Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Interviews

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...

How Maternity Care Home Model Reduces Premature Birth Rate

by Vera Gruessner

The healthcare industry has often found it problematic and costly to manage the health of newborns and mothers of preterm births. There have been social problems among pregnant women that have led to higher rates of preterm births such...

Is Primary Care the Solution to Value-Based Care Challenges?

by Vera Gruessner

Transitioning to value-based care reimbursement and managing accountable care organizations (ACOs) comes fraught with specific challenges. Both reports from healthcare organizations and interviews with experts who’ve implemented ACOs tend...

How Accountable Care Organizations Meet Quality Benchmarks

by Vera Gruessner

Accountable care organizations (ACOs) are relatively new patient care models that can operate with either public or private health payers. Initially, the Centers for Medicare & Medicaid Services (CMS) created the first accountable care organizations...

How Medical Consortium Handles Value-Based Care Reimbursement

by Vera Gruessner

Healthcare organizations around the country have been revamping their strategies to keep revenue stable in the midst of changing healthcare payment models. Reforms have been aimed at helping providers adopt value-based care reimbursement. With...

URAC Stresses Accreditation in Medicare Physician Fee Schedule

by Vera Gruessner

This past July, the Centers for Medicare & Medicaid Services (CMS) released revisions to the Medicare Physician Fee Schedule for next year and placed the proposed rule on the Federal Register for display. CMS called on for payers, providers,...

How Healthcare Information Technology Boosts Member Engagement

by Vera Gruessner

Healthcare information technology and communication channels remain an imperative aspect of the relationship between health payers and their consumers. As the healthcare industry continues to reform toward a value-based care platform, new legislation...

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