Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Patient Outcomes

Pharmaceutical Industry Slow to Embrace Value-Based Contracts

September 21, 2017 - Sixty-one percent of pharmaceutical companies are not yet participating in value-based contracts due largely to the belief that current policies make it too difficult to negotiate with payers and see a return on investment, according to a PricewaterhouseCoopers report. Only 25 percent of pharmaceutical companies are participating in these contracts, and another 14 percent weren’t sure...


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Veterans Gained Coverage under ACA, but May Lose Big from Repeal

by Thomas Beaton

While the Affordable Care Act (ACA) produced significant coverage gains for veterans, currently proposed repeal actions could hit this population particularly hard, according to a study from RAND Corporation. Prior to the ACA, 9.1 percent of...

AHIP: Permanently Renew Medicare Advantage Special Needs Plans

by Thomas Beaton

Congress should consider a permanent renewal of the Medicare Advantage Special Needs Plans (SNPs) because of the consumer protections they provide and their market implications, AHIP wrote in a letter to the House of Representatives. A permanent...

Cost of Implementing Quality Measures Key for Value-Based Care

by Thomas Beaton

Healthcare payers and providers must develop a better sense of the costs and burdens of implementing quality measures if they are to succeed with value-based care, according to the authors of a recent commentary in JAMA. Leaders from Boston Children’s...

How Preventive Healthcare Services Reduce Spending for Payers

by Thomas Beaton

Reducing healthcare spending is a multi-faceted challenge for payers that requires creative and innovative strategies like offering a wide range of preventive healthcare services in health plans. Payers that encourage beneficiaries to take advantage...

Employers Must Prepare Retirees for $275K in Expected Care Costs

by Thomas Beaton

Employers are starting to prepare and educate retirees for expected post-retirement care costs of $275,000, according to market analysis published by Fidelity Investments. The analysis found a 6-percent increase in costs over a similar report...

Socioeconomic Data Improves Public Health, Payer Programs

by Thomas Beaton

CMS programs recognize that the social determinants of health (SDOH) play a large role in the health of their beneficiaries and, when neglected, can create negative health implications for beneficiaries covered by Medicare, Medicaid, and CHIP....

Harvard Pilgrim Enters Outcomes-Based Pharmaceutical Contracts

by Jesse Migneault

Harvard Pilgrim Health Care has signed a three-year value-based care contract with drug maker AstraZeneca for two therapies used to treat acute coronary disease and type 2 diabetes. The arrangements will use patient outcomes as a measure of the...

GAO Report: VA Benefits Appeals Process in Need of Reform

by Thomas Beaton

The Government Accountability Office (GAO) has identified notable inefficiencies in the VA benefits appeals process which have resulted in an average processing wait time of three years.   In its report on the issue, GAO also makes several...

Out-Of-Pocket Healthcare Spending on the Decline Since 2000

by Thomas Beaton

The Agency for Healthcare Research and Quality (AHRQ) reported that out-of-pocket healthcare spending decreased for all age groups between 2000 and 2014. A statistical brief of the report presents data from the Household Component of the Medical...

Healthcare Leaders Air Concerns about NQF SDS Trial Period

by Thomas Beaton

A group of healthcare organizations wrote a letter to the National Quality Forum (NQF) calling for a one-year extension of the Sociodemographic (SDS) Trial Period that evaluates how social factors impact a hospital's or provider’s ability...

Emergency Coverage Top Healthcare Consumer Demand For Payers

by Thomas Beaton

A new poll from the American College Of Emergency Physicians (ACEP) and Morning Consult found that 95 percent of healthcare consumers say payers should cover emergency services. Out of the 1,791 healthcare consumers surveyed, about 31 percent...

Patient Satisfaction Key for Payer Measurement of ACO Quality

by Thomas Beaton

An article from the American Journal of Managed Care reveals that patient satisfaction within an accountable care organization (ACO) is a strong indicator of the care quality level the organization delivers, giving payers an opportunity to use...

Wait Times Still High for Veterans in VA Choice Program

by Thomas Beaton

Research from the Government Accountability Office (GAO) found that veterans waited an average 24 days to receive care at any care facility that is administered by the Veterans Choice Program. The program allows veterans to receive care from...

Researchers Expect ACA Repeal Adverse Effects on Uninsured

by Thomas Beaton

Authors of a recent viewpoint published in the Journal of the American Medical Association foresee health and financial risks the uninsured patient population following a partial or complete repeal of the Affordable Care Act (ACA). “The...

Impact of Wage Level Variation on Employer-Sponsored Plans

by Thomas Beaton

Findings from a recent study of healthcare utilization and spending by four self-insured employers show a correlation between wage levels and the types of services received. Based on data on 42,936 employees at four self-insured employers that...

Two-Sided Financial Risk Model Reduces Socioeconomic Disparities

by Thomas Beaton

A two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. Disadvantaged patients receiving...

How to Reduce Obesity Rates, Increase HEDIS Quality Scores

by Vera Gruessner

When attempting to improve provider performance on HEDIS quality scores, healthcare payers may need to pick and choose the quality measures that could be realistically raised. For example, childhood obesity may be one of the most common health...

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...

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