Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value-Based Care News

Lawmakers Propose HDHP Coverage for Chronic Disease Prevention

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A new bill introduced into the House and Senate would allow high-deductible health plans (HDHPs) to provide chronic disease prevention services before a patient meets his or her deductible, which could help to accelerate a growing HDHP...

Employer Guide Offers Strategies for Wellness Program Success

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An employer guide developed by The Transamerica Center for Health Studies (TCHS) and the Interdisciplinary Center for Healthy Workplaces (ICHW) determined that employers may need a better understanding of the factors that inhibit wellness...

AHIP: 25% of Opioid Prescriptions Top CDC Dosage Guidelines

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An AHIP retrospective analysis of claims data found that 25 percent of opioid prescriptions were above CDC dosage recommendation and provides a basic snapshot of problematic areas where payers could minimize patient safety risks related to...

Member Incentives for Lower Cost Health Services Saved Payer $3.2M

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Commercial payers struggling to curb costs and encourage their members to make smarter financial choices may be able to save millions of dollars each year by investing in modest member incentives. Offering small financial rewards for...

Amazon, JP Morgan, Berkshire Hathaway Form Healthcare Company

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Amazon, JP Morgan Chase & Co., and Berkshire Hathaway have announced a long-term partnership to form an independent company that focuses on cost-effective healthcare for employees. The company will aim to remove profit-making...

Consumer-Directed Care, High Deductibles Popular for Employees

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Consumer-directed care, high-deductible health plans (HDHPs), and financial benefits related to healthcare spending have increased in popularity and demand by employees from 2017 to 2018, according to a new report from Benefitfocus. The...

DE Shifts Managed Medicaid Contracts to Value-Based Agreements

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Delaware’s Department of Health and Social Services (DHSS) announced it is translating the state’s managed Medicaid Contracts into value-based agreements to improve the outcomes and costs of the state’s public healthcare...

Health Insurance Costs Placing Stress on Majority of Americans

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Sixty-nine percent of Americans with an income of $50,000 a year or more cited the cost of health insurance as a major stressor and 63 percent of Americans with incomes less than $50,000 per year cited insurance costs as a major life...

High Care Costs Driving Employer-Sponsored Insurance Spending

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The Health Care Cost Institute (HCCI) found that high care costs were the primary driver of increased employer-sponsored insurance spending in 2016, which grew by 4.6 percent and exceeded any rate between 2012 and 2015. A HCCI report of...

Payers Support Integrated Care Services for NC Medicaid Patients

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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...

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...

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...

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’...

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...

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...

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...

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...

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...

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...

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...

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