Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Insurance

Strategies for Designing Consumer-Centric Health Plans

November 12, 2018 - 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 design. The goal of the task force, a consortium of leading healthcare payers, providers, purchasers and patient organizations, is to accelerate the industry’s move to...


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Employer-Sponsored Medicare Advantage Enrollment Up 12% for 2019

by Thomas Beaton

Employer-sponsored Medicare Advantage (MA) enrollment for plan year 2019 increased by 12 percent, representing a bump of more than 443,000 individual members, according to a new analysis by Mark Farrah Associates. Individual Medicare...

Commercial, Managed Care Insurance Sectors Profits Boom in Q3

by Thomas Beaton

Commercial and managed care payers experienced significant third quarter profits, reductions in healthcare spending, and enrollment growth, according to the latest financial statements from insurance companies. Medicare Advantage (MA),...

BCBSAZ Shared Savings Program Reduces Hospital Readmissions by 26%

by Thomas Beaton

BlueCross BlueShield of Arizona’s (BCBSAZ) shared savings program has reduced 30-day hospital readmission rates by 26.3 percent while generating shared savings for providers.. BCBSAZ also reported 15.2 percent fewer ED visits per...

Consumer Demand for High-Deductible Health Plans Dwindles

by Thomas Beaton

Consumer demand for high-deductible health plans (HDHPs) is expected to decline in 2019 as more beneficiaries look for health plans with customized benefits instead, according to a new survey from Oliver Wyman. Half of consumers surveyed...

Cigna: Integrated Pharmacy, Medical Benefits Improve Overall Health

by Thomas Beaton

Integrating pharmacy benefits with medical benefits can help to improve overall health and reduce employer costs, according to a new study released by Cigna. Individuals with connected medical, behavioral and pharmacy health benefits...

60% of Employers Fail to Address Healthcare Spending Waste

by Thomas Beaton

Sixty percent of employers don’t capitalize on opportunities to address healthcare spending waste, even though they say wasteful spending is a key concern, according to a new survey from the National Alliance of Healthcare Purchaser...

Venture-Funded Medicare Advantage Plans Launch into 2019 Market

by Thomas Beaton

Several Medicare Advantage (MA) plans entering the market for the 2019 plan year are backed by millions in venture capital funding and are planning to compete with established payers by promoting new health plan solutions. The recent...

Medicare Advantage Plans Proliferate in 2019, Raising Competition

by Thomas Beaton

Medicare Advantage (MA) payer competition is increasing significantly for plan year 2019 as more than 400 new options hit an already-crowded market, says a new report from the Kaiser Family Foundation (KFF).   More than 2700...

Insured Critical Illness Beneficiaries Face High Treatment Costs

by Thomas Beaton

Health plan members with critical illnesses face high treatment costs and other financial issues even with comprehensive health insurance, said a new survey conducted by the Harvard T. Chan School of Public Health, New York Times, and...

Medicare Diabetes Prevention Program May Have Cost Concerns

by Thomas Beaton

The Medicare Diabetes Prevention Program (MDPP) may not fully cover provider costs needed to administer classes and other programs to prevent diabetes among Medicare members, says a new report from the University of Colorado (UC) School of...

Medicare Deductibles, Premiums to Increase Slightly in 2019

by Thomas Beaton

CMS has announced that Medicare Part A and Part B premiums and deductibles are expected to increase slightly for the 2019 plan year. Part B members will see small increases in both their premiums and their deductibles, while Part A...

CMS Releases 2019 Medicare Advantage Health Plan Star Ratings

by Thomas Beaton

CMS has released its 2019 star ratings for Medicare Advantage (MA) health plans, noting that the Medicare Advantage market continues to grow in affordability and access for consumers. CMS estimates that 74 percent of MA beneficiaries will...

CVS-Aetna Merger Gets DOJ Nod as Aetna Sheds Medicare Part D

by Thomas Beaton

The Department of Justice (DOJ) has announced that it will approve the proposed merger between CVS and Aetna as soon as Aetna completes the divestiture of its Medicare Part D business line.   Two weeks ago, Aetna initiated the sale...

Payers Partner with Trade Orgs to Roll Out Association Health Plans

by Thomas Beaton

Healthcare payers are beginning to launch partnerships with trade organizations and chambers of commerce to provide association health plans (AHPs) to small businesses and contractors. The roll out of AHPs follows federal and state...

Managed Care Payers Struggle to Staff Long Term Support Services

by Thomas Beaton

Managed care payers and state Medicaid agencies are finding it difficult to find personnel to administer long-term support services (LTSS) within home and community-based settings (HCBS), says a new GAO report. Currently, Medicaid spends...

Payers Can Leverage Telehealth for Chronic Disease Management

by Thomas Beaton

Telehealth offers a cost-effective way to improve member satisfaction with benefits and support meaningful chronic disease management, according to a new report from AHIP and the Coalition to Transform Advanced Care (C-TAC)....

Cigna’s Digital Diabetes Prevention Program Cuts Costs, Ups Outcomes

by Thomas Beaton

With more than one out of every three Americans living with prediabetes, payers are actively seeking out innovative strategies for preventing progression of the costly and life-changing disease.   Most payers offer clinical benefits...

How Managed Care Payers Can Improve Substance Use Treatment

by Thomas Beaton

Managed care payers can use data analytics, case management strategies, and patient engagement tools to address the needs of high-risk individuals with substance use disorders (SUDs), states a new report from the Association for Community...

Consumer Engagement Tools Prep Members for Open Enrollment

by Thomas Beaton

Mobile apps, enrollment platforms, and search engines help the majority of consumers prepare for open enrollment and make informed healthcare choices, says a new survey from UnitedHealthcare. Thirty-six percent of consumers said they used...

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