Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value-Based Care News

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. ...

Humana Expands Orthopedic Bundled Payment Program to NC, VA

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Humana will bring its value-based orthopedic bundled payment program to 11 orthopedic specialty groups in North Carolina and Virginia.  The move follows a recent expansion into Kentucky and Indiana in 2017, and Ohio and Tennessee in...

Pharmacy Benefit Managers Help Reduce Payer Drug Spending

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Pharmacy benefit managers (PBMs) are instrumental in helping payers provide appropriate access to prescriptions, expand access, and rein in drug spending, according to a recent report from the Pharmaceutical Care Management Association (PCMA)....

Aetna to Offer New HMO Option for Delaware State Employees

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Health insurer Aetna was recently awarded a three-year contract as a provider of Delaware’s health plan offerings for its employees and pensioners.  Aetna has chosen a coordinated care approach partnering with local innovators to move...

Patient-Centered Medical Home Benefits Payers, Providers, Patients

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Blue Cross-Blue Shield of Michigan has one of the nation’s most successful patient-centered medical home (PCMH) networks.  The model has improved patient outcomes, lowered payer costs and increased provider satisfaction and revenue. ...

Population Health Approach to Prenatal Care Cuts Payer Costs

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Health insurance payers can improve patient outcomes and reduce spending by expanding the use of population health management models for expectant mothers.  Early intervention and preventive care can lower costs in high-risk birth situations,...

Humana Expands Medicare Orthopedic Bundled Payment Programs

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The nation’s fourth largest healthcare payer recently announced it will be expanding its orthopedic bundled payment programs to eight new groups in Indiana and Kentucky.  The value-based care model will also offer participating providers...

Prescription Drugs Account for 22% of Payer Premium Spending

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Prescription drug costs consume the largest proportion of dollars spent on healthcare premiums, with 22 cents out of every dollar going to medication costs, says AHIP in a new data brief. Eighty percent of every dollar is spent on medical expenses,...

Can Value-Based Purchasing Work with Pharmaceutical Companies?

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The Network for Excellence in Health Innovation (NEHI) believes that developing value-based purchasing contracts between payers and pharmaceutical companies will be a critical next step for healthcare reform. Having payer and pharma companies...

APMs, Health Data Exchange among Top Payer Reform Goals

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The National Academy of Medicine (NAM) offered policymakers and stakeholders healthcare reform priorities, including alternative payment models (APMs) and health data exchange, that aim to lower overall healthcare costs and improve patient...

Out-Of-Pocket Healthcare Spending on the Decline Since 2000

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The Agency for Healthcare Research and Quality (AHRQ) reported that out-of-pocket healthcare spending decreased for all age groups between 2000 and 2014. A statistical brief of the report presents data from the Household Component of the Medical...

HFPP Provides New Resource for Payers to Combat Opioid Abuse

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A new 64-page report from the Healthcare Fraud Prevention Partnership (HFPP), a public-private partnership which includes CMS, gives payers resources that treat, educate, and develop improvements for combating opioid harm to patients. CMS has...

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