Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value-Based Care News

Employer Reference Pricing Lowers Prescription Drug Expenses

August 22, 2017 - As payers and employers learn to counter significant increases of prescription drug expenses, reference pricing may hold the key to lowering drug spending and increasing consumer purchases of lower cost drugs, according to research published in The New England Journal of Medicine. A team from UC Berkeley School of Public Health found that the RETA Trust — an employer group that purchases...


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Tufts Health Plan Launches Four Medicaid ACO Partnerships

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Tufts Health Plan has signed contracts to form Medicaid accountable care organizations (ACOs) with Atrius Health, Beth Israel Deaconess Care Organization, Cambridge Health Alliance, and Boston Children’s Hospital ACO, according to a press...

Latest Earnings Reports Show State of Health Payers in 2017

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At the half-year mark, payers have a good sense of how well their efforts to promote value-based care have fared and the opportunity to make the necessary adjusts where they have not. As part of the business-facing side of value-based care, payers...

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...

Effective Steps for Health Insurance Marketing, Consumer Engagement

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Creating and deploying effective health insurance marketing and consumer engagement plans can be difficult for payers in today’s complex purchasing landscape.   Payers must focus on building strong brands, clear messaging, and effective...

Boston Children’s, Cleveland Clinic Partner for Pediatric Care

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Boston Children’s Hospital and Cleveland Clinic have announced a partnership to provide complex pediatric heart care through Cleveland Clinic’s national employer-based insurance network. “Together, our goal to develop and provide...

Large Employers Aim to DRIVE the Expansion of Value-Based Care

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Large employers are deeply invested in bringing down healthcare spending rates, and have embraced value-based care strategies for ensuring that their employees stay as healthy and productive as possible. As care costs continue to rise across...

Can Healthcare Payers Inspire ACOs to Take on Two-Sided Risk?

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While two-sided risk arrangements are attractive for healthcare payers, even experienced accountable care organizations (ACOs) are wary of jumping into contracts which make them financially responsible for falling short of their quality benchmarks. ...

Opioid Use Fell 32% in CA BCBS Prescription Drug Safety Program

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The Blue Shield of California Health Plan, an independent member of Blue Cross Blue Shield (BCBS), successfully lowered overall opioid use by 32 percent during the first two years of its Narcotic Safety Initiative (NSI).   The NSI leveraged...

Top 10 Most Expensive Chronic Diseases for Healthcare Payers

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Chronic diseases are on the rise in the United States, leaving healthcare payers with the challenge of covering care for patients with these expensive, long-term conditions. Chronic diseases are such a costly healthcare endeavor that experts...

Humana, Oscar Health to Deliver Small Business Insurance

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Humana and startup insurance provider Oscar Health have entered into a strategic partnership that aims to provide commercial small business insurance to consumers in a nine-county area surrounding Nashville, TN. The partnership merges Humana’s...

Guides Help Employers Decide on Accountable Care Organization Use

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The National Business on Health Group (NBHG) has released two comprehensive guides to help employers evaluate the pros and cons of using accountable care organizations (ACOs). Both resources are part of an ACO toolkit to help employers assess...

Managed Care Plays Key Role in Expanding Long Term Services

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Due to legal and financial reasons, the past several decades have seen LTSS move from institutional settings to home or community based care, increasingly adopting the use of MCOs.   As states adopt the MCO system into their LTSS design,...

ACA Medicaid Expansion Boosted Care Access, Patient Outcomes

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Low-income adults taking advantage of the Affordable Care Act’s Medicaid expansion experience more financial stability and better outcomes, according to a new study from the Harvard T. H. Chan School of Public Health. “Our four years...

Payers, Providers Differ in Value Based Care, Health IT Opinions

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Payers see the move towards value-based care as a permanent fixture in the nation’s healthcare delivery system, with 82 percent of organizations responding to a Quest Diagnostics and Inovalon survey expecting it to continue despite any...

Two Payers Liable for $32.5M in Medicare Advantage Fraud Suit

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Insurers Freedom Health and Optimum Healthcare have agreed to pay $32.5 million to avoid further litigation in a whistleblower lawsuit which alleges systemic Medicare Advantage fraud.    The insurers will pay the federal government $16.7...

Healthcare Costs Vary Widely Across Geographic Regions

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New research from the Health Care Cost Institute (HCCI) shows that healthcare costs for three common procedures, including knee injections, ACL repairs, and knee replacements, varied greatly across 61 metro areas.   The results...

AHIP: Congress Must Stabilize Payer Market, Consider Reforms

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With passage of the AHCA, the insurance industry group AHIP has sent its response to congress and presented its recommendations for what direction to go in with healthcare reform The payer industry organization submitted recommendations in four...

Understanding the Basics of Accountable Care Organizations

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Accountable care organizations (ACOs) are provider-based networks which utilize data analytics and population health management strategies to increase efficiency, improve patient outcomes, and reduce healthcare costs. Originally established in...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

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In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the nation’s patients. ...

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