMS to create more opportunities for providers interested in value-based...

Consumers Support Laws to Limit Payer Prescription Switching

by Thomas Beaton

The vast majority of patients living with chronic diseases would support legislation to limit a payer’s ability to switch their prescriptions without medical necessity, according to a new series of surveys.   Ninety-four percent of...

Senate Hearing Opens Policy Discussion on Prescription Drug Costs

by Thomas Beaton

At a Senate HELP Committee hearing this month, policy experts and advocacy groups suggested several strategies that could lower prescription drug costs, including removing Medicare Part D cost-sharing, increasing federal oversight of the pharmaceutical...

Medicare Advantage, Consumer Engagement Top Payer Trends for 2018

by Thomas Beaton

Payers will face a number of industry challenges in 2018, including improving Medicare Advantage (MA) member satisfaction, expanding access to community outreach programs for individuals, and creating more drug pricing transparency for consumers,...

Member Engagement, Payer Spending Lead Top 10 Stories of 2017

by Thomas Beaton

The 2017 news cycle was a constant flurry of political and financial developments for payers. From the turbulent efforts to repeal and replace the ACA in the House and Senate to challenges with member engagement, population health, and cost cutting,...

2016 Healthcare Spending Growth Slowed, Totaled $3.3 Trillion

by Thomas Beaton

US healthcare spending totaled $3.3 trillion in 2016, representing a 4.3 increase in the spending growth rate since 2015. While spending continued to rise, the rate of increase was actually slower than the 5.8 percent growth rate between...

Most High-Deductible Health Plan Consumers Lack Financial Management

by Thomas Beaton

Less than half of high-deductible health plan (HDHP) consumers engage in positive financial management tasks such as negotiating costs for healthcare services or saving for future healthcare expenses, says a research letter published in JAMA...

The Pros and Cons of Pharmacy Benefits Managers for Payers

by Thomas Beaton

Prescription drug spending is a billion-dollar problem for the payer industry. While pharmacy benefit managers (PBMs) are often a positive way for payers to manage prescription drug benefits for their members, savings for payers can be limited...

How Payers Can Improve the Value of Small Business Health Plans

by Thomas Beaton

Payers offering insurance plans for the employer market need to provide flexible benefits and cost-saving strategies that create value for small businesses. Small businesses are an excellent market opportunity for payers because health plans...

Ensuring High Out-of-Pocket Spending Won’t Lead to Negative Outcomes

by Thomas Beaton

High deductible health plans (HDHPs) are intended to reduce payer and beneficiary spending on healthcare services, but untenable out-of-pocket spending for beneficiaries could lead to patients letting preventable conditions develop into catastrophic...

Employer Health Plans Can Engage Members with Data, Targeting

by Thomas Beaton

The use of data analytics and employee wellness engagement platforms may help employer health plans improve spending efficiency while producing a healthier, more productive workforce.    Employees are not always ready to take part in...

Single-Employee Businesses Experience High, Burdensome Premiums

by Thomas Beaton

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....

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...

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