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Value-Based Care News

Payers Support Integrated Care Services for NC Medicaid Patients

January 15, 2018 - Payers and provider organizations that support integrated care systems can help lower healthcare costs by addressing the healthcare concerns of vulnerable patient populations, including Medicaid beneficiaries. Several commercial payers have recently announced agreements to work with Community Care of North Carolina (CCNC), a leader in data-driven population health, towards developing integrated...


Articles

Outcomes-Based Contracts Offer Payers New Pharmaceutical Options

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Payers may be more willing to provide their beneficiaries with genetic drug therapies that costs hundreds of thousands of dollars if they enter into outcomes-based pharmaceutical contracts that lessen financial risks. An outcomes-based pharmaceutical...

Top 10 Highest Performing Commercial Health Plans

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The top performing commercial health plans in the US for 2017-18 exceeded expectations for customer satisfaction, preventive care, and outcomes of their beneficiaries, according to the National Committee for Quality Assurance (NCQA). NCQA aggregated...

Considerations for Designing Consumer-Directed Health Plans

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Employers and health plans are rapidly adopting consumer-directed health plans (CDHPs) as a way to lower benefit costs and encourage cost-effective care utilization among beneficiaries. CDHPs are becoming part of many US employers’ efforts...

Expanding Air Ambulance Service May Help Payers Control Costs

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Expanding air ambulance benefits may help payers lower beneficiary premiums and help beneficiaries avoid several thousand dollars in out-of-pocket healthcare spending. An air ambulance costs between $12,000 to $25,000 per flight to account for...

How Payers Can Build a Successful Bundled Payment Strategy

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Bundled payment models are a popular reimbursement option for payers because they present an opportunity to improve healthcare quality, lower costs, and participate in value-based agreements with limited financial risk.   However, if payers...

Wellness, Preventive Care to Drive Employer Health Plans in 2018

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Employer-sponsored health plans are expected to widely embrace value-based purchasing agreements and patient engagement technologies that improve employee wellness programs and preventive care, according to the National Business Group on Health...

How Process, Outcome Measures Contribute to Population Health

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Payers rely on process and outcome quality measures to communicate healthcare performance to new and current beneficiaries. Quality measurements such as HEDIS, CMS Star Ratings, and standardized core quality measures (CQMs) are some of the tools...

Payer, Provider Collaboration Required for Accountable Care Success

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The accountable care organization (ACO) movement has gained traction over the last year as payers and providers begin to share the same viewpoints on the benefits of value-based care. Provider attitudes about ACOs and related value-based care...

Member Engagement, Medicare Advantage Growth Top 2018 Payer Trends

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2018 is a year in which payers are likely to implement strategies aimed at improving growth in Medicare Advantage markets, increasing the use of the social determinants of health  to improve outcomes, and expanding member engagement with...

How HEDIS, CMS Star Ratings, CQMs Impact Healthcare Payers

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Quality performance metrics such as HEDIS, CMS Star Ratings, and standardized core quality measures (CQMs) can give consumers an objective indication of healthcare payer quality. Standardized quality measures aggregate how well a payer has performed...

CMS Asked to Bolster Value-Based Payment Models for Providers

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The American Academy of Physicians, Aledade, the Texas Medical Association, Iora Health, and the Medical Group Management Association (MGMA) are among provider advocates urging CMS to create more opportunities for providers interested in value-based...

UnitedHealthcare Assists Phoenix Children’s Value-Based Care Goals

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UnitedHealthcare and Phoenix Children’s Care Network (PCCN) have launched an accountable care program aimed at a lowering costs and improving care quality. UnitedHealthcare will share data with PCCN to inform providers of a patient’s...

Medicare Advantage, Consumer Engagement Top Payer Trends for 2018

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Payers will face a number of industry challenges in 2018, including improving Medicare Advantage (MA) member satisfaction, expanding access to community outreach programs for individuals, and creating more drug pricing transparency for consumers,...

How Payers Address the Four Domains of Chronic Disease Prevention

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Payers have an opportunity to improve chronic disease prevention and limit chronic disease spending by addressing the both medical and non-medical factors of chronic conditions. Payers can determine their chronic disease costs, and lower those...

Why Bundled Payments Are a Popular Option for Healthcare Payers

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Bundled payments are ideal for payers that want to participate in value-based care. Bundled payments tend to have lower financial risks than other payment models for payers and are beneficial to providers as well as payers. In a bundled payment...

Member Engagement, Payer Spending Lead Top 10 Stories of 2017

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The 2017 news cycle was a constant flurry of political and financial developments for payers. From the turbulent efforts to repeal and replace the ACA in the House and Senate to challenges with member engagement, population health, and cost cutting,...

Integrated Care Model Lowers Health System Medical Costs

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Cigna’s integrated care model partnership with Texas-based Catalyst Health helped reduce the health system’s total medical costs to 5.6 percent below industry averages, the organizations announced in a press release. The Cigna Collaborative...

61% of Employees Dissatisfied with Employer Wellness Programs

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Fifty-two percent of employers believe their wellness programs improve their employee’s health behaviors, but only 32 percent of employees agree, according to a new survey from Willis Towers Watson. More than 60 percent are actively dissatisfied...

How Provider-Sponsored Health Plans Can Find Consumer Success

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Provider-sponsored health plans (PSHPs) are seen as a way for provider organizations to compete with commercial payers while lowering their own costs and improving care quality, because provider organizations can manage the cost of healthcare...

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