Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Spending

Balance Billing Hits Patients with Surprise Healthcare Costs

by Jesse Migneault

Patients who received treatment within an in-patient network can still face surprise healthcare costs from balance billing. Balance billing occurs when an individual receives an unforeseen bill for treatment by an out-of-network provider,...

High Costs, Little Return are Hurting Health Insurers under ACA

by Jesse Migneault

High cost beneficiaries, risk adjustment methodologies, and insufficient capital are the top three issues facing health insurers today, according to MinuteMan CEO Tom Policelli.  As the national debate over the future of the ACA and...

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...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

Does Reference Pricing Reduce Costs of Diagnostics for Payers?

by Vera Gruessner

Health insurers and consumers can benefit from seeking reference pricing when it comes to choosing specific diagnostic tests among a set of different laboratories. Researchers from the University of Southern California and the Brookings...

Healthcare Spending Growth Hits 5.8% Yearly from 2015-2025

by Vera Gruessner

Healthcare spending may not be rising as quickly as in previous years, but it is still moving upwards. The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT) released a report last week that states the...

Consumer Healthcare Spending Trends Show Uptick in Engagement

by Vera Gruessner

Consumers today are becoming more and more responsible for covering the costs of healthcare services especially due to the greater proliferation of high-deductible health plans and out-of-pocket spending. What are the biggest healthcare...

How Pharmacy Benefit Managers Could Reduce Drug Cost Growth

by Vera Gruessner

From a health insurance perspective, more analysis needs to be taken into account when attempting to reduce healthcare spending. For instance, health payers may be interested in learning that pharmacy benefit managers (PBM) actually play a...

Healthcare Spending for Diabetes Patients Rose 6% in 2014

by Vera Gruessner

People who have to manage diabetes are in worse shape financially than those without the disease. The Health Care Cost Institute (HCCI) published a study showing that healthcare spending rates among diabetes patients with...

Ambulatory Surgery Centers Decrease Costs by $38 Billion

by Vera Gruessner

Health payers are often looking for ways to reduce healthcare spending, especially with regard to the costs of covering medical claims. Many have focused on implementing value-based care reimbursement structures like bundled payments while...

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