Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

Why Provider-Sponsored Health Plans are Gaining Ground

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There are a number of reasons why provider-sponsored health plans are growing and more hospitals are considering investing in their own health plans instead of partnering with health payers, says Paul Keckley, Ph.D., a healthcare industry expert...

Does Reference Pricing Reduce Costs of Diagnostics for Payers?

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Health insurers and consumers can benefit from seeking reference pricing when it comes to choosing specific diagnostic tests among a set of different laboratories. Researchers from the University of Southern California and the Brookings Institution...

One-third of Hispanic Texans Lack Medical Insurance in 2016

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There is still more work that needs to be done to ensure all American citizens have access to healthcare coverage. The Episcopal Health Foundation and Rice University’s Baker Institute for Public Policy found that approximately 32 percent...

1.5M Workers Gained Employer-Sponsored Healthcare Coverage

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The number of employees who have gained healthcare coverage through employer-sponsored health plans has been rising in recent years as the economy recovered and more Americans gained a foothold in the workplace. With a stronger economy, the health...

Payers’ Perspective: Insurance Mergers Benefit Consumers

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As previously reported, the Department of Justice (DOJ) has announced that it will be blocking the Anthem-Cigna and Aetna-Humana insurance mergers due to the potential harm it may bring to consumers along with employers, hospitals and providers....

NCQA Proposes New Changes to HEDIS Quality Measures in 2017

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The National Committee for Quality Assurance (NCQA) is looking to broaden a number of HEDIS quality measures for the 2017 edition, according to a news release from NCQA. These changes include the addition of four new HEDIS quality measures and...

Why Value-Based Care Reimbursement Needs Risk Adjustment

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The Patient Protection and Affordable Care Act is a very complex piece of legislation that covers a wide range of provider and payer issues. Several not commonly discussed factors include the ACA’s impact on risk adjustment and risk selection....

Cost Shifting to Consumers May Reduce Patient Satisfaction

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Consumer choice, patient satisfaction, and out-of-pocket spending is becoming a more pressing issue in the new political climate caused due to a blossoming of healthcare reforms. Within this new landscape, a new coalition called Partners for...

DOJ Sees Continued Opposition to Health Insurance Mergers

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Last month, a number of senators came forward with some significant reservations about the health insurance mergers taking place between Anthem and Cigna as well as Aetna and Humana. According to a news release, Senators Richard Blumenthal (D-CT),...

Why HEDIS Quality Measures Matter for Value-Based Care

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The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of health payers to assess and collect data on the performance of providers. HEDIS consists of a number of different measures on which healthcare providers...

Communication, Cost Transparency Impact Patient Engagement

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Patient engagement is becoming a more and more relevant term in today’s changing healthcare landscape. With more consumers than ever before becoming responsible for their healthcare costs via high-deductible health plans and out-of-pocket...

High-Deductible Health Plans Dominate Employer Offerings

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Today, the consumer or employee is left with much higher out-of-pocket costs than in previous years. Within the Kaiser Family Foundation’s 2015 Employer Health Benefits Survey, statistics show that the number of workers with a standard...

Payers Seek Cost, Integration Efficiencies for Value-Based Care

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Health insurance is no longer primarily a business-to-business transaction between payer organizations and employers. Today, payers must be prepared to holistically meet the needs of millions of individual consumers—from onboarding and...

Consumer Healthcare Spending Trends Show Uptick in Engagement

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Consumers today are becoming more and more responsible for covering the costs of healthcare services especially due to the greater proliferation of high-deductible health plans and out-of-pocket spending. What are the biggest healthcare spending...

How Pharmacy Benefit Managers Could Reduce Drug Cost Growth

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From a health insurance perspective, more analysis needs to be taken into account when attempting to reduce healthcare spending. For instance, health payers may be interested in learning that pharmacy benefit managers (PBM) actually play a role...

Healthcare Spending for Diabetes Patients Rose 6% in 2014

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People who have to manage diabetes are in worse shape financially than those without the disease. The Health Care Cost Institute (HCCI) published a study showing that healthcare spending rates among diabetes patients with employer-sponsored health...

Major Health Insurance Mergers May Leave Consumers “Worse Off”

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Four of the top five major payers in the nation are looking to consolidate into two combined health insurance companies. The Anthem-Cigna and Aetna-Humana health insurance mergers could lead to a complete transformation of the market and impact...

Ambulatory Surgery Centers Decrease Costs by $38 Billion

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Health payers are often looking for ways to reduce healthcare spending, especially with regard to the costs of covering medical claims. Many have focused on implementing value-based care reimbursement structures like bundled payments while others...

29% of Doctors Have Tools Needed for Value-Based Care Payments

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While value-based care payments are making headway across the country, there are still barriers that stand in the way of payers and providers fully embracing these alternative payment models. A report from Quest Diagnostics and Inovalon found...

Why Payers Should Adhere to Patient Engagement, Consumer Choice

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Consumer choice in health plans and provider networks is becoming a more popular topic of late among payers looking to increase patient engagement. There is a growing movement around the nation aimed at improving consumer satisfaction and healthcare...

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