Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Spending

Customer Service is Primary Driver of Health Plan Satisfaction

by Thomas Beaton

Health plan members are seeking high-quality customer service experiences from their insurers, and will use positive interactions to make decisions about continued loyalty, according to a new Forrester analysis emailed to members of the...

Value-Based Payment Adoption Drives 5.6% Reduction in Care Costs

by Thomas Beaton

Payers that implemented value-based payment models reduced healthcare costs by an average of 5.6 percent, improved provider collaboration, and created more impactful member engagement, according to a new study from Change Healthcare. The...

Automated Claims Administration Could Bring Billions in Savings

by Thomas Beaton

Automated claims administration could bring around $11 billion in savings to health plans and providers if the technology is implemented more broadly, according to the latest CAQH Index. Payers should encourage providers to adopt...

Quality Analytics, Risk Adjustment Tools Prep Payers for Success

by Thomas Beaton

Quality analytics and risk adjustment technologies are effective solutions for payers when these tools can structure claims and clinical information into actionable models, identify multiple risk indicators, and foster provider...

Humana, Roche Diagnostics Face $45M Federal Kickback Lawsuit

by Thomas Beaton

Humana and Roche Diagnostics will face a $45 million federal kickback lawsuit after a whistleblower filed a False Claims Act violation, which alleges Roche tried to entice Humana financially to secure access to the payer’s business...

Private Payers Deny Hepatitis C Drug Coverage to 52% of Members

by Thomas Beaton

Private payers denied Hepatitis C drug coverage to 52.4 percent of commercially insured beneficiaries from 2014 to 2017, according to new research from the Perelman School of Medicine at the University of Pennsylvania. Hepatitis C drug...

AHIP, BCBSA, AMA Join to Improve Public, Private Payer Ecosystem

by Thomas Beaton

The Partnership for America’s Health Care Future (PAHCF), a newly formed coalition, consisting of leading healthcare provider societies and payer organizations, has committed to strengthening the nation’s private and public...

BCBS of TX Delays Non-Emergency ED Claims Review Policy

by Thomas Beaton

BlueCross BlueShield of Texas has delayed implementation of a claims review policy that would require HMO members to pay the total cost of an emergency department visit if the encounter is later deemed to be a non-emergency, according to a...

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...

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