Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Insurance

Senate Bill Proposes Medicare Health Plan for All Ages

April 23, 2018 - Senator Jeff Merkley (D-OR), with sponsorship from 11 other Democrats, has introduced a bill to create a Medicare health plan for all ages that would be offered in state and federal health exchanges, as well as the employer-sponsored market. The Choose Medicare Act proposes to use initial funding of $2 billion to offer “Medicare E” plans to any consumer. Medicare E plans would...


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Humana Launches Bundled Payment Model for Maternity Care

by Thomas Beaton

Humana has launched a bundled payment model to improve outcomes and lower costs of maternity by partnering with OBG-YNs across the country. Humana’s Maternity Episode-Based Model bundles payments that covers the cost of a mother’s...

Bundled Payments Require Clinical Insights, Provider Buy-In

by Thomas Beaton

Payers see bundled payments as a way to promote value-based reimbursement practices but must first leverage clinical insights and provider buy-in to maximize a bundle’s potential effectiveness. Bundled payments are valuable to payers because...

Health Plan Variety Does Not Boost Managed Medicaid Performance

by Thomas Beaton

Managed Medicaid performance does not increase as state Medicaid programs introduce more health plan variety, but a single health plan with value-based characteristics may be more effective in improving performance, a new JAMA commentary...

How Payers Can Add More Value to Medicare Advantage Health Plans

by Thomas Beaton

Payers striving to compete in the Medicare Advantage (MA) market can add more value to their health plans by taking advantage of regulatory changes established under a new final rule. Starting in plan year 2019, payers can offer a greater variety...

High-Deductible Health Plan, HSA Enrollment Reached 21M in 2017

by Thomas Beaton

High-deductible health plan (HDHP) and health savings account (HSA) enrollment reached 21 million members in 2017, according to new research from AHIP.  These health plan options are expected to see continued growth in the near future. In...

How Payers Can Succeed in Association Health Plan Markets

by Thomas Beaton

Association health plans (AHPs) may completely alter the nation’s health insurance markets with increasing support from federal entities and a handful of state insurance commissions. An expansion of the AHP market may materialize based...

Humana Expands Bundled Payment Model for Medicare Advantage

by Thomas Beaton

Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations. The payer has teamed up with orthopedic specialists to expand its Total Joint Replacement...

CVS Health Offers New Tools for Lowering Prescription Drug Costs

by Thomas Beaton

CVS Health has launched new cost-saving initiatives that aim to lower beneficiary prescription drug costs through co-pay adjustments, pricing transparency technology, and increased promotion of generic drugs. The initiatives follow a CVS Health...

JP Morgan: Value-Based Care Will Guide Amazon, Berkshire Work

by Thomas Beaton

Amazon, JP Morgan, and Berkshire Hathaway will build their new company upon best practices in value-based care, including improving preventive care and managing member costs through data sharing, said JP Morgan Chase & Co. CEO Jamie Dimon...

BCBS Association: Use Alternative Pain Therapies Before Opioids

by Thomas Beaton

The BlueCross BlueShield Association (BCBSA) has announced a new professional standard that removes opioid prescriptions as a primary pain treatment in a majority of clinical situations. The payer’s National Council of Physician and Pharmacist...

Health Plan Data Governance Assists Value-Based Reimbursement

by Thomas Beaton

Health plan data governance plays a key role in overcoming barriers related to industry-wide adoption of value-based reimbursement, according to a two-year study conducted by CAQH CORE.  Health plans are industry leaders who should take...

Aetna Will Apply Pharmacy Rebates to Prescription Drugs in 2019

by Thomas Beaton

Aetna has announced plans to automatically apply pharmacy rebates to eligible prescription drug benefits by 2019 in an effort to increase pricing transparency and control costs. Nearly three million Aetna members are likely to experience lower...

Payers Form Coalition to Address Social Determinants of Health

by Thomas Beaton

A group of commercial payers and other healthcare organizations have formed a coalition to explore how addressing the social determinants of health can lower care costs and improve outcomes. A number of large payer companies have joined the Aligning...

Humana Bold Goal Targets Members’ Social Determinants of Health

by Thomas Beaton

Humana is improving the overall physical and mental health of its Medicare members by addressing social determinants of health and targeting problematic community health behaviors under its Bold Goal initiative. The Bold Goal 2018 Progress Report...

BCBS of MI Launches Bundled Payments for Hip, Knee Replacements

by Thomas Beaton

BlueCross BlueShield of Michigan has launched a pilot program that will use bundled payments for knee and hip replacements in order to manage costs and improve member outcomes. BCBS data estimates that knee and hip replacements can cost between...

Member Engagement is Key for High-Deductible Health Plan Success

by Thomas Beaton

Payers and employers who offer high-deductible health plans (HDHPs) to attract low-cost members may need member engagement strategies to generate higher value for these beneficiaries. Member engagement is critical for HDHP success because low...

Payers Enter New Value-Based Care Agreements with Providers

by Thomas Beaton

Commercial payers including Aetna, Cigna, and Tufts Health are launching new value-based care agreements with providers to reduce healthcare costs and increase care quality for beneficiaries. Many payers are acting on the need to implement holistic...

Prior Authorization Issues Contribute to 92% of Care Delays

by Thomas Beaton

Prior authorization issues are associated with 92 percent of care delays and may contribute to patient safety concerns as well as administrative inefficiencies, according to a new survey from AMA. Payers should work to change their prior authorization...

Payment Cuts Drive Medicare Advantage Plans to Contain Costs

by Thomas Beaton

Medicare Advantage (MA) plans contained beneficiary costs and remained profitable despite reductions to federal MA payments from 2009 to 2014, according to new research from the Commonwealth Fund. The report found that as Medicare reduced Medicare...

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