Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Insurance

Harvard Pilgrim, Partners HealthCare Discuss Possible Merger

by Thomas Beaton

Harvard Pilgrim and Partners HealthCare are engaging in discussion of a possible merger.  A deal would combine Massachusetts’s largest payer organization with the state’s largest provider group and may create a dominant...

Supplemental Insurance is a Value-Add Opportunity for Employers

by Thomas Beaton

Employers may have a prime opportunity to add value to their health plan options by offering supplemental insurance, according to a recent AHIP survey. The survey found that 95 percent of employees are satisfied with supplemental plan...

Medicaid Spending Drops When Members Transition to Community Care

by Thomas Beaton

Medicaid spending declined when beneficiaries transitioned from long-term institutional care into community care, a new report conducted by Mathematica Health Policy found. Researchers observed cost outcomes of Medicaid’s Money...

How Payers Can Effectively Scale Value-Based Care Networks

by Thomas Beaton

Value-based care networks are a promising opportunity for payers that want to manage costs and improve outcomes of beneficiaries.  But effectively scaling collaborative, risk-based reimbursement networks for millions of beneficiaries...

Medicare Diabetes Prevention Program Offers Model for Chronic Care

by Thomas Beaton

CMS’s Medicare Diabetes Prevention Program (MDPP) aims to address diabetes prevalence within the Medicare program, and may help other payers develop a model for chronic care, based on the MDPP’s promising initial...

64% of Employees Say Financial Incentives Boost Member Engagement

by Thomas Beaton

Sixty-four percent of employees that participated in a new survey said financial incentives helped connect them to necessary healthcare resources and equip them for improved member engagement. The Clear Insights Survey fielded by Wex...

Medicare Advantage Data Transparency Can Enhance Insights

by Thomas Beaton

Expanding Medicare Advantage data transparency may allow researchers to gain more comprehensive insights into cost and quality within the popular MA program. Healthcare experts and academic organizations currently have limited Medicare...

CMS Proposes Value-Based Payment for Skilled Nursing Facilities

by Thomas Beaton

CMS has proposed to implement value-based payment reforms for skilled nursing facilities (SNFs) and other Medicare inpatient facilities in order to reduce fraud and create higher quality healthcare experiences for beneficiaries. The...

Medicare Advantage, Premium Revenues Drive Q1 Payer Profits

by Thomas Beaton

Healthcare payers experienced strong first quarter profits in 2018 because of sharp growth in Medicare Advantage (MA) enrollment and premium revenues, according to newly released earnings statements. The reports confirm the stability and...

CMS Releases Medicare Advantage Encounter Data to the Public

by Thomas Beaton

CMS has planned to release Medicare Advantage encounter data so that researchers and consumers have the ability to make informed opinions about the cost and healthcare outcomes of the MA program. The agency will allow researchers to...

CMS Value-Based Payment Programs Show Satisfactory Performance

by Thomas Beaton

CMS value-based payment programs, including Medicare accountable care organization (ACO) initiatives, have met many of their goals in recent program years, although some work remains to accelerate growth and achieve federal targets,...

CMS Aims to Catalyze Advancements in Consumer Price Transparency

by Thomas Beaton

A proposed rule that requires hospitals to post their standard service rates online is only the start of CMS efforts to advance consumer price transparency across the entire agency, according to CMS Administrator Seema Verma. Verma...

Payers, Orgs Provide Feedback on CMS Value-Based Care Reform

by Thomas Beaton

CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider accountability, chronic disease management,...

How Payers Address Deep-Rooted Social Determinants of Health

by Thomas Beaton

The social determinants of health (SDOH) have gained traction in payer discussions and are driving payers to take a thoughtful look into factors that create long-lasting effects on healthcare costs and outcomes. Payers recently have...

Senate Bill Proposes Medicare Health Plan for All Ages

by Thomas Beaton

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...

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...

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...

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...

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...

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...

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