Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Indiana, Florida Approve Anthem, Aetna Health Insurance Mergers

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The major health insurance mergers taking place between Anthem-Cigna and Aetna-Humana have shown some progress of late. Recently, the Indiana Department of Insurance approved the acquisition between Cigna and Anthem, according to a press...

Top 6 Factors for Success in Provider-Sponsored Health Plans

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The health insurance industry may have a complete transformation on their hands with regard to hospital and medical practice reimbursement. The number of provider-sponsored health plans is growing among physician groups and hospitals,...

‘Data is Key’ to Cut Healthcare Spending, Boost Engagement

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A major goal among health payers today is to decrease continually rising healthcare spending. One way to do so is to identify patients who are at higher risk of deteriorating medical conditions and looking to engage with their provider to...

How State Policymakers Impact the Health Insurance Mergers

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In the state of Missouri, policymakers issued an order that would prevent the Aetna-Humana acquisition from proceeding in post-merger activity within Missouri's Medicare Advantage plans as well as some commercial health plans. The two...

Key Ways Blue Cross Blue Shield Raises its HEDIS Scores

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The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of all health plans situated around the country to compare performance and year-to-year success. HEDIS scores allow health plans to determine...

Why Cigna Succeeds in Value-Based Care Reimbursement Model

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Earlier this month, the mobile technology company athenahealth released its annual PayerView Report, which delves into the complex and evolving relationship between payers and providers, according to a company press release. This report...

Why Payers Need to Address Patient-Centered Medicine

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The healthcare insurance industry needs to meet the demands of consumers looking for quality provider data. Patient-centered medicine is becoming a mainstay throughout the country and cost transparency is a major aspect of this movement....

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