Value-Based Contracting

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...

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,...

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...

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...

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...

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...

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...

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...

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...

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,...

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....

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...

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...

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’...

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...

NCQA Updates, Adds HEDIS Performance Measures for Plan Year 2019

by Thomas Beaton

The National Committee for Quality Assurance (NCQA) has released updates to its HEDIS performance measures for plan year 2019. The refresh includes several new measures to guide population health...

Medicare, Medicaid Home Health Benefits Stabilize Care Costs

by Thomas Beaton

Providing extended home health benefits for Medicare beneficiaries is likely to stabilize care costs for public payer programs, according to a new analysis from the Commonwealth Fund. Researchers from...

Highmark BCBS Saves $260M Using Value-Based Reimbursement

by Thomas Beaton

Highmark BlueCross BlueShield has saved $260 million in avoidable care costs by using value-based reimbursement and provider performance standards to hold healthcare organizations accountable for...

Can Retail Clinics Improve Patient Access, Reduce Costs for Payers?

by Thomas Beaton

Retail clinics are gaining in popularity among patients looking for quick, convenient care for minor ailments. Kiosks and no-appointment-needed offices located in corner pharmacies and big box stores...

Partners HealthCare to Self-Insure 100K Employees

by Thomas Beaton

Partners HealthCare has announced it will self-insure 100,000 of its employees, transitioning coverage from BlueCross BlueShield of Massachusetts to its own Neighborhood Health Plan, according to The...