Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Interviews

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...

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...

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