Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value-Based Care News

Commercial Payers See Promise in Diabetes Prevention Program

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The Diabetes Prevention Program could offer commercial payers an impactful way to prevent chronic disease for beneficiaries, according to a new report from AHIP.   In 2012, AHIP recruited seven large payers to a pilot program which...

Insurance Coverage Rates Dip by 12% Due to High Premium Costs

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Individual health plan enrollment between 2017 and 2018 fell by 12 percent as high premiums and a scarcity of subsidy assistance force consumers out of the market, according to an analysis from the Kaiser Family Foundation (KFF). Health...

How to Improve Cost Sharing to Enhance Chronic Disease Management

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A tailored cost sharing program that helps beneficiaries pay for chronic disease care can reduce wasteful spending and increase access to chronic disease management services. However, relying on one-size-fits all cost-sharing plans can...

How to Address Medicare Advantage Beneficiary Disenrollment

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Medicare Advantage is a growing market and an attractive opportunity for payers to offer quality plans to older beneficiaries.  Competition is increasing in the MA environment, and beneficiaries have more options than ever to meet...

Using a Commercial Shared Savings Program to Reduce Care Costs

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A commercial shared savings program equipped with the right leadership, clinical insights, and comprehensive care strategies can help payers save significantly on healthcare costs and produce exceptional beneficiary outcomes. In order to...

Rhode Island Aims to Expand Value-Based Care in Medicaid Program

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Rhode Island officials have requested an extension of a 1115 demonstration from CMS to expand the use of value-based care within the state’s Medicaid program. State Medicaid administrators are looking to add new value-based care...

High Dollar Claims Rise by 87% in Employer-Sponsored Stop-Loss Insurance

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The number of employer-sponsored stop-loss insurance claims of $1 million or more grew by 87 percent from 2014 to 2017, according to a new analysis from Sun Life Financial. Over the four-year period, 634 employees with $1 million claims...

How Payers Can Succeed Under Updated 2019 HEDIS Measures

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The Healthcare Effectiveness Data and Information Set (HEDIS) provides 90 percent of America’s health plans with the ability to directly compare performance across the national stage.   Currently, the HEDIS set contains 92...

BCBSA Adds Opioid Abuse Accreditation to Treatment Facilities

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The BlueCross BlueShield Association has announced a new accreditation program for opioid abuse treatment centers as a larger part of the organization’s mission to combat the US opioid crisis. In 2013, only 22 percent of treatment...

Medicare Advantage Star Ratings Tied to Member Socioeconomic Strata

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Medicare Advantage (MA) health plans with a greater proportion of socioeconomically challenged members are more likely to have lower star ratings, according to new research from Brown University. Insufficient risk adjustment criteria in...

Transitional Health Insurance Plays Key Role in Coverage

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Transitional health insurance, otherwise known as a short-term health plan, is a temporary insurance policy intended to provide stop-gap coverage when an individual is in between ACA compliant policies.  The National Association of...

NCQA Updates, Adds HEDIS Performance Measures for Plan Year 2019

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The National Committee for Quality Assurance (NCQA) has released updates to its HEDIS performance measures for plan year 2019. The refresh includes several new measures to guide population health management initiatives, as well....

Highmark BCBS Saves $260M Using Value-Based Reimbursement

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Highmark BlueCross BlueShield has saved $260 million in avoidable care costs by using value-based reimbursement and provider performance standards to hold healthcare organizations accountable for improving beneficiary...

Can Retail Clinics Improve Patient Access, Reduce Costs for Payers?

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Retail clinics are gaining in popularity among patients looking for quick, convenient care for minor ailments. Kiosks and no-appointment-needed offices located in corner pharmacies and big box stores have the potential to keep patients...

Narrow Networks, Customer Satisfaction Contain Payer Spending

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Payers can curb spending on medical care by investing in narrow networks and customer satisfaction tools, says a new PricewaterhouseCoopers (PwC) Health Research Institute (HRI) analysis. PwC found that medical costs for...

Beneficiaries Want More Holistic Health, Wellness Benefit Options

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Health plan beneficiaries are increasing their demand for holistic health and wellness benefits, which can help payers deliver value and improve outcomes, according to a new report from Aetna. The Health Ambitions Study found that...

Customer Service is Primary Driver of Health Plan Satisfaction

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Health plan members are seeking high-quality customer service experiences from their insurers, and will use positive interactions to make decisions about continued loyalty, according to a new Forrester analysis emailed to members of the...

Value-Based Payment Adoption Drives 5.6% Reduction in Care Costs

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Payers that implemented value-based payment models reduced healthcare costs by an average of 5.6 percent, improved provider collaboration, and created more impactful member engagement, according to a new study from Change Healthcare. The...

Quality Analytics, Risk Adjustment Tools Prep Payers for Success

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Quality analytics and risk adjustment technologies are effective solutions for payers when these tools can structure claims and clinical information into actionable models, identify multiple risk indicators, and foster provider...

AHIP, BCBSA, AMA Join to Improve Public, Private Payer Ecosystem

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The Partnership for America’s Health Care Future (PAHCF), a newly formed coalition, consisting of leading healthcare provider societies and payer organizations, has committed to strengthening the nation’s private and public...

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