Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Insurance

Ongoing Payer Consolidation Leads to Consumer Premium Hikes

February 19, 2018 - The four largest payers in the US have continued to get bigger over the past few years, said Leemore S. Dafny, a professor of the Bruce V. Rauner Professor of Business Administration at Harvard Business School, during a House Energy and Commerce Committee hearing. The trend is worrying, he said, comparing payer consolidation practices to anticompetitive practices in the airline industry to...


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70% of Providers See Data Sharing as Key to Value-Based Care

by Thomas Beaton

Seventy percent of executives participating in a survey conducted by Humana and HFMA believe that the need for interoperability and seamless data sharing will be required for payers and providers to succeed with value-based care. The Value-Based...

80% of Payers Aim to Address Social Determinants of Health

by Thomas Beaton

Eighty percent of payers believe that addressing the social determinants of health (SDOH) of their beneficiary populations will be a key way to improve their population health programs, according to a new Change Healthcare survey. The findings...

Lawmakers Propose HDHP Coverage for Chronic Disease Prevention

by Thomas Beaton

A new bill introduced into the House and Senate would allow high-deductible health plans (HDHPs) to provide chronic disease prevention services before a patient meets his or her deductible, which could help to accelerate a growing HDHP market....

Employer Guide Offers Strategies for Wellness Program Success

by Thomas Beaton

An employer guide developed by The Transamerica Center for Health Studies (TCHS) and the Interdisciplinary Center for Healthy Workplaces (ICHW) determined that employers may need a better understanding of the factors that inhibit wellness program...

71% of Workers Satisfied with Employer-Sponsored Health Plans

by Thomas Beaton

Over 70 percent of employees are generally satisfied with their employer-sponsored health plans, but are concerned with rising health plan costs, an AHIP study found. Employer sponsored health plans have provided fair premium and deductible financing...

AHIP: 25% of Opioid Prescriptions Top CDC Dosage Guidelines

by Thomas Beaton

An AHIP retrospective analysis of claims data found that 25 percent of opioid prescriptions were above CDC dosage recommendation and provides a basic snapshot of problematic areas where payers could minimize patient safety risks related to opioids....

House Bill Retains Low-Quality Medicare Advantage Plans until 2027

by Thomas Beaton

Update on 2/12/2018: Presdient Trump signed the spending bill into effect on Feburary 9th, 2018 which funds the government for two years and extends quality deadlines for Medicare Advantage plans.  The latest government spending bill to...

Alaska Bill to Alter Emergency Room Payment Rules Brings Concern

by Thomas Beaton

A bill in the Alaska Senate intended to repeal protections around emergency room payments has drawn significant concern from the state’s chapter of the American College of Emergency Physicians (ACEP).  The bill would remove a rule...

NQF Aims to Improve Medicaid Use of Social Determinants Data

by Thomas Beaton

Collaborating with public health and community organizations to foster informed decision-making can help Medicaid entities better address the social determinants of health (SDOHs), says new guidance issued by the National Quality Forum (NQF)....

How All-Payer Claims Databases Can Identify Wasteful Spending

by Thomas Beaton

An all-payer claims database (APCD) can hold data on millions of patients and the services they receive, giving payers, providers, and related stakeholders the ability to identify wasteful spending and develop strategies to cut costs and reduce...

Top 10 Highest Performing Medicare, Medicaid Health Plans

by Thomas Beaton

The top-performing Medicare and Medicaid health plans for the 2017-18 plan year earned exceptional quality scores based on the plans’ customer satisfaction, preventive care, and treatment outcomes of beneficiaries, according to the most...

2018 Best in KLAS Taps Vendors for Claims Admin, Price Transparency

by Thomas Beaton

The 2018 Best in KLAS report ranked the best vendor solutions for payer claims administration, care management, price transparency, and payer analytics based on five industry performance criteria.    KLAS ranked vendor solutions based...

Member Incentives for Lower Cost Health Services Saved Payer $3.2M

by Thomas Beaton

Commercial payers struggling to curb costs and encourage their members to make smarter financial choices may be able to save millions of dollars each year by investing in modest member incentives. Offering small financial rewards for choosing...

Amazon, JP Morgan, Berkshire Hathaway Form Healthcare Company

by Thomas Beaton

Amazon, JP Morgan Chase & Co., and Berkshire Hathaway have announced a long-term partnership to form an independent company that focuses on cost-effective healthcare for employees. The company will aim to remove profit-making incentives for...

Consumer-Directed Care, High Deductibles Popular for Employees

by Thomas Beaton

Consumer-directed care, high-deductible health plans (HDHPs), and financial benefits related to healthcare spending have increased in popularity and demand by employees from 2017 to 2018, according to a new report from Benefitfocus. The State...

DE Shifts Managed Medicaid Contracts to Value-Based Agreements

by Thomas Beaton

Delaware’s Department of Health and Social Services (DHSS) announced it is translating the state’s managed Medicaid Contracts into value-based agreements to improve the outcomes and costs of the state’s public healthcare programs....

Health Insurance Costs Placing Stress on Majority of Americans

by Thomas Beaton

Sixty-nine percent of Americans with an income of $50,000 a year or more cited the cost of health insurance as a major stressor and 63 percent of Americans with incomes less than $50,000 per year cited insurance costs as a major life stressor,...

High Care Costs Driving Employer-Sponsored Insurance Spending

by Thomas Beaton

The Health Care Cost Institute (HCCI) found that high care costs were the primary driver of increased employer-sponsored insurance in 2016, which grew by 4.6 percent and exceeded any rate between 2012 and 2015. A HCCI report of employer-sponsored...

Humana Expands Long-Term Social Health Determinant Investments

by Thomas Beaton

Humana, and its philanthropic arm the Humana Foundation, announced changes to their grant making processes that provide long-term investments into community programs that address the social determinants of health (SDOH). The new investment strategy...

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