Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value-Based Care News

How the Medicare Advantage Market Can Offer Payer Opportunities

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Medicare Advantage (MA) market data from A.M Best and the Kaiser Family Foundation reveals that the MA market has remained profitable and provides financial opportunity, but payers looking to enter into the market should expect to address...

Mercy Health, Centene Form Medicaid Accountable Care Organization

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Mercy Health of Arkansas and the Centene Corporation have received approval to operate an accountable care organization within the state focusing on Medicaid beneficiaries, the organizations announced in a press release. Centene...

Only 30% of Employers Get Pharmacy Benefit Manager Contracts

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Only 30 percent of employers have a complete understanding of their pharmacy benefit manager (PBM) contracts, according to a new survey from the National Pharmaceutical Council (NPC). Just 40 percent of the 88 employers participating in...

Medicare Consumers Prefer Phone Calls from Health Plans

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Medicare consumers tend to prefer traditional phone calls or mailings over digital engagement strategies such as text messaging or using a member portal, according to a new Healthmine survey. Forty-eight percent of Medicare consumers aged...

Payer Strategies for Boosting Consumer Engagement, Satisfaction

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In an increasingly competitive health insurance environment, payers that can successfully increase consumer engagement and beneficiary satisfaction will be best positioned for success. David Biel, the US Leader for Health Plans consulting...

Quality Measures Challenging in Pharmaceutical Value-Based Contracts

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Healthcare payers may find it difficult to establish value-based contracts (VBCs) with pharmaceutical companies due to the challenges of creating meaningful, workable quality measures.   Pharmaceutical companies are generally...

How to Create Balanced Risk Pools that Lower Premiums

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Payers have been increasingly challenged to manage the high cost of healthcare while lowering the premiums their beneficiaries pay.  Creating balanced risk pools that benefit medically complex individuals while also serving healthier...

High-Deductible Health Plans Reduce Care Costs, Needed Services

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High-deductible health plans (HDHPs) may reduce spending, but are also prone to preventing health care consumers from accessing necessary services and recommended preventive care, according to a study published in Health...

Health Plan Consumers Report Insufficient Payer Communications

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Health plans may not be effectively communicating with consumers about member  benefits and largely fail to understand their members’ health and financial needs, a survey from Healthmine found. A sample of 750 consumers...

80% of Payers Investing in Member Engagement, Satisfaction

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Eighty percent of health plans are focusing on improving member engagement and consumer satisfaction, according to a survey by Change Healthcare.   Member engagement is a growing opportunity for payers because of the potential...

Medicaid Drug Pricing Rule May Inhibit Value-Based Contracts

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A Medicaid drug pricing rule which safeguards deep discounts for the public program can potentially inhibit value-based contracts agreements between payers and pharmaceutical companies, according to research from the Journal of Health...

Beneficiary Segmentation, Spending by Healthcare Payer Type

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Healthcare spending in the US continues to grow steadily across all beneficiary segments and healthcare payers. 2015 data from CMS, the CDC, and the Kaiser Family Foundation (KFF) indicates that payers and individuals sponsoring their own...

Payer Pricing, Partnership Strategies for Population Health

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Effective population health management and comprehensive preventive care open the door to new opportunities that maximize payer spending, raise care quality, and slow the progression of costly chronic conditions such as diabetes and...

Payers Driving Value by Promoting Connected Care Models

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As payers vie to remain competitive in commercial insurance markets, they must be able to effectively manage consumer costs while providing beneficiaries the best possible healthcare experience now and in the future. Rising healthcare...

Large Variations Seen in Consumer Healthcare Spending

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As healthcare costs rise, beneficiaries will be more responsible for out-of-pocket healthcare expenses not covered by their health plans. But those costs drastically vary by state, family size and income, and other variables, according to...

Pharmaceutical Industry Slow to Embrace Value-Based Contracts

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Sixty-one percent of pharmaceutical companies are not yet participating in value-based contracts due largely to the belief that current policies make it too difficult to negotiate with payers and see a return on investment, according to a...

Top 10 Healthcare Spending Categories in the United States

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The upward trajectory of US healthcare spending doesn’t seem to be slowing down anytime soon, leaving payers, providers, and beneficiaries wondering how to control costs while maintaining a high level of quality. Value-based...

Medicaid Analytics Support Social Determinant Incentive Payments

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Payers looking for innovative ways to control the costs of care have been turning their attention to the social determinants of health, the non-clinical factors that often lead to issues with care access, non-adherence, and the development...

Narrow Provider Networks are 16% Cheaper for ACA Plans

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Economists from Harvard Business School and Northeastern University found individual ACA silver plans with narrow provider networks were 16 percent cheaper for consumers and offer payers a promising savings opportunity in the commercial...

Cost of Implementing Quality Measures Key for Value-Based Care

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Healthcare payers and providers must develop a better sense of the costs and burdens of implementing quality measures if they are to succeed with value-based care, according to the authors of a recent commentary in JAMA. Leaders from...

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