Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Spending

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...

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...

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...

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...

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...

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...

Pediatric Data Reveals Private Payer, Medicaid Spending Gaps

by Thomas Beaton

Private payers spend close to twice as much on pediatric services as Medicaid, according to a statistical brief from AHRQ, highlighting significant disparities in cost related to visit type and geographical region. Data from the 2015...

Payers Driving Value by Promoting Connected Care Models

by Thomas Beaton

As payers vie to remain competitive in commercial insurance markets, they must be able to effectively manage consumer costs while providing beneficiaries the best possible healthcare experience now and in the future. Rising healthcare...

Large Variations Seen in Consumer Healthcare Spending

by Thomas Beaton

As healthcare costs rise, beneficiaries will be more responsible for out-of-pocket healthcare expenses not covered by their health plans. But those costs drastically vary by state, family size and income, and other variables, according to...

Pharmaceutical Industry Slow to Embrace Value-Based Contracts

by Thomas Beaton

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...

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...

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...

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...

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...

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...

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...

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...

Top 10 Most Expensive Chronic Diseases for Healthcare Payers

by Thomas Beaton

Chronic diseases are on the rise in the United States, leaving healthcare payers with the challenge of covering care for patients with these expensive, long-term conditions. Chronic diseases are such a costly healthcare endeavor that...

Commercial Payer Prices Outpace Medicare, Medicare Advantage

by Jesse Migneault

Commercial payers charge significantly higher prices for common clinical services than Medicare fee-for-service (FFS) and Medicare Advantage plans, according to a new report from the Congressional Budget Office (CBO). Commercial insurers...

Healthcare Spending Growing at Slower Than Expected Rate

by Jesse Migneault

Expenditures on healthcare grew at a historically low rate between 2009 and 2013, according to a recent report, defying the conventional wisdom that healthcare spending has skyrocketed.  A Robert Wood Johnson Foundation report looked...

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