Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Population Health Management

PCPs, Psychiatrists Much Less Likely to Accept Medicaid

February 6, 2019 - Primary care providers (PCPs) and psychiatrists are among the least likely professionals to accept Medicaid, leaving patients without some of the most fundamental resources for preventing or managing chronic diseases, according to recent data compiled by MACPAC. The Medicaid and CHIP Payment and Access Commission found that only 68 percent of general practice or family physicians...


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CMS to Expand Tailored Benefits for Medicare Advantage Plans

by Jennifer Bresnick

CMS is proposing significant changes to Medicare Advantage geared towards expanding choice and increasing competitiveness in a highly lucrative market. The proposals would increase the number and scope of supplemental benefits available...

After Buying Aetna, CVS Health Commits $100M to Address SDOHs

by Jennifer Bresnick

With its $69 billion acquisition of Aetna in the books, the newly expanded CVS Health is now investing heavily in developing and deploying new models to address community wellness and the social determinants of health (SDOH). The...

Government Shutdown Spares Medicare, Medicaid, But Has Other Impacts

by Jennifer Bresnick

The partial government shutdown will have no impact on Medicare and Medicaid at the federal level, CMS has stressed to industry observers. The nation’s public payers will continue to operate as normal, since funding for CMS is...

How Payers Can Improve the Value of Long-Term Support Services

by Thomas Beaton

Providing long-term support services (LTSS) impact commercial payers who need to address complications and billions in costs associated with this kind of care. In 2016, the United States spent $92.4 billion on home health care services...

CPC+ Model Offers Payers Insight into Population Health Management

by Thomas Beaton

CMS’s Comprehensive Primary Care Plus (CPC+) model may offer lessons and strategies for payers that want to increase primary care efficiency with population health management strategies. The CPC+ model is the nation’s largest...

First Steps for Payers Developing Value-Based Care Initiatives

by Thomas Beaton

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...

Rumors Swirl of Possible Walmart Acquisition of Humana

by Jennifer Bresnick

Walmart may be making a move to acquire Humana, one of the nation’s biggest health payers, according to The Wall Street Journal. Citing sources familiar with the matter – but without comment from Humana or Walmart – the...

Integrated Medical, Pharmacy Benefits Help Costs, Member Engagement

by Jennifer Bresnick

Integrating medical benefits with pharmacy benefits can help healthcare payers and employer sponsors lower spending, improve member engagement, raise satisfaction, increase care coordination, and manage population health – ticking...

CMS Uses Gender, Race For Quality of Care Medicare Study

by Jesse Migneault

The CMS office of Minority Health released a report with data on the quality of care received by Medicare Advantage (MA) enrollees by gender in four ethnic or racial categories.  The data generated by these reports was not used to...

Payers Offer 10 Ways to Improve Cost, Quality of Long-Term Care

by Jesse Migneault

The National Association of Insurance Commissioners (NAIC) issued ten long term care (LTC) federal policy recommendations to Congress.   The report was completed as part of the group’s Retirement Security...

Population Health Approach to Prenatal Care Cuts Payer Costs

by Jesse Migneault

Health insurance payers can improve patient outcomes and reduce spending by expanding the use of population health management models for expectant mothers.  Early intervention and preventive care can lower costs in high-risk birth...

Payers, Providers Collaborate to Combat Opioid Abuse, Addiction

by Jesse Migneault

Insufficient control of opioid prescriptions is one of the key reasons why opioid abuse and addiction have risen dramatically over the past few years.    To mitigate the epidemic, payers have developed programs to directly...

CMS Extends Pediatric Alternative Payment Model Comment Period

by Thomas Beaton

CMS will continue to take public comment on its pediatric alternative payment model (APM) initiatives until April 7, 2017.   In March, CMS issued a request for information (RFI) related to establishing an APM specifically focused on...

Can Value-Based Purchasing Work with Pharmaceutical Companies?

by Thomas Beaton

The Network for Excellence in Health Innovation (NEHI) believes that developing value-based purchasing contracts between payers and pharmaceutical companies will be a critical next step for healthcare reform. Having payer and pharma...

Org Offers 25-Point Plan for NJ Medicaid Program Improvement

by Jacqueline LaPointe

The New Jersey Health Care Quality Institute (NJHCQUI) recently partnered with the Nicholson Foundation to release a 25-point plan for modernizing and improving New Jersey’s Medicaid program. “The current program has too often...

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...

Are Bundled Payment Models or Capitation the Better Choice?

by Vera Gruessner

  Today, healthcare payers have multiple ways to reimburse providers for performing medical services that move away from the traditional and more costly fee-for-service reimbursement system. Two such possibilities include capitation...

Value-Based Care Drives Progress in Population Health Management

by Vera Gruessner

Population health management is becoming a more prominent topic of interest among healthcare payers as they strive to transition to value-based care reimbursement and improve patient outcomes. A report from the Institute for Health...

Humana Advances Population Health Management, Value-Based Care

by Vera Gruessner

The health insurer Humana has been progressing with population health management and value-based care by partnering with the population health company FullWell in December 2016, according to a company press release. The partnership creates...

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