Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Spending

Helping Payers Implement Value-Based Hospital Reimbursement

by Thomas Beaton

Hospitals generate some of the largest revenues and create exceptionally high costs for payers, which combine open the possibility for value-based hospital reimbursement programs to control spending.        In March...

Amazon, Berkshire Hathaway, JP Morgan to Name Healthcare CEO

by Thomas Beaton

The new Amazon, Berkshire Hathaway, and JP Morgan & Chase healthcare company will have its inaugural CEO in the next two weeks, Berkshire Hathaway’s CEO Warren Buffett told CNBC in an interview. Buffett was joined by...

Unstable Future Predicted for Medicare, Depletion by 2026

by Thomas Beaton

The Medicare Board of Trustees (MBT)’s latest report anticipates that Medicare’s Hospital Insurance (HI) Trust Fund will deplete by the year 2026 as Medicare spending continues to outgrow the trust’s collective...

Preventing Provider Fraud through Health IT, Data Analytics

by Thomas Beaton

Healthcare fraud is an industry-wide problem can impact a payer’s ability to protect their revenue streams and maintain financial integrity. Fraud costs the nation’s healthcare payers almost $68 billion annually. Between 3 and...

NYCHH Seeks $11.5M from UnitedHealthcare for Denied Claims

by Thomas Beaton

A New-York based health system has initiated arbitration with UnitedHealthcare in order to collect $11.5 million in denied reimbursement from claims. NYC Health + Hospitals, a public healthcare network that serves New York City’s...

First Steps for Payers Developing Value-Based Care Initiatives

by Thomas Beaton

Successful value-based care initiatives require payers to learn which populations experience a high prevalence of chronic disease, where their organizations overspend, and how value-based contracting can solve these problems. Carefully...

Pros and Cons of High Cost Sharing for Employer Health Plans

by Thomas Beaton

Employer-sponsored health plans that include high cost sharing expectations can help control spending for plan sponsors, but could create longer-term health risks for employee beneficiaries.   Striking the right balance between...

Medicaid Plans More Cost Effective, Stable than Exchange Plans

by Thomas Beaton

Medicaid health plans are more cost effective than federal exchange plans and could offer beneficiaries more affordable coverage options, according to a UnitedHealth Group analysis. UnitedHealth Group said that federal healthcare agencies...

Commercial Health Plan Customer Satisfaction Remains Steady

by Thomas Beaton

Commercial health plan customer satisfaction rates remained stable from 2017 to 2018, but payers still have a number of opportunities to improve their customer service and beneficiary education, according to a new JD Power consumer...

Medicaid Spending Drops When Members Transition to Community Care

by Thomas Beaton

Medicaid spending declined when beneficiaries transitioned from long-term institutional care into community care, a new report conducted by Mathematica Health Policy found. Researchers observed cost outcomes of Medicaid’s Money...

Medicare Advantage Data Transparency Can Enhance Insights

by Thomas Beaton

Expanding Medicare Advantage data transparency may allow researchers to gain more comprehensive insights into cost and quality within the popular MA program. Healthcare experts and academic organizations currently have limited Medicare...

Medicare Advantage, Premium Revenues Drive Q1 Payer Profits

by Thomas Beaton

Healthcare payers experienced strong first quarter profits in 2018 because of sharp growth in Medicare Advantage (MA) enrollment and premium revenues, according to newly released earnings statements. The reports confirm the stability and...

Short-Term Health Plans Lack Mental Health, Prescription Benefits

by Thomas Beaton

Short-term health plans generally lack mental health and prescription drug benefits and may create financial-based health insurance barriers for unhealthy beneficiary populations, according to a Kaiser Family Foundation (KFF)...

HHS Must Address Adverse Selection in Medicaid, Medicare Renal Care

by Thomas Beaton

AHIP is urging HHS secretary Alex Azar to address adverse selection related to Medicaid or Medicare end stage renal disease (ESRD) in order to ensure that vulnerable beneficiaries continue to receive appropriate healthcare services. AHIP...

High-Deductible Health Plan, HSA Enrollment Reached 21M in 2017

by Thomas Beaton

High-deductible health plan (HDHP) and health savings account (HSA) enrollment reached 21 million members in 2017, according to new research from AHIP.  These health plan options are expected to see continued growth in the near...

Rising Medical Costs Created Health Plan Enrollment Shifts in MN

by Thomas Beaton

The Minnesota of Council of Health Plans (MCHP) associated rising beneficiary medical costs in 2017 to irregular health plan enrollment shifts in both the private and public market. The Council said in a press release that a three percent...

CVS, Aetna Merger May Face Antitrust, Consumer Protection Issues

by Thomas Beaton

The American Antitrust Institute (AAI) has warned the Department of Justice (DoJ) that the proposed CVS and Aetna merger would violate consumer protections and damage competition in the healthcare industry. AAI believes that the merger of...

Aetna Will Apply Pharmacy Rebates to Prescription Drugs in 2019

by Thomas Beaton

Aetna has announced plans to automatically apply pharmacy rebates to eligible prescription drug benefits by 2019 in an effort to increase pricing transparency and control costs. Nearly three million Aetna members are likely to experience...

Payers Form Coalition to Address Social Determinants of Health

by Thomas Beaton

A group of commercial payers and other healthcare organizations have formed a coalition to explore how addressing the social determinants of health can lower care costs and improve outcomes. A number of large payer companies have joined...

Humana Bold Goal Targets Members’ Social Determinants of Health

by Thomas Beaton

Humana is improving the overall physical and mental health of its Medicare members by addressing social determinants of health and targeting problematic community health behaviors under its Bold Goal initiative. The Bold Goal 2018...

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