Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

Stop-Loss Insurance a Growing Market Opportunity for Healthcare

August 18, 2017 - Even though payers may experience higher total revenues on commercial self-insurance, stop-loss and third-party protected insurance revenues have been growing at a higher rate with stronger market stability according to market research from AM Best. Unlike reinsurance, a market stabilization program where self-insured payers contribute funds to protect health plans from premium increases,...


Articles

Explaining Out-of-Pocket Costs May Ease Cancer Care Stress

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Patients who are not prepared for the magnitude of their out-of-pocket costs for cancer care are more likely to be distressed and less likely to pay their bills than other individuals, according to a research letter published in JAMA Oncology....

Can Healthcare Price Transparency Tools Cut Costs for Payers?

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As out-of-pocket costs for patients continue to rise alongside payer spending on services, many health insurance companies are turning to online price transparency tools to help beneficiaries decide how to purchase low cost, high quality care....

CMS Approves State Capitated Medicaid Program in Florida

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Florida received CMS approval to operate a state capitated Medicaid program and a low-income pool (LIP) to improve care for uninsured individuals, the federal agency announced. The state submitted a request to extend Florida’s Managed Medicaid...

Employer Cost Management Strategies Combat High Insurance Costs

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Employers expect healthcare spending to increase by 5.5 percent in 2018, up from a 4.6 percent increase in 2017, according to a Willis Towers Watson survey. The continued rise in costs has turned health cost management as a top employer concern,...

Payer Collaboration Can Address Social Determinants of Health

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Billions in overspending on medical costs are attributed to social determinants of health (SDOH), and SDOH can identify if beneficiaries covered by insurance plans are at risk for adverse health conditions outside their coverage. SDOH include...

How Can Health Savings Accounts Help, Hinder Patients and Payers?

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Health savings accounts (HSAs) have been widely discussed as lawmakers consider policy reforms, at the federal level, and have become a fixture in conversations about healthcare spending among payers and patients alike.   HSAs are consumer...

What to Look for in Health Insurance Enrollment Technology

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Health insurance enrollment technology is designed to offer payers convenience, cost savings, and administrative ease-of-mind when it comes managing beneficiaries enrolled in health plans. Many Americans face challenges when seeking new health...

Member Engagement for Payers Should Focus on Simplicity

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For payers, an effective member engagement strategy can lead to better member health, lower claims cost, and improved product loyalty.  To achieve these goals, payers should start by identifying pain points and implementing processes that...

ACA Risk Adjustment, Reinsurance Improved Payer Financials

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A new study published in Health Affairs found risk adjustment and reinsurance provisions of the Affordable Care Act improved financial outcomes for certain payers with higher risk enrollees.   Researchers from AHRQ and CMS found that before...

Does Tiered Cost-Sharing Promote Appropriate Medication Use?

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Health plans have traditionally used tiered formulary cost-sharing arrangements to reduce healthcare spending and incentivize appropriate medication use. But a recent Journal of Managed Care & Specialty Pharmacy study found that stakeholders...

Joint Replacement Bundled Payment Cut Costs, Maintained Volume

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A new Altarum Institute study confirmed previous research that bundled payment models for lower extremity joint replacements decreased care costs without sacrificing care quality or substantially increasing procedure volumes. In September 2016,...

How to Develop HEDIS Quality Measures for Pediatric Care

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The American Academy of Pediatrics (AAP) announced yesterday on its website that it will be partnering with the National Quality Forum (NQF) to connect quality metrics to the interests of children and pediatric care. The National Quality Forum...

How to Reduce Obesity Rates, Increase HEDIS Quality Scores

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When attempting to improve provider performance on HEDIS quality scores, healthcare payers may need to pick and choose the quality measures that could be realistically raised. For example, childhood obesity may be one of the most common health...

Why Payers Should Reduce Cost Sharing for High-Value Care

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Today, more healthcare payers are positioning greater cost-sharing onto the consumers to keep from raising premium rates, according to commentary published in JAMA Internal Medicine. The 2016 National Health Insurance Survey discovered that 40...

How Payers, Providers Could Streamline Medical Claims Management

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Successful medical claims management and processing is not always easy to garner for health insurance companies due to a lack of training among insurance agents, missing or inaccurate documentation, and the general time-consuming aspect...

4 Key Ways Payers Could Reach HEDIS Score Thresholds

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Health payers looking to increase consumer satisfaction and member retention may need to reach care quality metrics and HEDIS measures. The National Committee for Quality Assurance (NCQA) is responsible for many aspects of HEDIS measures and...

How Healthcare Payers Could Reduce Wasteful Spending

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For many years, the health insurance industry has been working to address wasteful spending among hospitals and medical practices. Some of the areas of wasteful spending relate to duplicative medical testing, unnecessary diagnostics, and excessive...

4 Ways Payers Could Improve Healthcare Price Transparency

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Healthcare price transparency remains a key issue for health payers across the country. In order to strengthen member retention efforts especially during open enrollment periods, payers will need to boost price transparency to improve consumer...

How Payers Could Improve Population Health Management with Tech

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When payers transition their reimbursement structures toward a value-based care payment model, healthcare quality improvement needs to be addressed. In order to boost quality, payers could target population health management and data analytics...

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