Value-based Care

ACOs Call for Transparency in CMS Alternative Payment Model Design

by Jessica Kent

The National Association of ACOs (NAACOS) has urged the CMS Innovation Center to improve transparency throughout the process of releasing and updating alternative payment models. “While we...

Humana Expands Value-Based Care Options for Medicare Advantage

by Jessica Kent

Humana has announced a series of initiatives to increase value-based care for orthopedic services among its Medicare Advantage members. The organization will partner with orthopedic and neurosurgery...

AMA: Payers Moving Too Slowly on Prior Authorization Fixes

by Jennifer Bresnick

Physicians are still frustrated by problematic prior authorization (PA) procedures and believe that health payers are moving too slowly on necessary solutions, finds a new survey by the American...

Cambia Health Solutions, Blue Cross NC Enter Strategic Affiliation

by Jennifer Bresnick

Cambia Health Solutions and Blue Cross of North Carolina have announced a new strategic affiliation that will combine management operations into a single entity retaining the Cambia name. The two...

Amazon-Backed Health Venture Reveals Name: Haven Healthcare

by Jennifer Bresnick

The partnership between Amazon, Berkshire Hathaway, and JPMorgan Chase now has a name in addition to a high-profile executive team.  The venture, which aims to reduce costs and develop innovative...

NCQA Seeks Comment on Proposed Updates to HEDIS Quality Measures

by Jessica Kent

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

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...

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...

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