Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Interviews

Lack of Price Transparency Leading Employers to Self-Insure

by Vera Gruessner

Some employers are finding it difficult to keep contracting with their health payers due to continually increasing monthly premium costs and a general lack of price transparency across the health insurance industry. As such, the notion of a company...

Primary Care, Coordination Drive Accountable Care Organizations

by Vera Gruessner

Within the new value-based care payment strategies being developed among healthcare providers, payers, and government agencies, accountable care organizations (ACOs) continue playing an important role in bringing greater quality improvements...

Did Aetna Need Merger to Stay in Health Insurance Exchanges?

by Vera Gruessner

More and more payers are slowly dropping out of the Affordable Care Act’s health insurance exchanges. Earlier this year, UnitedHealth formally announced the decision to discontinue selling plans on the health insurance exchanges. More recently,...

How Risk Adjustment Challenges the Health Insurance Market

by Vera Gruessner

Ever since the provisions of the Patient Protection and Affordable Care Act came into effect on January 1, 2014, healthcare payers have been unable to deny health insurance or charge larger premium costs to those with pre-existing conditions....

Cigna Boosts Outcomes Despite Affordable Care Act Obstacles

by Vera Gruessner

With many health payers experiencing significant challenges while operating through the health insurance exchanges and adhering to various provisions of the Patient Protection and Affordable Care Act, it grows more important than ever before...

Aetna Leaving Health Insurance Exchanges Due to DOJ Lawsuit

by Vera Gruessner

The latest news coming from the major health payer Aetna is its move to drop out of the majority of the health insurance exchanges it had been participating in this year. According to a press release from Aetna, it will leave most of the public...

Price Transparency Key Issue Among Health Payers and Employers

by Vera Gruessner

The movement toward price transparency is gaining strength as healthcare reform continues to stress consumer and patient satisfaction. Employers have been seeking ways to improve price transparency for their employees when working with partnering...

How to Educate Employers on Value-Based Care Reimbursement

by Vera Gruessner

Value-based care reimbursement is becoming a mainstay of the healthcare industry as hospitals, physician practices, and health insurance companies continue to incorporate alternative payment models. Many payers and providers have pursued bundled...

How Presidential Election will Impact the Affordable Care Act

by Vera Gruessner

For months now, the media has been broadcasting 24 hours per day, seven days a week news related to the upcoming presidential election. Many have postulated on how the nation will be impacted if either the Republican Party or the Democratic Party...

3 Key Strategies for a Successful Payer-Provider Relationship

by Vera Gruessner

What are the key ingredients that health insurance companies need to integrate in order to have a successful payer-provider relationship? There are a number of steps that payers and providers will need to follow in order to improve their working...

How Accountable Care Organizations Use Preventive Services

by Vera Gruessner

What accomplishments have accountable care organizations (ACOs), providers, and payers reached in their effort to operate value-based reimbursement systems? This is the question that many ACOs are answering today. With value-based care reimbursement...

Affordability, Cost Transparency Key for Patient Satisfaction

by Vera Gruessner

The biggest healthcare reforms impacting health payers today include the movement toward consumer engagement and patient satisfaction. Patient advocacy groups are bringing more attention toward keeping the patient voice at the center of healthcare...

Why Value-Based Care Reimbursement Needs Risk Adjustment

by Vera Gruessner

The Patient Protection and Affordable Care Act is a very complex piece of legislation that covers a wide range of provider and payer issues. Several not commonly discussed factors include the ACA’s impact on risk adjustment and risk selection....

Cost Shifting to Consumers May Reduce Patient Satisfaction

by Vera Gruessner

Consumer choice, patient satisfaction, and out-of-pocket spending is becoming a more pressing issue in the new political climate caused due to a blossoming of healthcare reforms. Within this new landscape, a new coalition called Partners for...

Medicare’s Hospital Insurance Trust Fund May Deplete by 2028

by Vera Gruessner

The Medicare program may be in trouble with regard to its financial standing. The latest Medicare Trustees report found that the Hospital Insurance Trust Fund may be depleted in as little as six more years. The longest it is expected to last...

Why GOP Should Hold Off on Replacing the Affordable Care Act

by Vera Gruessner

When the Patient Protection and Affordable Care Act was passed into law, it has had a variety of proponents as well as opposition from the GOP with many calling on the healthcare law to be repealed. However, repealing the Affordable Care Act...

Accountable Care Organizations Rely on Population Health Data

by Vera Gruessner

Accountable care organizations (ACOs) are slowly becoming a mainstay of the healthcare industry, as more payers and providers are partnering through these care coordination programs and negotiating value-based reimbursement contracts. However,...

Communication, Cost Transparency Impact Patient Engagement

by Vera Gruessner

Patient engagement is becoming a more and more relevant term in today’s changing healthcare landscape. With more consumers than ever before becoming responsible for their healthcare costs via high-deductible health plans and out-of-pocket...

How Quality Metrics Affect Value-Based Care Reimbursement

by Vera Gruessner

In today’s changing healthcare landscape, public and private health payers are attempting to investigate new payment models in order to reduce the continually rising medical spending. Whether it’s bundled payments or accountable care...

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 spending...

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