Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Interviews

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it has had a variety of proponents as well as opposition from the GOP with many calling on the healthcare law to be repealed.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...

How the Affordable Care Act Influenced CORE Certification

by Vera Gruessner

Health plans, vendors, and providers will need to meet CORE certification requirements in order to comply with mandates under the Patient Protection and Affordable Care Act. CORE stands for Committee on Operating Rules for Information Exchange...

Major Health Insurance Mergers May Leave Consumers “Worse Off”

by Vera Gruessner

Four of the top five major payers in the nation are looking to consolidate into two combined health insurance companies. The Anthem-Cigna and Aetna-Humana health insurance mergers could lead to a complete transformation of the market and impact...

The Role Risk Plays in Value-Based Care Reimbursement Models

by Vera Gruessner

The expansion of value-based care reimbursement is making headway across US hospitals and clinics. To better prepare for the transition to value-based care reimbursement, IDC Health Insights, a healthcare IT consulting company, offers advice...

Top 6 Factors for Success in Provider-Sponsored Health Plans

by Vera Gruessner

The health insurance industry may have a complete transformation on their hands with regard to hospital and medical practice reimbursement. The number of provider-sponsored health plans is growing among physician groups and hospitals, according...

‘Data is Key’ to Cut Healthcare Spending, Boost Engagement

by Vera Gruessner

A major goal among health payers today is to decrease continually rising healthcare spending. One way to do so is to identify patients who are at higher risk of deteriorating medical conditions and looking to engage with their provider to improve...

Humana’s Top Suggestions for Operating Bundled Payment Models

by Vera Gruessner

The major health payer Humana will be moving toward adopting additional bundled payment models that will serve Humana Medicare Advantage members. The payer will be partnering with four orthopedic specialty establishments through these bundled...

Key Ways Blue Cross Blue Shield Raises its HEDIS Scores

by Vera Gruessner

The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of all health plans situated around the country to compare performance and year-to-year success. HEDIS scores allow health plans to determine where...

Coordination, Interoperability Key for MACRA Requirements

by Vera Gruessner

Last month, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will essentially drop meaningful use requirements in favor of the Merit-based...

Is the Health Insurance Industry Heading on a ‘Death March?’

by Vera Gruessner

The health insurance industry has been undergoing tremendous reforms in recent years due to new federal regulations including the Affordable Care Act. Reimbursement between payers and providers have been changing as well. Coverage for the majority...

Why Cigna Succeeds in Value-Based Care Reimbursement Model

by Vera Gruessner

Earlier this month, the mobile technology company athenahealth released its annual PayerView Report, which delves into the complex and evolving relationship between payers and providers, according to a company press release. This report offers...

NY’s Medicaid Payment Reforms Aim to Reduce Hospital Use

by Vera Gruessner

The state of New York is undergoing significant payment reforms within its Medicaid program. In 2014, Governor Andrew Cuomo finalized negotiations with federal agencies to create a waiver that would allow New York to renew $8 million in federal...

Service-Based Organization Strengthens Population Health

by Vera Gruessner

Blue Cross Blue Shield of Arizona (BCBSAZ) has recently partnered with McKesson Business Performance Services to form a service-based organization called ACO Partner meant to function in the evolving value-based care reimbursement environment...

Are Skilled Nursing Facilities Fraudulently Billing Medicare?

by Vera Gruessner

Skilled nursing facilities are an essential part of improving the health among the elderly and the disabled. However, some skilled nursing facilities and rehabilitation centers have taken advantage of Medicare beneficiaries by fraudulently billing...

What will the Future Bring for the Affordable Care Act?

by Vera Gruessner

The future of the Affordable Care Act and health insurance exchanges may not be as favorable as the Obama administration had hoped. Many fear that the major health insurer UnitedHealthcare leaving the state-based exchanges could lead other payers...

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