Consumers of dental plans may benefit from more transparency around the medical loss ratio (MLR) of dental insurance options, asserts the California Dental Association (CDA).
In a recent research...
Payer and provider members of the Da Vinci Project are undertaking a series of pilot projects exploring how to best leverage FHIR for data exchange to enhance value-based care.
“Da Vinci is a...
Providing long-term support services (LTSS) impact commercial payers who need to address complications and billions in costs associated with this kind of care.
In 2016, the United States spent $92.4...
CMS’s Comprehensive Primary Care Plus (CPC+) model may offer lessons and strategies for payers that want to increase primary care efficiency with population health management strategies.
The...
Eighty-six percent of health plan beneficiaries primarily blame payers for surprise medical bills, according to a survey from NORC at the University of Chicago, indicating that insurers may wish to...
Maintaining a profitable individual health plan product is already challenging, but adverse selection can create additional problems that impede a payer’s ability to control health plan...
Health plan accreditation programs can help payers highlight offerings that deliver on key quality, efficiency, and beneficiary satisfaction measures.
Many health plans currently participate in the...
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...
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)...
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...
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...
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...
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,...
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...
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...
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...
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,...
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...
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...
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...
