Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Interviews

How to Favorably Manage Risk in Value-Based Care Reimbursement

by Vera Gruessner

While downside risk does not incentivize providers to take part in value-based care reimbursement policies, data-driven technology and a combination of financial motivations may encourage physicians to transition to alternative payment models,...

Why Reviewing Pricing Trends is Key for Bundled Payment Models

by Vera Gruessner

When payers begin to adopt bundled payment models, they may find some challenges standing in their way to truly succeed within these alternative payment solutions. For example, when attempting to contract through bundled payments, it may be difficult...

How Payers Could Adjust to MACRA Regulations, Value-Based Care

by Vera Gruessner

MACRA regulations may seem overly complex and lengthy for the average medical practice but there are steps that providers can follow to succeed under MACRA’s quality payment program. Providers can work with payers to better identify similar...

How MACRA Legislation Advances Value-Based Care Reimbursement

by Vera Gruessner

MACRA legislation may play a major part in advancing the adoption of value-based care reimbursement among both payers and providers. CMS Acting Administrator Andy Slavitt emphasized this past May that MACRA legislation will bring real progress...

Health Insurance Exchanges Require Engagement, Narrow Networks

by Vera Gruessner

Since some private health payers are struggling with enrollment and the ability to make a profit on the health insurance exchanges, engaging consumers, reducing the administrative burden, and creating a narrow provider network will become an...

Blue Cross to Expand Value-Based Care Reimbursement in 2017

by Vera Gruessner

The coming years will further position the medical industry including payers to adopt value-based care reimbursement models and new healthcare delivery systems partially due to the reforms that came about from the Patient Protection and Affordable...

How Blue Cross Blue Shield Achieved Value-Based Care Payment

by Vera Gruessner

The transition to value-based care payment from fee-for-service payment methodology has come about due to the constant rise of healthcare spending. In fee-for-service, healthcare providers are incentivized to perform more services and offer often...

Medicare Diabetes Prevention Program Saves $2,650 per Patient

by Vera Gruessner

In March 2016, the Department of Health & Human Services (HHS) proposed the expansion of Medicare coverage for the Diabetes Prevention Program. The funding for this program comes from the Affordable Care Act and research shows that Medicare...

Data Analytics Key for Strengthening Employer-Payer Relationship

by Vera Gruessner

Health insurance companies, employers, and the workforce take a number of different steps to ensure that the best decisions are made in terms of health plan policies and covered benefits. For a variety of reasons, some businesses choose employer-sponsored...

Private Payers Falling Behind in MACRA Implementation, APMs

by Vera Gruessner

Earlier this month, the Department of Health & Human Services (HHS) announced the release of the finalized ruling for the MACRA legislation. Along with gutting the flawed Sustainable Growth Rate formula, MACRA legislation brings forward Advanced...

Commercial Payers Behind CMS in Bundled Payment Models

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) have heavily invested in pursuing bundled payment models as an alternative form of payment for medical care among Medicare beneficiaries. Commercial payers, however, have been more slow to...

Healthcare Payers Struggle with Price Transparency, Technology

by Vera Gruessner

Health insurance companies are still struggling with improving price transparency in order to gain greater trust from their consumer base. One survey has shown low customer service satisfaction and a need for payers to inform consumers on their...

Private Payers Follow CMS Lead, Adopt Value-Based Care Payment

by Vera Gruessner

Commercial payers are following the lead of the Centers for Medicare & Medicaid Services (CMS) when it comes to adopting value-based care payment protocols. More private payers have implemented various value-based CMS programs such as accountable...

Two Legal Arguments For and Against Health Insurance Mergers

by Vera Gruessner

In 2015, the national insurer Anthem began proceedings to acquire Cigna while Aetna planned to merge with Humana. Very quickly, opposition lined up against the two planned health insurance mergers, with some arguing that bringing the top five...

Revisions to Affordable Care Act May Improve Payer Performance

by Vera Gruessner

Health insurance executives have faced various regulatory challenges since the Patient Protection and Affordable Care Act was passed in 2010. Payers have had to participate in new health insurance marketplaces and face different restrictions...

How Healthcare Price Transparency Could Gain Consumer Loyalty

by Vera Gruessner

The lack of price transparency remains a major concern of consumers that healthcare payers will need to address in the coming years. A HealthEdge survey shows that 88 percent of polled consumers are looking for better price transparency from...

How Payers Could Meet Employer Needs in Bundled Payment Models

by Vera Gruessner

While the number of bundled payment models adopted by hospitals and payers is growing, implementation of value-based care is an innovative and modern idea that many healthcare providers are still unfamiliar with. For instance, bundled payments...

Marketplace Instability May Cause Affordable Care Act Reforms

by Vera Gruessner

While the Patient Protection and Affordable Care Act has decreased uninsurance rates to historically low levels, the healthcare law also led to higher premium costs and insurance rates among health plans sold on the health insurance exchanges....

49M Americans Risk Losing Fixed Indemnity Health Insurance

by Vera Gruessner

A new proposed rule called Expatriate Health Plans, Expatriate Health Plan Issuers, and Qualified Expatriates; Excepted Benefits; Lifetime and Annual Limits; and Short-Term, Limited-Duration Insurance may negatively impact access to fixed indemnity...

Top Three Ways Health Information Exchange Benefits Payers

by Vera Gruessner

When health payers and providers utilize health information exchange, they will make significant gains in reducing healthcare spending, reducing duplicative testing and services, and improving their use of preventive medical services, according...

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