Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Interviews

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...

How to Prevent Healthcare Underuse in Bundled Payment Models

by Vera Gruessner

Value-based care reimbursement including bundled payment models or accountable care organizations may help medical providers and payers achieve the Triple Aim of Healthcare which is better patient care, stronger population health outcomes, and...

Long-Term Care has a Shorter Time Frame Due to ACA, CMS

by Vera Gruessner

The Affordable Care Act has impacted a variety of aspects of the health insurance landscape as well as the healthcare delivery system. The Patient Protection and Affordable Care Act also led to the Center for Medicare & Medicaid Innovation...

End-of-Life Counseling Sessions Stall despite Medicare Payment

by Vera Gruessner

Starting in January 2016, the Centers for Medicare & Medicaid Services (CMS) began reimbursing physicians for conducting end-of-life and advanced care planning discussions with patients who are Medicare beneficiaries. Doctors are able to...

State Medicaid Expansion Should Reduce Emergency Room Visits

by Vera Gruessner

The Patient Protection and Affordable Care Act brought a variety of changes for the healthcare industry as well as individual states. For example, the Affordable Care Act called on for Medicaid expansion among the 50 states. However, a Supreme...

Consumer Engagement Vital in Health Insurance Exchanges

by Vera Gruessner

The Patient Protection and Affordable Care Act has brought a variety of changes for both insurers and healthcare providers with the establishment of health insurance exchanges holding a top place in reforming reimbursement between payers and...

Why Health Insurance Claims Data Needs Medical Device ID

by Vera Gruessner

If health insurance companies truly want to improve patient health outcomes including the quality of care and boost patient safety in an effort to reduce wasteful spending, it may be beneficial for health insurance claims data to include medical...

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