Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Population Health

First Steps for Payers Developing Value-Based Care Initiatives

May 24, 2018 - Successful value-based care initiatives require payers to learn which populations experience a high prevalence of chronic disease, where their organizations overspend, and how value-based contracting can solve these problems. Carefully assessing value-based care opportunities, implementing analytics strategies that can accurately identify opportunities, and monitoring success with...


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NQF Aims to Improve Medicaid Use of Social Determinants Data

by Thomas Beaton

Collaborating with public health and community organizations to foster informed decision-making can help Medicaid entities better address the social determinants of health (SDOHs), says new guidance issued by the National Quality Forum...

How Provider-Sponsored Health Plans Can Find Consumer Success

by Thomas Beaton

Provider-sponsored health plans (PSHPs) are seen as a way for provider organizations to compete with commercial payers while lowering their own costs and improving care quality, because provider organizations can manage the cost of...

Payer Housing Programs Address Social Determinants of Health

by Thomas Beaton

Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services. A new report...

Payer Pricing, Partnership Strategies for Population Health

by Thomas Beaton

Effective population health management and comprehensive preventive care open the door to new opportunities that maximize payer spending, raise care quality, and slow the progression of costly chronic conditions such as diabetes and...

Medicaid Analytics Support Social Determinant Incentive Payments

by Thomas Beaton

Payers looking for innovative ways to control the costs of care have been turning their attention to the social determinants of health, the non-clinical factors that often lead to issues with care access, non-adherence, and the development...

BCBS Minnesota Launches Prediabetes Prevention Campaign

by Thomas Beaton

Blue Cross Blue Shield (BCBS) of Minnesota is launching a prediabetes prevention campaign to lessen the rate of diabetes in local communities, the payer announced in a press release. Titled “Reverse It,” the campaign focuses on...

Payer Collaboration Can Address Social Determinants of Health

by Thomas Beaton

Billions in overspending on medical costs are attributed to social determinants of health (SDOH), and SDOH can identify if beneficiaries covered by insurance plans are at risk for adverse health conditions outside their coverage. SDOH...

UnitedHealthcare of WI Grants $100K to Community Disability Groups

by Thomas Beaton

UnitedHealthcare Community Plan of Wisconsin awarded four non-profit community health organizations a total of $100,000 to enhance healthcare access and resources for individuals with disabilities. Lt. Gov. Rebecca Kleefisch of Wisconsin...

Humana Foundation Awards $735K To Improve Community Health

by Thomas Beaton

The Humana Foundation announced awards totaling $735,000 to help South Florida nonprofits to help improve community health. As part of the payer’s philanthropic pursuits, the grants are being awarded during their 2017 donation cycle...

Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut

by Jesse Migneault

A significant rollback of Medicaid coverage in Tennessee has led to a spike in late stage diagnosis for breast cancer, according to a new data analysis published in the American Cancer Society journal Cancer. The research team led by...

Managed Care Plays Key Role in Expanding Long Term Services

by Jesse Migneault

Due to legal and financial reasons, the past several decades have seen LTSS move from institutional settings to home or community based care, increasingly adopting the use of MCOs.  As states adopt the MCO system into their LTSS...

KY Medicaid Awarded for Exceeding Quality, Patient Care

by Jesse Migneault

Kentucky’s Anthem Blue Cross and Blue Shield Kentucky Medicaid has received an award from the National Committee for Quality Assurance (NCQA) for its Medicaid managed care plan.  The award recognizes the plan’s service...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

by Jesse Migneault

In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the...

Patient Incentives from Payers Encourage Preventive Care Visits

by Jesse Migneault

To reduce payer claim costs, would you pay members to go see their doctor once a year?  That’s the premise for a wave of patient incentive programs currently being offered by health insurance companies. For healthcare insurance...

Medicaid Waiver Adds More Beds For Drug Addiction Treatment

by Jesse Migneault

To circumvent an obscure Medicaid requirement, seven more states applied to join California, Maryland, Massachusetts and New York to receive a Medicaid waiver to expand drug addiction treatment.   Current federal policy prohibits...

Are Health Insurance Subsidies Enough for Low-Income Patients?

by Jesse Migneault

Despite financial penalties designed to prompt consumers to keep their health insurance, current efforts to subsidize care for low-income individuals may not be enough to incentivize patients, according to a recent study by economists at...

Tufts Health Plan Sees Opportunities as New RI Medicaid Option

by Jesse Migneault

Rhode Island will add Tufts Health Plan (THP) as its first new Medicaid option in seven years, according to the Rhode Island Executive Office of Health & Human Services (EOHHS).  The new program, RITogether, will allow...

Patient-Centered Medical Home Benefits Payers, Providers, Patients

by Jesse Migneault

Blue Cross-Blue Shield of Michigan has one of the nation’s most successful patient-centered medical home (PCMH) networks.  The model has improved patient outcomes, lowered payer costs and increased provider satisfaction and...

Medicaid Service Equals or Surpasses Private Health Payers

by Jesse Migneault

A new report by the Commonwealth Fund found that Medicaid provides equal or better quality health coverage to private health insurance plans.  The Commonwealth Fund’s 2016 Biennial Health Insurance Survey measured statistics...

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