Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Insurance

Alaska Bill to Alter Emergency Room Payment Rules Brings Concern

by Thomas Beaton

A bill in the Alaska Senate intended to repeal protections around emergency room payments has drawn significant concern from the state’s chapter of the American College of Emergency Physicians (ACEP).  The bill would remove a...

Merger Impacts, Medicaid Growth Drove 2017 Earnings for Payers

by Thomas Beaton

Aetna experienced a 4 percent drop in year-to-year earnings because of fallout from its proposed Humana merger, while other payers increased revenues by taking advantage of growing Medicaid, Medicare, and ACA-compliant business...

NQF Aims to Improve Medicaid Use of Social Determinants Data

by Thomas Beaton

Collaborating with public health and community organizations to foster informed decision-making can help Medicaid entities better address the social determinants of health (SDOHs), says new guidance issued by the National Quality Forum...

How All-Payer Claims Databases Can Identify Wasteful Spending

by Thomas Beaton

An all-payer claims database (APCD) can hold data on millions of patients and the services they receive, giving payers, providers, and related stakeholders the ability to identify wasteful spending and develop strategies to cut costs and...

Top 10 Highest Performing Medicare, Medicaid Health Plans

by Thomas Beaton

The top-performing Medicare and Medicaid health plans for the 2017-18 plan year earned exceptional quality scores based on the plans’ customer satisfaction, preventive care, and treatment outcomes of beneficiaries, according to the...

2018 Best in KLAS Taps Vendors for Claims Admin, Price Transparency

by Thomas Beaton

The 2018 Best in KLAS report ranked the best vendor solutions for payer claims administration, care management, price transparency, and payer analytics based on five industry performance criteria.    KLAS ranked vendor solutions...

Member Incentives for Lower Cost Health Services Saved Payer $3.2M

by Thomas Beaton

Commercial payers struggling to curb costs and encourage their members to make smarter financial choices may be able to save millions of dollars each year by investing in modest member incentives. Offering small financial rewards for...

Amazon, JP Morgan, Berkshire Hathaway Form Healthcare Company

by Thomas Beaton

Amazon, JP Morgan Chase & Co., and Berkshire Hathaway have announced a long-term partnership to form an independent company that focuses on cost-effective healthcare for employees. The company will aim to remove profit-making...

Consumer-Directed Care, High Deductibles Popular for Employees

by Thomas Beaton

Consumer-directed care, high-deductible health plans (HDHPs), and financial benefits related to healthcare spending have increased in popularity and demand by employees from 2017 to 2018, according to a new report from Benefitfocus. The...

DE Shifts Managed Medicaid Contracts to Value-Based Agreements

by Thomas Beaton

Delaware’s Department of Health and Social Services (DHSS) announced it is translating the state’s managed Medicaid Contracts into value-based agreements to improve the outcomes and costs of the state’s public healthcare...

Health Insurance Costs Placing Stress on Majority of Americans

by Thomas Beaton

Sixty-nine percent of Americans with an income of $50,000 a year or more cited the cost of health insurance as a major stressor and 63 percent of Americans with incomes less than $50,000 per year cited insurance costs as a major life...

High Care Costs Driving Employer-Sponsored Insurance Spending

by Thomas Beaton

The Health Care Cost Institute (HCCI) found that high care costs were the primary driver of increased employer-sponsored insurance spending in 2016, which grew by 4.6 percent and exceeded any rate between 2012 and 2015. A HCCI report of...

Humana Expands Long-Term Social Health Determinant Investments

by Thomas Beaton

Humana, and its philanthropic arm the Humana Foundation, announced changes to their grant making processes that provide long-term investments into community programs that address the social determinants of health (SDOH). The new...

Payers, Providers Pledge to Improve Prior Authorizations

by Thomas Beaton

AHIP, BCBSA, AHA, and other leading payer and provider organizations announced an industry pledge to improve the efficiency of prior authorizations while reducing administrative burden. Leaders of organizations participating in the pledge...

AMGA: Align Quality, Performance across Medicare Advantage, ACOs

by Thomas Beaton

CMS should work to align quality and performance standards across all Medicare programs, including Medicare Advantage (MA) and the Medicare accountable care organization (ACO) initiatives, says AMGA. In a letter issued in response to...

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

by Thomas Beaton

Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in...

Payers Support Integrated Care Services for NC Medicaid Patients

by Thomas Beaton

Payers and provider organizations that support integrated care systems can help lower healthcare costs by addressing the healthcare concerns of vulnerable patient populations, including Medicaid beneficiaries. Several commercial payers...

Humana Becomes Latest Payer to End AHIP Membership

by Thomas Beaton

Humana is the latest commercial payer to end its membership in AHIP, the nation’s largest health insurance trade organization. “Humana has not actively participated in AHIP since early 2017,” a Humana spokesperson told...

Outcomes-Based Contracts Offer Payers New Pharmaceutical Options

by Thomas Beaton

Payers may be more willing to provide their beneficiaries with genetic drug therapies that costs hundreds of thousands of dollars if they enter into outcomes-based pharmaceutical contracts that lessen financial risks. An outcomes-based...

Top 10 Highest Performing Commercial Health Plans

by Thomas Beaton

The top performing commercial health plans in the US for 2017-18 exceeded expectations for customer satisfaction, preventive care, and outcomes of their beneficiaries, according to the National Committee for Quality Assurance (NCQA). NCQA...

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