Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

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Shareholder Class Action Lawsuit Filed Against Aetna

February 3, 2017 - A shareholder class action lawsuit has been filed against the national health insurance company Aetna Inc., according to a press release from the law firm of Kessler Topaz Meltzer & Check, LLP. The announcement came earlier this week and delves into Aetna’s alleged leverage of its participation in the health insurance exchanges for the Department of Justice to overlook...


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Shareholder Class Action Lawsuit Filed Against Aetna

by Vera Gruessner

A shareholder class action lawsuit has been filed against the national health insurance company Aetna Inc., according to a press release from the law firm of Kessler Topaz Meltzer & Check, LLP. The announcement came earlier this...

Bundled Payment Model Attracts More Oncologists than Expected

by Vera Gruessner

The new bundled payment model from the Centers for Medicare & Medicaid Services (CMS) called the Oncology Care Model has shown strong participation numbers among healthcare providers with twice as many medical organizations participating...

Congress Votes to Nominate Tom Price as HHS Secretary

by Vera Gruessner

On February 1, House Representative Tom Price, R-Ga., was officially nominated as the Secretary for the Department of Health & Human Services (HHS), according to the US News & World Report. The Senate Finance Committee moved forward with...

Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement

by Vera Gruessner

  In recent years, the national health payer Anthem has been advancing value-based care reimbursement by collaborating with primary care providers and operating the Enhanced Personal Health Care program, according to a report released...

Stakeholders Offer Key Principles for Alternative Payment Models

by Vera Gruessner

More than 100 medical organizations sent a letter to President Trump and Vice President Mike Pence on behalf of supporting the healthcare industry’s transition to alternative payment models. The letter outlined the complexities and hindrances...

How CMS Alternative Payment Programs Impact Healthcare

by Vera Gruessner

Over the last five years, the Centers for the Medicare & Medicaid Services (CMS) has released many new payment systems for Medicare providers including shared savings, pay-for-performance programs, and bundled payment models. The alternative...

Why a Court Stopped the Aetna-Humana Health Insurance Merger

by Vera Gruessner

On January 23, Judge John D. Bates of the Federal District Court for the District of Columbia ruled that the Aetna-Humana health insurance merger would lead to antitrust problems and was not allowed to continue. The Coalition to Protect Patient...

Federal Court Blocks Aetna-Humana Health Insurance Merger

by Vera Gruessner

Today, a federal judge ruled that the health insurance merger between the healthcare payers Aetna and Humana should be blocked on the grounds that it would create antitrust issues, according to The New York Times. The health insurance...

Health Information Technology Allows Payers to Share Data

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) strive to create programs meant to bring “better care, smarter spending, and healthier people.” CMS partnered with healthcare payers across seven regions to improve primary care...

3 Ways Bundled Payment Models Brought Hospital Cost Savings

by Vera Gruessner

Case studies of bundled payment models show significant cost savings among hospitals and both public and private health insurers. The Centers for Medicare & Medicaid Services (CMS), for instance, invested in bundled payment models for lowering...

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 a...

20% of Surveyed Physicians Familiar with MACRA Regulations

by Vera Gruessner

No more than 20.6 percent of primary care physicians and 19.5 percent of specialists are “very or somewhat familiar” with MACRA regulations, according to a survey completed in 2016 by Merritt Hawkins for The Physicians Foundation....

Cigna Partners with Scripps Health in Pay-for-Performance Model

by Vera Gruessner

The national health insurer Cigna announced in a company press release yesterday that it will be partnering with the nonprofit healthcare delivery system Scripps Health through a pay-for-performance contract to provide employers in the San Diego...

Cigna’s Key Principles for Healthcare Quality Measures

by Vera Gruessner

Cigna is one national health insurance company that has moved forward with creating successful healthcare quality measures for their provider networks. The company uses national standards along with physician feedback when creating its own healthcare...

Humana, Aetna, Cigna Invest in Value-Based Care Payment Models

by Vera Gruessner

Value-based care payment models are continuing to make headlines among major health insurance companies around the nation. Last month, Humana entered into a value-based care arrangement with the population health management company Fullwell,...

70% of Medical Groups Concerned About MACRA Regulations

by Vera Gruessner

MACRA regulations have impacted the revenue cycle of providers across the country particularly regarding Medicare reimbursement from the Centers for Medicare & Medicaid Services (CMS). The American Academy of Family Physicians outlined how...

How Blue Cross Health Plans Affect Anthem-Cigna Merger Lawsuit

by Vera Gruessner

The Anthem-Cigna merger lawsuit has brought significant evidence to light ever since the case began on November 21, 2016. The Department of Justice has been able to illuminate that the health insurance merger would create major market concentration...

6.4 Million Enrollees Sign Up on Affordable Care Act Exchanges

by Vera Gruessner

As of December 21, a total of 6.4 million consumers have enrolled in health plans through the Affordable Care Act exchanges on HealthCare.gov, reported the Centers for Medicare & Medicaid Services (CMS) in a fact sheet. The number of enrollees...

CMS Halts on Changing Medicare Part B Prescription Guidelines

by Vera Gruessner

The American Hospital Association (AHA) reported on December 16 that a finalized rule for the prior proposal to test new models for prescription drug payments under Medicare Part B has been scrapped. The Centers for Medicare & Medicaid Services...

CMS Issues Bundled Payment Models for Cardiac, Orthopedic Care

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) released earlier this week the finalized bundled payment models for cardiac and orthopedic care including the Medicare ACO Track 1+ Model, according to a CMS fact sheet. The bundled payment...

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