Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Insurance

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Patient, Provider Engagement Drives High Health Plan Performance

by Thomas Beaton

Health plan performance, and how to improve it, is always an issue at the forefront of payers’ minds.  While payers have engaged in several strategies in the past aimed at improving clinical quality, reducing costs, and boosting...

BCBS Launches Institute to Address Social Determinants of Health

by Thomas Beaton

The BlueCross BlueShield Association has created a new subsidiary called the BlueCross BlueShield Institute to help identify and address the social determinants of health (SDOH) for its beneficiaries. BCBS credits the Institute as the...

Tavenner Steps Down from AHIP, Hands Leadership to Matt Eyles

by Thomas Beaton

The AHIP Board of Directors has appointed Matt Eyles as the organization’s new President and CEO to replace Marilyn Tavenner after she retires on June 1st, 2018.    Eyles was elected unanimously as Tavenner’s...

Payer Input is Key for High Performance Provider Networks

by Thomas Beaton

Payer input is critical for developing high performance networks (HPNs) that are efficient and cost-effective while delivering high quality care, says the Academy of Actuaries in a new report.   HPNs are narrow provider networks...

Cigna, Amazon Alexa Offer Voice Control Beneficiary Education

by Thomas Beaton

Cigna is entering the voice control product space with an Amazon Alexa feature called “Answers by Cigna” that educates beneficiaries about complex health insurance terminology and customizes health benefits...

UnitedHealthcare Finds Value-Based Care Closed 50M Gaps in Care

by Thomas Beaton

Value-based care helped close 50 million gaps in care between 2013 and 2017 while reducing care costs, lowering ED utilization, and increasing provider care quality, according to a new report from UnitedHealthcare (UHC). UHC examined data...

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