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...
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...
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...
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...
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...
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...
Employers and health plans are rapidly adopting consumer-directed health plans (CDHPs) as a way to lower benefit costs and encourage cost-effective care utilization among beneficiaries.
CDHPs are...
Expanding air ambulance benefits may help payers lower beneficiary premiums and help beneficiaries avoid several thousand dollars in out-of-pocket healthcare spending.
An air ambulance costs between...
Bundled payment models are a popular reimbursement option for payers because they present an opportunity to improve healthcare quality, lower costs, and participate in value-based agreements with...
Employer-sponsored health plans are expected to widely embrace value-based purchasing agreements and patient engagement technologies that improve employee wellness programs and preventive care,...
All-payer claims databases (APCDs) allow payers, providers, and regulators to analyze claims from millions of beneficiaries to learn where spending is directed and whether or not spending on certain...
Prior authorization may allow payers to limit unnecessary spending on high-cost prescription drugs, but leading provider experts suggest that payers could do more to boost the efficiency of prior...
Payers rely on process and outcome quality measures to communicate healthcare performance to new and current beneficiaries.
Quality measurements such as HEDIS, CMS Star Ratings, and standardized core...
The accountable care organization (ACO) movement has gained traction over the last year as payers and providers begin to share the same viewpoints on the benefits of value-based care.
Provider...
2018 is a year in which payers are likely to implement strategies aimed at improving growth in Medicare Advantage markets, increasing the use of the social determinants of health to improve...
Humana signed a definitive agreement to acquire a 40 percent minority in the Kindred at Home division of Kindred Healthcare, the nation’s largest home health care provider. The $800 million...
Consumers purchasing health insurance through the ACA exchanges are likely to actively seek out lower-cost options when enrolling or re-enrolling in individual health plans, says new data from GAO,...
Aetna will be the first national payer to waive Narcan co-pays for fully-insured members as part of a larger effort to address the nation’s opioid crisis, the payer announced in a press release....
UnitedHealthcare and Phoenix Children’s Care Network (PCCN) have launched an accountable care program aimed at a lowering costs and improving care quality.
UnitedHealthcare will share data with...
Payers will face a number of industry challenges in 2018, including improving Medicare Advantage (MA) member satisfaction, expanding access to community outreach programs for individuals, and creating...