Payer Expands Value-Based Care Footprint for Clinical Procedures
Regence BlueShield (Regence) is welcoming new providers to its value-based care program and offering coverage for additional services to lower costs and improve patient health outcomes. The payer...The Fundamentals of Medicare Advantage Star Rating Methodology
The way to determine the quality of a Medicare Advantage health plan is simple: look at the five-star rating on the Medicare website. However, the Medicare Advantage Star Rating methodology that...ACHP Recommends Federal Employee Plan Comparison Tool Updates
The Alliance of Community Health Plans (ACHP) has proposed a number of recommendations to improve the Federal Employees Health Benefits (FEHB) program’s plan comparison tool in order to boost...Pros, Cons of Non-Emergency Medical Transportation Benefits
A small fraction of the Medicaid population utilizes non-emergency medical transportation (NEMT) benefits, but for that community of beneficiaries NEMT programs can be indispensable, a MACPAC...Sponsored Article
How Healthcare Workflows Can Use Intelligent Automation for Better Care
In 2020, spending on healthcare decreased slightly due to members postponing non-emergency medical services. However, as the country slowly starts to open up with vaccinations this year, spending will...Social Risk Adjustment Promotes Health Equity In Value Based Care
Adjusting quality measures for social risk factors can promote health equity, according to expert guidance published in Health Affairs. As value-based payment programs expand, there is growing...Medicare Advantage Cost Burden Is Lower Than in FFS Medicare
The Medicare Advantage cost burden—or the number of individuals for whom healthcare costs absorb 20 percent or more of their income—is lower than the fee-for-service Medicare cost burden...How Payers Can Prepare for the Payer Price Transparency Rule
Payers should prepare for the payer price transparency rule to go into effect by building clear communication paths with members, reassessing their contracting processes, and asking themselves a couple...How Medicaid Managed Care Orgs Can Confront Care Disparities
Reducing racial care disparities and promoting health equity are key functions of Medicaid managed care organizations, particularly in the context of the coronavirus pandemic, an issue brief from...Creating Strategies to Expand Transgender Healthcare Coverage
For the nearly 1.4 million Americans who identify as transgender, transgender healthcare coverage is lined with hurdles. One in five transgender individuals reported being uninsured at some point during 2017 to 2018, according to the...BCBSMA Invests in Electronic Registry for End-Of-Life Care Quality
With funding from Blue Cross Blue Shield of Massachusetts (BCBSMA) and the Massachusetts Coalition for Serious Illness Care, Massachusetts is developing an electronic registry of...Sponsored Article
Improving Member Experience with a Unified Data Platform
The coronavirus pandemic is proving to be a seminal moment for health payers eager to reimagine their role in ensuring that members have access to timely and appropriate care. Doing so requires health...How Payers Can Improve Care Management To Enhance Quality, ROI
Payers are not leveraging care management to its fullest capacity and they have an opportunity reform their care management programs to improve quality of care and return on investment, a report from...Consolidated Medicare Advantage Plans See Quality Improvement
CMS Medicare Advantage Star Ratings accurately indicate patient outcomes, a Health Affairs study recently confirmed. “Higher star ratings have been found to be associated with increased...Medicare Advantage Quality of Care Surpasses Traditional Medicare
Medicare Advantage quality of care exceeded traditional Medicare, particularly in preventive care, a recent Better Medicare Alliance study revealed. “The hallmark features of Medicare...59% MA Plan Proxies Rate End-of-Life Care Quality “Not Excellent”
Responses from families and friends of deceased Medicare Advantage members indicate that Medicare Advantage plans have room for improvement on end-of-life care, a study published in JAMA Network Open...21 Part D Plans Rank Tops in 2021 Medicare Advantage Star Ratings
CMS has released Medicare Advantage Star Ratings for 2021 and the results demonstrate a continuation of last year’s positive trends. Medicare Advantage health plan quality steadily continued its...Medicaid Expansion Produces Mixed Results on Health Disparities
Medicaid expansion has had mixed results in reducing health disparities and advancing coverage, utilization, and quality of care equity, an issue brief from Kaiser Family Foundation revealed. The...Sponsored Article
