Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Care

NCQA Seeks Comment on Proposed Updates to HEDIS Quality Measures

February 13, 2019 - The National Committee for Quality Assurance (NCQA) is seeking comments from health plans, purchasers, consumers, and other stakeholders on proposed updates to the Healthcare Effectiveness Data and Information Set (HEDIS) measures. “When clinical guidelines change, or new evidence becomes available in the scientific literature, NCQA reviews HEDIS measures to determine whether...


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Humana, Aledade Bring Value-Based Care to Medicare Advantage Members

by Jessica Kent

Humana and Aledade have announced a value-based care agreement that will increase access to value-based care for Medicare Advantage members. The partnership will enable physicians in Aledade’s accountable care organizations (ACOs)...

Cigna Value-Based Care Participation Tops 50%, Saving $600M

by Jennifer Bresnick

Cigna has surpassed its goal of having 50 percent of its Medicare and commercial health reimbursements tied to value-based care models in top markets by the end of 2018, the payer announced. Between 2013 and 2017, value-based care...

91% of Physicians Say Prior Authorizations Negatively Impact Care

by Jennifer Bresnick

Prior authorizations (PAs) are causing significant delays in care and adding unsustainably to the administrative burdens of physicians, according to a new survey published by the American Medical Association (AMA). The majority of...

UPMC, AstraZeneca Enter Value-Based Pharmaceutical Contract

by Jennifer Bresnick

UPMC Health Plan and AstraZeneca are taking on the challenge of a value-based pharmaceutical contract for one of the manufacturer’s cardiovascular medications. Reimbursement for prescriptions of BRILINTA, a drug intended to help...

Payer Investment May Improve Delaware Primary Care Access

by Jessica Kent

Payers can expand primary care access in Delaware by progressively increasing primary care spending until it accounts for 12 percent of all healthcare investment, according to a report from Delaware’s Primary Care...

Blue Cross of NC, Major Health Systems Partner for Value-Based Care

by Jennifer Bresnick

Blue Cross and Blue Shield of North Carolina has launched Blue Premier, a new value-based care model that increases accountability for participating providers and their accountable care organizations (ACOs). Beginning in January of 2019,...

Anthem Medicare Advantage Members Can Use OTC Allowance at CVS

by Jennifer Bresnick

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...

Patient-Centered Methods Help Health Plans Boost Cancer Care

by Jessica Kent

Employers and payers should ensure their health plans use patient-centered methods and provider performance measurement strategies to reduce costs and improve cancer care, a report from the National Alliance of Healthcare Purchaser...

47% of Payer, Provider Business Tied to Value-Based Care

by Jennifer Bresnick

Value-based care is nudging the half-way mark as more and more payers and providers shift their contracts away from fee-for-service arrangements, according to the Health Care Transformation Task Force (HCTTF). In a new report, the Task...

Cigna Announces Closing of $67B Purchase of Express Scripts

by Jennifer Bresnick

Cigna is officially the new owner of Express Scripts after announcing on December 20 that the $67 billion acquisition has closed. Cigna calls the acquisition a “blueprint to transform the healthcare system,” indicating that...

Humana Value-Based Care Program Unveils First Participants

by Kyle Murphy, PhD

Nearly seven months since announcing its value-based care incentive program for hospitals, Humana has revealed its first participants. Four hospitals have agreed to participate in the Hospital Incentive Program (HIP) for commercial...

Narrow Network Health Plans Continue to Dominate ACA Exchanges

by Kyle Murphy, PhD

New analysis of available health plans on ACA exchanges in 2019 shows that narrow networks remain a dominant force. Avalere researchers found that more restrictive networks own nearly three-quarters of all health plans on health insurance...

Strategies for Designing Consumer-Centric Health Plans

by Chuck Green

The Health Care Transformation Task Force recently released a new set of guiding principles to help healthcare industry leaders and policymakers better integrate consumer needs into benefit design. The goal of the task force, a consortium...

Can Payers Reduce Stress of Alternative Payment Models for Physicians?

by Chuck Green

Alternative payment models (APMs) may be placing significant burdens and stress on physicians, requiring payers to make additional efforts to improve their communication and smooth the process of transitioning to value-based care,...

How Capitated Payments Prompt Payer, Provider Innovation

by Thomas Beaton

The challenges of lowering care costs and improving healthcare quality may lead payers to consider the use of capitated payments as part of their value-based payment model strategies. Capitated payments are pre-arranged payments for...

Value-Based Care Slashes Per Member Per Month Costs in Kansas

by Thomas Beaton

BlueCross BlueShield of Kansas has seen significantly lower per member per month costs for beneficiaries participating in value-based care arrangements, including accountable care organizations (ACOs) and patient-centered medical homes...

Automated Claims Administration Could Bring Billions in Savings

by Thomas Beaton

Automated claims administration could bring around $11 billion in savings to health plans and providers if the technology is implemented more broadly, according to the latest CAQH Index. Payers should encourage providers to adopt...

Helping Payers Implement Value-Based Hospital Reimbursement

by Thomas Beaton

Hospitals generate some of the largest revenues and create exceptionally high costs for payers, which combine open the possibility for value-based hospital reimbursement programs to control spending.        In March...

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...

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