Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Insurance

Nearly 20% of Employees Have Inpatient Out-of-Network Claims

August 14, 2018 - Approximately twenty percent of employees with insurance had at least one out-of-network claim for inpatient care, according to a Peterson-Kaiser Tracker analysis. Employees with out-of-network provider bills may experience increased stress due to the cost of healthcare because they are largely responsible for out-of-network costs. In 2016, 15.5 percent of all inpatient admissions...


More Articles

Only 22% of Medicare Advantage Customers Aware of Star Ratings

by Thomas Beaton

Only 22 percent of Medicare Advantage (MA) beneficiaries are familiar with how star ratings work and increasing consumer awareness about star ratings would help beneficiaries choose high quality plans, according to a new Healthmine...

Provider Market Concentration Outweighs Payer Concentration

by Thomas Beaton

Healthcare provider systems tend to be bigger, more consolidated, and have more market share than payers in the same metropolitan areas, leaving some payers with less power to negotiate pricing and other contracts, according to the...

Insurance Coverage Rates Dip by 12% Due to High Premium Costs

by Thomas Beaton

Individual health plan enrollment between 2017 and 2018 fell by 12 percent as high premiums and a scarcity of subsidy assistance force consumers out of the market, according to an analysis from the Kaiser Family Foundation (KFF). Health...

How to Improve Cost Sharing to Enhance Chronic Disease Management

by Thomas Beaton

A tailored cost sharing program that helps beneficiaries pay for chronic disease care can reduce wasteful spending and increase access to chronic disease management services. However, relying on one-size-fits all cost-sharing plans can...

Centene, Ascension Partner for Medicare Advantage Offering

by Thomas Beaton

Centene and Ascension have partnered to offer a Medicare Advantage plan across multiple geographic markets in 2020.   Centene Chairman and CEO Michael F. Neidorff believes that the partnership will showcase effective strategies to...

CAQH CORE Urges Industry Collaboration on Prior Authorizations

by Thomas Beaton

CAQH CORE is urging healthcare payers, providers, and other stakeholders to promote industry-wide collaboration on how to improve prior authorizations. Leading provider and payer organizations, including AHIP, AHA, the BlueCross...

How to Address Medicare Advantage Beneficiary Disenrollment

by Thomas Beaton

Medicare Advantage is a growing market and an attractive opportunity for payers to offer quality plans to older beneficiaries.  Competition is increasing in the MA environment, and beneficiaries have more options than ever to meet...

10% of Medicare Advantage Members Receive Chronic Care Reminders

by Thomas Beaton

Only 10 percent of Medicare Advantage (MA) and Medigap plan members receive chronic care management reminders,, according to a new survey from Healthmine. The CDC estimates that 70 percent of all Medicare beneficiaries have at least one...

Using a Commercial Shared Savings Program to Reduce Care Costs

by Thomas Beaton

A commercial shared savings program equipped with the right leadership, clinical insights, and comprehensive care strategies can help payers save significantly on healthcare costs and produce exceptional beneficiary outcomes. In order to...

Rhode Island Aims to Expand Value-Based Care in Medicaid Program

by Thomas Beaton

Rhode Island officials have requested an extension of a 1115 demonstration from CMS to expand the use of value-based care within the state’s Medicaid program. State Medicaid administrators are looking to add new value-based care...

How Do Medicare Advantage, Medicare Supplemental Insurance Differ?

by Thomas Beaton

Medicare Advantage (MA) and Medicare supplemental insurance, or Medigap, are both intended to enhance the value of traditional Medicare coverage for seniors and other eligible beneficiaries. Both offer payers a lucrative opportunity to...

Pros and Cons of Small Business Health Options Program Health Plans

by Thomas Beaton

Health plans offered through the Small Business Health Options Program (SHOP) exchanges allow payers to provide the nation’s smallest businesses with affordable plan options that offer critical health benefits. SHOP health plans...

All-Payers Claims Databases May Increase Healthcare Price Transparency

by Thomas Beaton

Leveraging the data of all-payers claims databases (APCDs) could improve healthcare price transparency for consumers, according to testimony presented at a House Energy and Commerce Committee hearing. Jamie S. King, a professor at the USC...

High Dollar Claims Rise by 87% in Employer-Sponsored Stop-Loss Insurance

by Thomas Beaton

The number of employer-sponsored stop-loss insurance claims of $1 million or more grew by 87 percent from 2014 to 2017, according to a new analysis from Sun Life Financial. Over the four-year period, 634 employees with $1 million claims...

How Payers Can Succeed Under Updated 2019 HEDIS Measures

by Thomas Beaton

The Healthcare Effectiveness Data and Information Set (HEDIS) provides 90 percent of America’s health plans with the ability to directly compare performance across the national stage.   Currently, the HEDIS set contains 92...

BCBSA Adds Opioid Abuse Accreditation to Treatment Facilities

by Thomas Beaton

The BlueCross BlueShield Association has announced a new accreditation program for opioid abuse treatment centers as a larger part of the organization’s mission to combat the US opioid crisis. In 2013, only 22 percent of treatment...

Medicare Advantage Savings, Outcomes Exceed Fee-For-Service

by Thomas Beaton

The Medicare Advantage (MA) program has surpassed Medicare fee-for-service (FFS) in developing positive member healthcare outcomes and reducing care costs, according to an analysis of both programs from Avalere Health. Medicare Advantage...

Health Plan Cost Sharing, Deductibles Outpace Members’ Wage Growth

by Thomas Beaton

Health plan cost sharing and deductible spending have outpaced employee wage growth in the last ten years, according to data released by the Peterson-Kaiser Health System Tracker. Employees’ total financial responsibility increased...

Medicare Advantage Star Ratings Tied to Member Socioeconomic Strata

by Thomas Beaton

Medicare Advantage (MA) health plans with a greater proportion of socioeconomically challenged members are more likely to have lower star ratings, according to new research from Brown University. Insufficient risk adjustment criteria in...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...