Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Preventive Care

Anthem Medicare Advantage Members Can Use OTC Allowance at CVS

January 15, 2019 - Anthem Blue Cross (Anthem) Medicare Advantage members in California will now be allowed to purchase over-the-counter products at CVS Pharmacy stores using their health plan allowance. The partnership, launched on January 1, is intended to make it simpler and easier for older beneficiaries to engage in self-care in a cost-effective manner. Beneficiaries can purchase first aid supplies,...


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Employer Wellness Programs Reduce Costs by Targeting Chronic Diseases

by Thomas Beaton

In order to reduce overall spending, employers should focus on designing wellness programs that target chronic diseases and address other clinical factors impacting employee health, says a new research paper from Transamerica. The...

Cigna’s Digital Diabetes Prevention Program Cuts Costs, Ups Outcomes

by Thomas Beaton

With more than one out of every three Americans living with prediabetes, payers are actively seeking out innovative strategies for preventing progression of the costly and life-changing disease.   Most payers offer clinical benefits...

31% of Beneficiaries Face Social Isolation, More Health Risks

by Thomas Beaton

A new survey of Humana’s commercial population has found that almost one-third of members over 65 years old experience social isolation. The survey reveals that payers could benefit by addressing social isolation among their elderly...

How Payers Can Succeed Under Updated 2019 HEDIS Measures

by Thomas Beaton

The Healthcare Effectiveness Data and Information Set (HEDIS) provides 90 percent of America’s health plans with the ability to directly compare performance across the national stage.   Currently, the HEDIS set contains 92...

Medicare Advantage Savings, Outcomes Exceed Fee-For-Service

by Thomas Beaton

The Medicare Advantage (MA) program has surpassed Medicare fee-for-service (FFS) in developing positive member healthcare outcomes and reducing care costs, according to an analysis of both programs from Avalere Health. Medicare Advantage...

Beneficiaries Want More Holistic Health, Wellness Benefit Options

by Thomas Beaton

Health plan beneficiaries are increasing their demand for holistic health and wellness benefits, which can help payers deliver value and improve outcomes, according to a new report from Aetna. The Health Ambitions Study found that...

How Payers Can Add More Value to Medicare Advantage Health Plans

by Thomas Beaton

Payers striving to compete in the Medicare Advantage (MA) market can add more value to their health plans by taking advantage of regulatory changes established under a new final rule. Starting in plan year 2019, payers can offer a greater...

Medicaid Coverage Creates Significant Healthcare Opportunities

by Thomas Beaton

Medicaid coverage led to significant healthcare opportunities that rivaled commercial health insurance care quality, according to a new study from AHIP. Nearly 74 million adults and children who receive Medicaid were found to have...

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...

Payers Add Preventive Care, Wellness to Holistic Health Solutions

by Thomas Beaton

Payers have developed several initiatives to incorporate preventive care and wellness as part of their larger holistic health solutions. Adding wellness and preventive care can help payers keep their beneficiaries from developing costly...

Considerations for Designing Consumer-Directed Health Plans

by Thomas Beaton

Employers and health plans are rapidly adopting consumer-directed health plans (CDHPs) as a way to lower benefit costs and encourage cost-effective care utilization among beneficiaries. CDHPs are becoming part of many US employers’...

Employer Health Plans Can Engage Members with Data, Targeting

by Thomas Beaton

The use of data analytics and employee wellness engagement platforms may help employer health plans improve spending efficiency while producing a healthier, more productive workforce.    Employees are not always ready to take...

Top 4 Ways Payers Could Improve Patient Health Outcomes

by Vera Gruessner

Health insurance companies have been putting more focus on preventive care, a reduction in unnecessary medical testing, and better patient health outcomes by transitioning to value-based care reimbursement. National payers have utilized a...

Top 3 Reasons to Partner with Accountable Care Organizations

by Vera Gruessner

With value-based care reimbursement becoming the standard across health insurance companies and medical facilities around the country, stakeholders are investing more time and resources in accountable care organizations (ACOs). Why should...

How Investing in Social Services Could Cut Healthcare Spending

by Vera Gruessner

While healthcare spending is continually increasing, patient outcomes and overall health has not necessarily improved greatly, according to a report from Leavitt Partners and the Robert Wood Johnson Foundation. However, the study...

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