Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value-Based Care News

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...

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...

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...

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...

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...

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...

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...

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...

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...

CVS Caremark Provides Real-Time Benefits Data to Pharmacies

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CVS Caremark, the pharmacy benefit manager (PBM) of CVS Health, will provide pharmacies and prescribers with real-time benefits data on patients as a way to reduce payer and patient drug costs, the organization announced in a press...

The Pros and Cons of Pharmacy Benefits Managers for Payers

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Prescription drug spending is a billion-dollar problem for the payer industry. While pharmacy benefit managers (PBMs) are often a positive way for payers to manage prescription drug benefits for their members, savings for payers can be...

How Payers Can Improve the Value of Small Business Health Plans

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Payers offering insurance plans for the employer market need to provide flexible benefits and cost-saving strategies that create value for small businesses. Small businesses are an excellent market opportunity for payers because health...

Ensuring High Out-of-Pocket Spending Won’t Lead to Negative Outcomes

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High deductible health plans (HDHPs) are intended to reduce payer and beneficiary spending on healthcare services, but untenable out-of-pocket spending for beneficiaries could lead to patients letting preventable conditions develop into...

Employer Health Plans Can Engage Members with Data, Targeting

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The use of data analytics and employee wellness engagement platforms may help employer health plans improve spending efficiency while producing a healthier, more productive workforce.    Employees are not always ready to take...

Single-Employee Businesses Experience High, Burdensome Premiums

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Single-employee businesses paid an average of $500 per month on premiums, experienced high premium payment growth, and experienced polarizing financial burden based on their premium payment amounts, a new report from JPMorgan & Chase...

Payer Housing Programs Address Social Determinants of Health

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Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services. A new report...

Value-Based Care Outperforms Fee-for-Service Health Plans

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Health plans that include value-based care (VBC) principles are more cost-effective than fee-for-service (FFS) options and are starting to produce better patient outcomes, Humana asserts in a new report. The total healthcare costs...

44% of Employees Don’t Know Value of Health Plan Benefits

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Employers must increase their efforts to educate members about the value of their health plan benefits based on recent findings that only 44 percent of employees fully comprehend their benefits. That is the leading takeaway from research...

Payer Strategies for Improving Member Medication Adherence Rates

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Payers are spending billions of dollars annually on medications that aren’t improving the health outcomes, with financial and health literacy proving to be the most common barriers to adherence. Avoidable healthcare spending...

Top 4 Consumer Wellness Benefits for Payers to Add to Health Plans

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As payers explore innovative ways to improve beneficiary engagement and satisfaction, they may wish to consider adding enhanced consumer wellness benefits to their health plan offerings. Health plans that take a proactive approach to...

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