Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Insurance

Why Bundled Payments Are a Popular Option for Healthcare Payers

December 11, 2017 - Bundled payments are ideal for payers that want to participate in value-based care. Bundled payments tend to have lower financial risks than other payment models for payers and are beneficial to providers as well as payers. In a bundled payment arrangement, payers are only responsible for a single payment that covers all the services included in a defined episode of care, which means there...


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Member Engagement, Payer Spending Lead Top 10 Stories of 2017

by Thomas Beaton

The 2017 news cycle was a constant flurry of political and financial developments for payers. From the turbulent efforts to repeal and replace the ACA in the House and Senate to challenges with member engagement, population health, and cost cutting,...

Integrated Care Model Lowers Health System Medical Costs

by Thomas Beaton

Cigna’s integrated care model partnership with Texas-based Catalyst Health helped reduce the health system’s total medical costs to 5.6 percent below industry averages, the organizations announced in a press release. The Cigna Collaborative...

61% of Employees Dissatisfied with Employer Wellness Programs

by Thomas Beaton

Fifty-two percent of employers believe their wellness programs improve their employee’s health behaviors, but only 32 percent of employees agree, according to a new survey from Willis Towers Watson. More than 60 percent are actively dissatisfied...

How Provider-Sponsored Health Plans Can Find Consumer Success

by Thomas Beaton

Provider-sponsored health plans (PSHPs) are seen as a way for provider organizations to compete with commercial payers while lowering their own costs and improving care quality, because provider organizations can manage the cost of healthcare...

Ridesharing Benefit May Help Payers Improve Patient Engagement

by Thomas Beaton

Payers looking to help members overcome negative social determinants of health, such as transportation issues, may be able to offer beneficiaries a ridesharing benefit to improve patient engagement. The emergence of healthcare partnerships and...

Most High-Deductible Health Plan Consumers Lack Financial Management

by Thomas Beaton

Less than half of high-deductible health plan (HDHP) consumers engage in positive financial management tasks such as negotiating costs for healthcare services or saving for future healthcare expenses, says a research letter published in JAMA...

CMS Updates Payer Guidelines for 2019 Qualified Health Plans

by Thomas Beaton

CMS has issued a draft letter that outlines guidelines, dates, reporting, and regulatory requirements for payers that want to sell qualified health plans (QHPs) in 2019. The Annual Letter to Insurers includes new information, and updates from...

The Pros and Cons of Pharmacy Benefits Managers for Payers

by Thomas Beaton

Prescription drug spending is a billion-dollar problem for the payer industry. While pharmacy benefit managers (PBMs) are often a positive way for payers to manage prescription drug benefits for their members, savings for payers can be limited...

Health Plan Partnership Aims to Boost Care for Native Americans

by Thomas Beaton

A merger between Tribal First (a subsidiary of Alliant Specialty Insurance Services) and American Indian Health Services (AIHS) will combine two national leaders in providing quality care to Native Americans, the organizations announced in a...

How Payers Can Improve the Value of Small Business Health Plans

by Thomas Beaton

Payers offering insurance plans for the employer market need to provide flexible benefits and cost-saving strategies that create value for small businesses. Small businesses are an excellent market opportunity for payers because health plans...

Medicare Advantage Value-Based Insurance Design Updates for 2019

by Thomas Beaton

The Medicare Advantage (MA) Value-Based Insurance Design Model (VBID) for 2019 will extend into fifteen new states, allow Chronic Condition Special Needs plans to participate in the model, and allow all participating plans to specialize benefits,...

Ensuring High Out-of-Pocket Spending Won’t Lead to Negative Outcomes

by Thomas Beaton

High deductible health plans (HDHPs) are intended to reduce payer and beneficiary spending on healthcare services, but untenable out-of-pocket spending for beneficiaries could lead to patients letting preventable conditions develop into catastrophic...

Employer Health Plans Can Engage Members with Data, Targeting

by Thomas Beaton

The use of data analytics and employee wellness engagement platforms may help employer health plans improve spending efficiency while producing a healthier, more productive workforce.    Employees are not always ready to take part in...

Single-Employee Businesses Experience High, Burdensome Premiums

by Thomas Beaton

Single-employee businesses paid an average of $500 per month on premiums, experienced high premium payment growth, and experienced polarizing financial burden based on their premium payment amounts, a new report from JPMorgan & Chase reveals....

Payer Housing Programs Address Social Determinants of Health

by Thomas Beaton

Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services. A new report from the...

Value-Based Care Outperforms Fee-for-Service Health Plans

by Thomas Beaton

Health plans that include value-based care (VBC) principles are more cost-effective than fee-for-service (FFS) options and are starting to produce better patient outcomes, Humana asserts in a new report. The total healthcare costs associated...

11 Healthcare Payers to Enhance Substance Use Treatment Access

by Thomas Beaton

Executives from 11 healthcare payers have pledged to enhance substance use disorder (SUD) treatment access and offer provider incentives to more effectively address opioid misuse and other substance use issues. In a joint letter, payer executives...

44% of Employees Don’t Know Value of Health Plan Benefits

by Thomas Beaton

Employers must increase their efforts to educate members about the value of their health plan benefits based on recent findings that only 44 percent of employees fully comprehend their benefits. That is the leading takeaway from research published...

Payer Strategies for Improving Member Medication Adherence Rates

by Thomas Beaton

Payers are spending billions of dollars annually on medications that aren’t improving the health outcomes, with financial and health literacy proving to be the most common barriers to adherence. Avoidable healthcare spending totaling between...

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