Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Patient Safety

CAQH CORE Urges Industry Collaboration on Prior Authorizations

July 27, 2018 - CAQH CORE is urging healthcare payers, providers, and other stakeholders to promote industry-wide collaboration on how to improve prior authorizations. Leading provider and payer organizations, including AHIP, AHA, the BlueCross BlueShield Association, and MGMA, have already signed an agreement to reduce complexity and standardize the processes of prior authorization. “We are...


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CMS Offers Opioid Coverage, Health IT Guidance for Medicaid Plans

by Thomas Beaton

CMS has issued new opioid coverage strategies and health IT guidance to help states improve opioid safety within Medicaid plans. The guidelines include advice for state programs about treating infants with neonatal abstinence syndrome...

How Payers Address the Nation’s Opioid Crisis, Patient Safety

by Thomas Beaton

Commercial payers leverage community financing and engagement techniques to limit patient safety risks related to the nation’s opioid crisis. Payers find that contributing information to datasets can help stakeholders detect opioid...

BCBS Association: Use Alternative Pain Therapies Before Opioids

by Thomas Beaton

The BlueCross BlueShield Association (BCBSA) has announced a new professional standard that removes opioid prescriptions as a primary pain treatment in a majority of clinical situations. The payer’s National Council of Physician and...

Prior Authorization Issues Contribute to 92% of Care Delays

by Thomas Beaton

Prior authorization issues are associated with 92 percent of care delays and may contribute to patient safety concerns as well as administrative inefficiencies, according to a new survey from AMA. Payers should work to change their prior...

Payers Address Opioid Safety Via Education, $0 Narcan Co-Pays

by Thomas Beaton

Commercial payers are addressing the nation’s opioid crisis and promoting opioid safety by funding patient education programs and waiving Narcan co-pays to reduce barriers to access. Patient-centered strategies have allowed payers...

CA to Investigate Aetna after Insurance Claim Review Admission

by Thomas Beaton

The California Insurance Commission has opened an investigation into Aetna’s medical practices after a former medical director for the company testified in court that he did not review patient records before approving or denying...

AHIP: 25% of Opioid Prescriptions Top CDC Dosage Guidelines

by Thomas Beaton

An AHIP retrospective analysis of claims data found that 25 percent of opioid prescriptions were above CDC dosage recommendation and provides a basic snapshot of problematic areas where payers could minimize patient safety risks related to...

GAO: CMS Needs More Data to Manage Medicare Opioid Risks

by Thomas Beaton

The Government Accountability Office (GAO) has recommended that CMS should collect additional data on Medicare beneficiary opioid risks, including the number of beneficiaries with high-dose opioid prescriptions, the number of providers...

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

by Thomas Beaton

Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in...

BCBS Ohio Plans for Upping Patient ED Visit Costs Raise Concerns

by Thomas Beaton

BCBS of Ohio plans to charge beneficiaries the total cost of their emergency department visits  if a diagnosis suggests the visit wasn’t emergency-based, a policy which has been met with extensive concern from The American...

Consumers Support Laws to Limit Payer Prescription Switching

by Thomas Beaton

The vast majority of patients living with chronic diseases would support legislation to limit a payer’s ability to switch their prescriptions without medical necessity, according to a new series of surveys.   Ninety-four...

Aetna to Waive Narcan Co-Pays, Combat Opioid Overprescribing

by Thomas Beaton

Aetna will be the first national payer to waive Narcan co-pays for fully-insured members as part of a larger effort to address the nation’s opioid crisis, the payer announced in a press release. Narcan is considered a preferred...

AHIP Launches Initiative To Combat Nationwide Opioid Crisis

by Thomas Beaton

AHIP launched the Safe, Transparent Opioid Prescribing (STOP) Initiative to support health plans’ widespread adoption of clinical guidelines for pain care and opioid prescribing, and combat the national opioid crisis, the...

High-Deductible Health Plans Reduce Care Costs, Needed Services

by Thomas Beaton

High-deductible health plans (HDHPs) may reduce spending, but are also prone to preventing health care consumers from accessing necessary services and recommended preventive care, according to a study published in Health...

Medicaid Drug Pricing Rule May Inhibit Value-Based Contracts

by Thomas Beaton

A Medicaid drug pricing rule which safeguards deep discounts for the public program can potentially inhibit value-based contracts agreements between payers and pharmaceutical companies, according to research from the Journal of Health...

Medical Device Data, UDIs on Claims Impact Costs, Patient Safety

by Thomas Beaton

Adding medical device data and unique device identifiers (UDIs) to insurance claims could have a significant positive impact on healthcare spending and patient safety, according to reports from Pew Charitable Trusts, Brigham and...

Pre-Authorizations, Rx Limits Cut Opioid Abuse by 30% Nationwide

by Thomas Beaton

Anthem BlueCross BlueShield (BCBS) organizations across the country collectively pledged to lower opioid abuse by 30 percent, and the company as a whole reached that goal two years ahead of schedule according to a press release. Declared...

Opioid Use Fell 32% in CA BCBS Prescription Drug Safety Program

by Thomas Beaton

The Blue Shield of California Health Plan, an independent member of Blue Cross Blue Shield (BCBS), successfully lowered overall opioid use by 32 percent during the first two years of its Narcotic Safety Initiative (NSI).   The NSI...

Medicare Limitations on Diabetes Supplies Endanger Patients

by Thomas Beaton

Medicare’s Competitive Bidding Program (CBP) may increase the risk of negative patient safety events or medication nonadherence for diabetics by limiting the variety of available diabetes testing supplies, finds a survey by the...

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