Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

CMS Offers Opioid Coverage, Health IT Guidance for Medicaid Plans

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CMS has issued new opioid coverage strategies and health IT guidance to help states improve opioid safety within Medicaid plans. The guidelines include advice for state programs about treating infants with neonatal abstinence syndrome...

Medicare Bundled Payment Programs Primed to Produce Savings

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Medicare’s bundled payment programs are in an opportune position to produce additional savings and create a more cost-effective public payer program with certain revisions, a new white paper from USC Brookings explains. CMS’s...

Unstable Future Predicted for Medicare, Depletion by 2026

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The Medicare Board of Trustees (MBT)’s latest report anticipates that Medicare’s Hospital Insurance (HI) Trust Fund will deplete by the year 2026 as Medicare spending continues to outgrow the trust’s collective...

HHS Made Nearly $90B in Improper Payments to Medicaid, Medicare

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HHS made approximately $90 billion in improper payments to Medicaid and Medicare programs during 2017 and may require updated payment evaluation procedures to address improper payments, a new Government Accountability Office (GAO) report...

MSSP ACOs Taking on Downside Risk See Smaller Savings

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Medicare Shared Savings Program (MSSP) ACOs that take on downside risk generate smaller savings than upside risk ACOs, according a Center for Healthcare Quality and Payment Reform (CHQPR) analysis. In 2016, the average annual cost of care...

Medicaid Plans More Cost Effective, Stable than Exchange Plans

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Medicaid health plans are more cost effective than federal exchange plans and could offer beneficiaries more affordable coverage options, according to a UnitedHealth Group analysis. UnitedHealth Group said that federal healthcare agencies...

CMS Highlights Drug Price Transparency Data Dashboards

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CMS has released redesigned drug price dashboards to provide information about manufacturer drug costs and advance the agency’s goals of promoting consumer price transparency. Patients, providers, and researchers are able to explore...

MD Extends All-Payer Model, Targets $1B in Medicare Savings

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Maryland Governor Larry Hogan and CMS have announced a five year extension of the state’s All-Payer Model, targeting an additional $1 billion in Medicare savings over the coming years, according to a public statement from...

Medicaid Spending Drops When Members Transition to Community Care

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Medicaid spending declined when beneficiaries transitioned from long-term institutional care into community care, a new report conducted by Mathematica Health Policy found. Researchers observed cost outcomes of Medicaid’s Money...

Medicare Diabetes Prevention Program Offers Model for Chronic Care

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CMS’s Medicare Diabetes Prevention Program (MDPP) aims to address diabetes prevalence within the Medicare program, and may help other payers develop a model for chronic care, based on the MDPP’s promising initial...

CMS Value-Based Payment Programs Show Satisfactory Performance

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CMS value-based payment programs, including Medicare accountable care organization (ACO) initiatives, have met many of their goals in recent program years, although some work remains to accelerate growth and achieve federal targets,...

Humana Launches Bundled Payment Model for Maternity Care

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Humana has launched a bundled payment model to improve outcomes and lower costs of maternity by partnering with OBG-YNs across the country. Humana’s Maternity Episode-Based Model bundles payments that covers the cost of a...

HHS Must Address Adverse Selection in Medicaid, Medicare Renal Care

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AHIP is urging HHS secretary Alex Azar to address adverse selection related to Medicaid or Medicare end stage renal disease (ESRD) in order to ensure that vulnerable beneficiaries continue to receive appropriate healthcare services. AHIP...

Health Plan Variety Does Not Boost Managed Medicaid Performance

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Managed Medicaid performance does not increase as state Medicaid programs introduce more health plan variety, but a single health plan with value-based characteristics may be more effective in improving performance, a new JAMA...

Medicaid Coverage Creates Significant Healthcare Opportunities

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Medicaid coverage led to significant healthcare opportunities that rivaled commercial health insurance care quality, according to a new study from AHIP. Nearly 74 million adults and children who receive Medicaid were found to have...

CMS: Payers Must Make Claims Data Available to Beneficiaries

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CMS Administrator Seema Verma recently called on healthcare payers to make claims data available to their beneficiaries. The agency also announced a new initiative called MyHealthEData to give patients control of their healthcare...

Medicare Wellness Programs Promise Better Health Outcomes

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Medicare wellness programs have the potential to improve physical and mental health for beneficiaries with chronic conditions, according to a new report from the Center for Medicare and Medicaid Innovation (CMMI). Medicare members that...

IN Medicaid Waiver Uses Work Requirements, Tobacco Penalties

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Indiana is the second state to receive approval for a 1115 Medicaid demonstration that adds work requirements as a condition of beneficiary eligibility.  The demonstration also adds premium penalties for tobacco use as well as...

NQF Aims to Improve Medicaid Use of Social Determinants Data

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Collaborating with public health and community organizations to foster informed decision-making can help Medicaid entities better address the social determinants of health (SDOHs), says new guidance issued by the National Quality Forum...

Top 10 Highest Performing Medicare, Medicaid Health Plans

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The top-performing Medicare and Medicaid health plans for the 2017-18 plan year earned exceptional quality scores based on the plans’ customer satisfaction, preventive care, and treatment outcomes of beneficiaries, according to the...

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