Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value-Based Care News

BCBS Association: Use Alternative Pain Therapies Before Opioids

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The BlueCross BlueShield Association (BCBSA) has announced a new professional standard that removes opioid prescriptions as a primary pain treatment in a majority of clinical situations. The payer’s National Council of Physician and...

Health Plan Data Governance Assists Value-Based Reimbursement

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Health plan data governance plays a key role in overcoming barriers related to industry-wide adoption of value-based reimbursement, according to a two-year study conducted by CAQH CORE.  Health plans are industry leaders who should...

Payers Form Coalition to Address Social Determinants of Health

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A group of commercial payers and other healthcare organizations have formed a coalition to explore how addressing the social determinants of health can lower care costs and improve outcomes. A number of large payer companies have joined...

Humana Bold Goal Targets Members’ Social Determinants of Health

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Humana is improving the overall physical and mental health of its Medicare members by addressing social determinants of health and targeting problematic community health behaviors under its Bold Goal initiative. The Bold Goal 2018...

Urgent Care Center Utilization Skyrocketed by 1725% in Last Decade

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Healthcare payers saw urgent care center utilization grow by 1725 percent from 2007 to 2016, indicating that urgent care may the one of the fastest-growing choices for receiving healthcare. A white paper from FAIR Health found that...

BCBS of MI Launches Bundled Payments for Hip, Knee Replacements

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BlueCross BlueShield of Michigan has launched a pilot program that will use bundled payments for knee and hip replacements in order to manage costs and improve member outcomes. BCBS data estimates that knee and hip replacements can cost...

Member Engagement is Key for High-Deductible Health Plan Success

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Payers and employers who offer high-deductible health plans (HDHPs) to attract low-cost members may need member engagement strategies to generate higher value for these beneficiaries. Member engagement is critical for HDHP success because...

Payers Enter New Value-Based Care Agreements with Providers

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Commercial payers including Aetna, Cigna, and Tufts Health are launching new value-based care agreements with providers to reduce healthcare costs and increase care quality for beneficiaries. Many payers are acting on the need to...

Patient, Provider Engagement Drives High Health Plan Performance

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Health plan performance, and how to improve it, is always an issue at the forefront of payers’ minds.  While payers have engaged in several strategies in the past aimed at improving clinical quality, reducing costs, and boosting...

BCBS Launches Institute to Address Social Determinants of Health

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The BlueCross BlueShield Association has created a new subsidiary called the BlueCross BlueShield Institute to help identify and address the social determinants of health (SDOH) for its beneficiaries. BCBS credits the Institute as the...

Payer Input is Key for High Performance Provider Networks

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Payer input is critical for developing high performance networks (HPNs) that are efficient and cost-effective while delivering high quality care, says the Academy of Actuaries in a new report.   HPNs are narrow provider networks...

Payer Meal Program Addresses Social Determinants of Health

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Philadelphia-based Health Partners Plan (HPP) reduced blood glucose levels of diabetics and care utilization of other chronically ill members by implementing a healthy meal program to address food-related social determinants of health...

Aetna Highlights Emerging Drivers of Value-Based Care

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Payer-provider collaboration, holistic healthcare approaches that address the social determinants of health (SDOH), and the use of health IT tools will be among the most important drivers of value-based care, Aetna says in a new report....

Apple to Launch Healthcare, Wellness Clinics for Employees

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Apple is launching a new healthcare venture, called AC Wellness, that will deliver healthcare and wellness services to the company’s employees, according to major news outlets. The health and wellness clinics will primarily serve...

Payers Address Opioid Safety Via Education, $0 Narcan Co-Pays

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Commercial payers are addressing the nation’s opioid crisis and promoting opioid safety by funding patient education programs and waiving Narcan co-pays to reduce barriers to access. Patient-centered strategies have allowed payers...

Employers, Employees Face Disconnect Over Wellness Programming

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More than half of employers believe that their wellness programming is effective for improving health and reducing spending, but only a third of their employees think the same thing, according to a new Willis Watson Towers...

National Healthcare Expenditures Expected to Reach $5.5T by 2026

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The CMS Office the Actuary forecasts that national healthcare expenditures will reach $5.5 trillion by 2026 due to a 5.5 percent yearly growth rate. CMS said that the anticipated average growth rate of healthcare spending is lower than...

NCQA Seeks Stakeholder Comments on Updated HEDIS Measures

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NCQA is seeking health plan, provider, and related stakeholder public comments to weigh in on updated HEDIS measures and the implementation of new measures related to chronic disease management. NCQA wants to implement measures related to...

70% of Providers See Data Sharing as Key to Value-Based Care

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Seventy percent of executives participating in a survey conducted by Humana and HFMA believe that the need for interoperability and seamless data sharing will be required for payers and providers to succeed with value-based care. The...

80% of Payers Aim to Address Social Determinants of Health

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Eighty percent of payers believe that addressing the social determinants of health (SDOH) of their beneficiary populations will be a key way to improve their population health programs, according to a new Change Healthcare survey. The...

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