Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Insurance

Payers See Cost, Quality Gains with Value-Based Payment Models

by Thomas Beaton

Payers and providers participating in value-based payment models are seeing reduced costs and improvements in care quality.   Value-based payment, which is expected to account for 59 percent of all healthcare payments by 2020, helps...

Value-Based Care Slashes Per Member Per Month Costs in Kansas

by Thomas Beaton

BlueCross BlueShield of Kansas has seen significantly lower per member per month costs for beneficiaries participating in value-based care arrangements, including accountable care organizations (ACOs) and patient-centered medical homes...

Payers, Providers Create New Medicare Advantage Partnerships

by Thomas Beaton

New Medicare Advantage plans, many born of innovative partnerships between payers and providers, are creating more options for beneficiaries to supplement their existing coverage with high-value offerings. Commercial payers operating in...

How Employers Can Design High-Quality Cancer Care Benefits

by Thomas Beaton

Designing meaningful and high-quality cancer care benefits is a challenge for employer-sponsored health plans.   Cancer, a costly and complex condition that takes many different forms, requires coordination across the entire...

Anthem, Walmart Partner for Over-the-Counter Drug Allowance

by Thomas Beaton

A new partnership between Anthem and Walmart will allow Medicare Advantage beneficiaries to purchase over-the-counter drugs and other drug store necessities with a plan allowance. Starting in January of 2019, Anthem beneficiaries will be...

Google Invests $375M in Oscar Health for Medicare Advantage

by Thomas Beaton

Google’s parent company, Alphabet, has invested $375 million in Oscar Health to help the tech-focused payer enter into Medicare Advantage markets by 2020, according to multiple news outlets, including Reuters. Oscar Health said in...

OH Medicaid Adopts Pass-Through Model for Managed Care Drugs

by Thomas Beaton

Ohio’s Medicaid program has issued a mandate that requires managed care health plans to re-negotiate pharmacy benefit manager (PBM) contracts to transition from a spread-pricing drug purchasing model to a pass-through model. The...

Commercial Payers See Promise in Diabetes Prevention Program

by Thomas Beaton

The Diabetes Prevention Program could offer commercial payers an impactful way to prevent chronic disease for beneficiaries, according to a new report from AHIP.   In 2012, AHIP recruited seven large payers to a pilot program which...

Nearly 20% of Employees Have Inpatient Out-of-Network Claims

by Thomas Beaton

Approximately twenty percent of employees with insurance had at least one out-of-network claim for inpatient care, according to a Peterson-Kaiser Tracker analysis. Employees with out-of-network provider bills may experience increased...

Only 22% of Medicare Advantage Customers Aware of Star Ratings

by Thomas Beaton

Only 22 percent of Medicare Advantage (MA) beneficiaries are familiar with how star ratings work and increasing consumer awareness about star ratings would help beneficiaries choose high quality plans, according to a new Healthmine...

Provider Market Concentration Outweighs Payer Concentration

by Thomas Beaton

Healthcare provider systems tend to be bigger, more consolidated, and have more market share than payers in the same metropolitan areas, leaving some payers with less power to negotiate pricing and other contracts, according to the...

Insurance Coverage Rates Dip by 12% Due to High Premium Costs

by Thomas Beaton

Individual health plan enrollment between 2017 and 2018 fell by 12 percent as high premiums and a scarcity of subsidy assistance force consumers out of the market, according to an analysis from the Kaiser Family Foundation (KFF). Health...

How to Improve Cost Sharing to Enhance Chronic Disease Management

by Thomas Beaton

A tailored cost sharing program that helps beneficiaries pay for chronic disease care can reduce wasteful spending and increase access to chronic disease management services. However, relying on one-size-fits all cost-sharing plans can...

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 will showcase effective strategies to...

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, including AHIP, AHA, the BlueCross...

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 have more options than ever to meet...

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 Medicare beneficiaries have at least one...

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 exceptional beneficiary outcomes. In order to...

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 looking to add new value-based care...

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 offer payers a lucrative opportunity to...

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