Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Care

Automated Claims Administration Could Bring Billions in Savings

June 15, 2018 - 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 technologies that automate claims submissions, prior authorization, benefit coordination, and other administrative transactions to ensure that these processes can...


More Articles

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 2018,...

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 all the...

Humana Adds Former ONC Chief Karen DeSalvo as Board Member

by Thomas Beaton

Former National Coordinator for Health IT and Assistant HHS Secretary Karen DeSalvo, will join Humana’s board of directors, the payer announced in a press release. Humana believes that the addition of DeSalvo to the board will improve its...

Health Plan Consumers Report Insufficient Payer Communications

by Thomas Beaton

Health plans may not be effectively communicating with consumers about member  benefits and largely fail to understand their members’ health and financial needs, a survey from Healthmine found. A sample of 750 consumers enrolled in...

Boston Children’s, Cleveland Clinic Partner for Pediatric Care

by Thomas Beaton

Boston Children’s Hospital and Cleveland Clinic have announced a partnership to provide complex pediatric heart care through Cleveland Clinic’s national employer-based insurance network. “Together, our goal to develop and provide...

Can Healthcare Payers Inspire ACOs to Take on Two-Sided Risk?

by Jennifer Bresnick

While two-sided risk arrangements are attractive for healthcare payers, even experienced accountable care organizations (ACOs) are wary of jumping into contracts which make them financially responsible for falling short of their quality benchmarks. ...

Anthem BCBS Expands Value-Based Care Options with Premier Health

by Jesse Migneault

Anthem Blue Cross Blue Shield has partnered with Ohio-based Premier Health to expand its value-based care offerings to its employer-based, individual and Medicare Advantage members. The agreement aligns Premier’s population health model...

Payers, Providers Differ in Value Based Care, Health IT Opinions

by Jesse Migneault

Payers see the move towards value-based care as a permanent fixture in the nation’s healthcare delivery system, with 82 percent of organizations responding to a Quest Diagnostics and Inovalon survey expecting it to continue despite any...

Humana Expands Orthopedic Bundled Payment Program to NC, VA

by Jesse Migneault

Humana will bring its value-based orthopedic bundled payment program to 11 orthopedic specialty groups in North Carolina and Virginia.  The move follows a recent expansion into Kentucky and Indiana in 2017, and Ohio and Tennessee in...

Aetna to Offer New HMO Option for Delaware State Employees

by Jesse Migneault

Health insurer Aetna was recently awarded a three-year contract as a provider of Delaware’s health plan offerings for its employees and pensioners.  Aetna has chosen a coordinated care approach partnering with local innovators to move...

Humana Expands Medicare Orthopedic Bundled Payment Programs

by Jesse Migneault

The nation’s fourth largest healthcare payer recently announced it will be expanding its orthopedic bundled payment programs to eight new groups in Indiana and Kentucky.  The value-based care model will also offer participating providers...

APMs, Health Data Exchange among Top Payer Reform Goals

by Thomas Beaton

The National Academy of Medicine (NAM) offered policymakers and stakeholders healthcare reform priorities, including alternative payment models (APMs) and health data exchange, that aim to lower overall healthcare costs and improve patient...

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...

Key Challenges and Solutions of Healthcare Payment Reform

by Vera Gruessner

Healthcare payment reform is becoming more common across payers and providers with many stakeholders transitioning from the traditional fee-for-service reimbursement system to value-based care payments. Representatives from the National Academy...

UnitedHealthcare Partners with Accountable Care Organizations

by Vera Gruessner

In December, UnitedHealthcare announced in a company press release the release of NexusACO, a new health plan option for self-funded employers that is available in 15 markets. Tier 1 of NexusACO involves offering healthcare access to members...

Aetna, Humana, Harvard Pilgrim Target Patient Health Outcomes

by Vera Gruessner

Commercial health insurance companies have pursued a number of different approaches to improve patient health outcomes and reduce wasteful medical spending. The payers Aetna, Humana, and Harvard Pilgrim conducted some key collaborations to achieve...

How 3 Healthcare Insurers Expand Value-Based Care Payment

by Vera Gruessner

National health plans are leading the way in alternative reimbursement structures such as bundled payment models and shared saving programs. Blue Cross Blue Shield health plans, Cigna, and UnitedHealthcare have worked to expand their value-based...

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...

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...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks