Value-based healthcare
Value-based care is a reimbursement model wherein payers compensate providers based on key metrics for care quality, care coordination and health outcomes. Value-based care aims to reduce healthcare costs and improve patients’ experience and health by using health information technology for data collection, analysis and sharing among providers.
Top Stories
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01 Jul 2024
A VBC approach to improving pediatric behavioral healthcare access
Behavioral healthcare access for children and adolescents is lacking, but payers can use value-based care systems to increase and optimize referral opportunities. Continue Reading
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24 Jun 2024
How to accelerate value-based care despite looming healthcare crisis
Centering provider and member experience will be key to accelerating value-based care in the coming years. Continue Reading
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10 Jun 2024
How Inaccurate Provider Data from Payers Impacts Access to Care
When payers’ online provider information is wrong, it may impact not only members’ access to care but also the level of member-payer trust. Continue Reading
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25 Jan 2024
A Look Inside the Four Most Common Value-Based Care Arrangements
Payers have several different value-based care arrangements they can offer, including pay-for-performance programs, bundled payment models, and capitation. Continue Reading
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20 Nov 2023
Humana’s Value-Based Care Plans Improved Health Outcomes for MA Members
In addition to improving health outcomes, Humana’s Medicare Advantage value-based care plans generated $8 billion in cost savings in 2022. Continue Reading
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02 Oct 2023
How to Evaluate Benefits to Ensure Health Equity for All Members
Employers and health insurers need to evaluate their plans’ benefit designs for health equity to ensure that members are getting equal actuarial value. Continue Reading
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14 Sep 2023
How Do Payers Approach Care Management Strategies, Technologies?
Leveraging EHR systems, telehealth tools, and data analytics can help payers improve care management strategies. Continue Reading
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23 Aug 2023
Employers Grapple with Workforce Mental Health Needs Post-Pandemic
Mental health issues were the most commonly cited impact of COVID-19 and mental health initiatives were the highest priority for employers looking toward 2024. Continue Reading
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18 Aug 2023
CQMC Revises Quality Measures, AHIP Advocates for Better Alignment
The quality measure changes touched eight out of the ten core measure sets and could influence CMS quality measurement. Continue Reading
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17 Aug 2023
Blue Shield of CA Launches Value-Based Pharmacy Model to Lower Drug Costs
Blue Shield is working with five drug companies to launch the value-based pharmacy model and lower drug costs for members. Continue Reading
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09 Aug 2023
How Payers Can Reduce Emergency Department Admission Rates, Costs
To reduce emergency department admission rates, payers can implement virtual care, machine learning, and value-based care strategies. Continue Reading
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20 Jul 2023
Common Utilization Measures That Impact Value-Based Care Efforts
Utilization measures such as emergency department use, hospital readmissions, and preventive care use are crucial to improving quality of care. Continue Reading
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05 Jul 2023
How Long-Term Health Plan Enrollment Supports Value-Based Care
Long-term health plan enrollment can allow for better investments that drive lasting positive health outcomes. Continue Reading
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20 Jun 2023
How Value-Based Purchasing Program Design Influences Outcomes
Higher-intensity value-based purchasing programs were more likely to have positive outcomes for quality process, quality utilization, and spending reduction measures. Continue Reading
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15 Jun 2023
End of COVID-19 Policies Will Influence National Healthcare Spending
National healthcare spending will grow on average 5.4 percent each year from 2022 to 2031. Continue Reading
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16 May 2023
Delivering on the Promise of Value-Based Care
It’s been more than a decade since value-based care started making waves in healthcare. And from the start, there have been three core goals of the new model... Continue Reading
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21 Apr 2023
CVS Health ACO Partnership Expands Value-Based Care in Long Island
The collaboration will provide value-based care, personalized support, and care coordination services to 40,000 Medicare beneficiaries in Nassau and Suffolk counties. Continue Reading
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17 Apr 2023
How Specialty Pharmacies Compare to Provider, Hospital on Drug Pricing
Drug pricing is a major concern among employers and insurers, but research has highlighted a possible price control mechanism. Continue Reading
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14 Mar 2023
CA VBID Program Boosted Primary Care Use, Contained Healthcare Costs
Members enrolled in the value-based insurance design plan saw increased primary care use, leading to higher out-of-pocket healthcare costs for outpatient care but lower inpatient costs. Continue Reading
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10 Jan 2023
Going Beyond Benefits: How Employers Can Assess, Create Wellness Culture
Surveys have demonstrated that employers and employees do not share the same opinion on employer mental health initiatives, so how can employers improve wellness culture? Continue Reading
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04 Jan 2023
How Insulin Costs Vary Across Medicare, Medicaid, Private Plans, Uninsurance
Insulin costs take up a more significant share of prescribed medicine expenditures and overall healthcare spending for Medicare beneficiaries than for individuals with other types of insurance. Continue Reading
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27 Dec 2022
Improving Accessibility for Spanish-Speaking Seniors in Medicare Advantage
Spanish-speaking seniors face a variety of challenges in navigating Medicare, but payers can take steps to demystify the system by providing authentic Spanish-speaking services. Continue Reading
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22 Dec 2022
How Employers Can Achieve a Fair Price in Hospital Negotiations
With healthcare costs skyrocketing, it is time for employers to take the reins on negotiating hospital prices to achieve a fair price. Continue Reading
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30 Nov 2022
GA Payer Helps Providers Improve Access to Care for Disabled Individuals
Facilities that are not designed to fit the needs of disabled individuals can limit access to care for this member population, but an initiative in Georgia is seeking to resolve that issue. Continue Reading
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17 Oct 2022
How One Payer Expanded the Boundaries of Maternal Healthcare Benefits
BCBSM expanded its maternal healthcare benefits to encompass more of the childbirth and child-rearing journey. Continue Reading
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04 Oct 2022
Home Health Value Based Purchasing Model Slightly Improved Spending, Care
Home health value-based purchasing demonstrated slight decreases in certain types of utilization and also generated Medicare savings. Continue Reading
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08 Sep 2022
Concerns about Cost of Healthcare Supersede COVID-19 Concerns in MA
The cost of healthcare is of greater concern to Massachusetts residents than quality of care and access to care. Continue Reading
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01 Sep 2022
Emergency Department Patients Are More Likely to Have Chronic Diseases
Seniors who ended up in the emergency department were more likely to have multiple chronic diseases that can lead to severe coronavirus symptoms. Continue Reading
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15 Aug 2022
Healthcare Often Forces Patients to Make Financial Sacrifices
Recent research showed that 38 percent of American adults limited automobile activities and food consumption to ensure payment of medical bills. Continue Reading
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10 Aug 2022
Hepatitis C Treatment Rates Reveal Care Disparities in Public, Private Coverage
Care disparities for hepatitis C may result in differences in timely diagnosis and treatment based race, age, coverage type, and gender. Continue Reading
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28 Jul 2022
How Family Income Impacts Out-of-Pocket, Catastrophic Spending on Insulin
Catastrophic spending on insulin is highest for Medicare beneficiaries in part because their family income—after subsistence spending—is so low. Continue Reading
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12 Jul 2022
Health Net Shares Payer Best Practices for Bolstering Community Support
Reflecting on its participation in a California Medicaid initiative, the payer offered insight into how to drive community support benefits. Continue Reading
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11 Jul 2022
How Payers Can Deliver Value Through Care Management Models
Care management models need to improve care quality while cutting costs, but as member experience becomes more important payers must adapt their care models. Continue Reading
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28 Jun 2022
Health Insurance Is The Third-Highest Living Expense For Americans
Health insurance premiums take up 10.69 percent of the average American’s annual salary, the highest living expense after rent and childcare. Continue Reading
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15 Jun 2022
How States Can Improve, Increase Race and Ethnicity Data Collection
Race and ethnicity data collection is critical for advancing health equity, but many states need to improve their processes. Continue Reading
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13 Jun 2022
Humana Expands Home Healthcare Model to Serve Virginia
Humana enhanced its identity by expanding the boundaries of onehome, a home healthcare model the payer acquired in 2021. Continue Reading
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06 Jun 2022
How Loneliness Impacts Employees As A Social Determinant of Health
The report found that loneliness, a prevalent social determinant of health, was particularly prevalent among employees with mental health conditions, along with a variety of other factors. Continue Reading
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31 May 2022
Anthem Foundation Funds Substance Use Disorder Programs
Anthem Foundation donates $13 million to fifteen different organizations with substance use disorder programs to improve mental healthcare access. Continue Reading
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16 May 2022
How Payers Can Move Providers Along Value-Based Care Continuum
As providers move along the value-based care continuum, payers can offer financial and technical support, help them pursue primary care transformation, and present further research. Continue Reading
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02 May 2022
CVS Health: More Americans Value Mental Health Conversations
The survey found that an increasing share of adults values discussing mental health with a clinician, friend, family member, or even a coworker. Continue Reading
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28 Apr 2022
CA Medicaid Plan Seeks to Streamline Pay for Performance Model
Pay for performance models have long been one of the most popular types of reimbursement models, used to boost quality of care. Continue Reading
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27 Apr 2022
BCBSA Outlines Next Steps for Health Equity Data Standardization
Health equity data collection lacks standardization and BCBSA has called on the healthcare industry to take three steps to rectify this. Continue Reading
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25 Apr 2022
Humana Outlines Social Determinants of Health Industry Progress
CMS, Humana, and other payers have taken a variety of approaches to advancing social determinants of health data collection and utilization. Continue Reading
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25 Apr 2022
BCBSRI Joins Global Capitation Model, Starts 2022 RI Life Index
The payer will enter into a global capitation model with an ACO and will glean data on social determinants of health in Rhode Island through the index survey. Continue Reading
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28 Mar 2022
CQMC Finds Quality Measurement Gaps, Supports Digital Measures
The report found seven areas in which payers and healthcare stakeholders can fix quality measurement gaps, including health equity and digital quality measures. Continue Reading
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07 Mar 2022
Consumers Emphasize Insurer Role in High Healthcare Spending
While consumers wanted to see more transparency across the major healthcare stakeholders, they stressed the personal impact of insurance-related healthcare spending. Continue Reading
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10 Feb 2022
CMS Home Healthcare Policy Reduced Hospital Readmissions
Patients who received post-discharge home healthcare under the CMS PACT policy experienced lower rates of hospital readmissions. Continue Reading
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10 Feb 2022
Applying Whole Person Care to Digital Care for Underserved Members
Too often Medicaid beneficiaries receive transactional care, but payers can leverage digital solutions such as e-consulting services to advance whole person care. Continue Reading
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02 Feb 2022
How to Hone Wellness Programs Using Social Determinants Data
Payers and employers can collaborate to create more effective wellness programs by leveraging social determinants of health data from community sources. Continue Reading
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19 Jan 2022
How Employers Can Address Employee Needs, Social Determinants
Employers should prioritize demographic data, community partnerships, and multiple intervention strategies to successfully address employees’ social determinants of health. Continue Reading
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17 Jan 2022
COVID-19 Federal Spending Drove National 2020 Healthcare Spending
Federal dollars that went toward pandemic-related actions and initiatives were the driving force behind the increase in national healthcare spending in 2020. Continue Reading
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30 Dec 2021
Hospitalization of Unvaccinated COVID-19 Patients Cost $13B
Unvaccinated COVID-19 patients may have contributed over $13 billion to the national healthcare spend from June 2021 through November 2021. Continue Reading
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27 Dec 2021
Children, COVID-19 Are Drivers of Household Healthcare Spending
COVID-19 diagnoses and children were associated with more instances of high out-of-pocket household healthcare spending. Continue Reading
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13 Dec 2021
How Value-Based Care Can Support Efforts to Address Health Equity
Value-based care provides a pathway to remove barriers to health equity by addressing social determinants of health. Continue Reading
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07 Dec 2021
How Payers Can Expand Nutritional Benefits, Measure Impact
Reducing food insecurity is key to improving an individual’s health, but payers are still exploring how nutritional benefits can best serve their member populations. Continue Reading
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01 Dec 2021
High Deductibles Associated with More Medical Bill Problems
While the number of adults with medical bill problems decreased between 2013 and 2015, high deductible health plans, low income levels, and uninsurance contributed to a greater likelihood of payment struggles. Continue Reading
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17 Nov 2021
Humana Shares 2020 Medicare Advantage Value-Based Care Results
Medicare Advantage value-based care had an impact on hospitalizations, preventive care services, and healthcare spending during the coronavirus pandemic. Continue Reading
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16 Nov 2021
How A Rare Condition Can Fuel Medicaid Spending, Utilization
Sickle cell disease may impact a small portion of the Medicaid population, but this community of beneficiaries has high Medicaid spending and emergency care utilization. Continue Reading
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09 Nov 2021
Centene Highlights Ways to Improve Mental Healthcare for Children
Payers can take steps to improve mental healthcare for children as the coronavirus pandemic continues to impact children’s development. Continue Reading
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26 Oct 2021
CMMI Aims to Lower Out-of-Pocket Healthcare Spending by 2030
CMMI outlined its goals for lowering out-of-pocket healthcare spending—and healthcare spending overall—in the next decade. Continue Reading
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20 Oct 2021
COVID-19 Out-of-Pocket Spending Lower with Cost-Sharing Waivers
Few patients had high out-of-pocket spending for facility services during a COVID-19 hospitalization, indicating that services cost-sharing waivers may have covered the costs. Continue Reading
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12 Oct 2021
How Payers Leverage Apps to Improve Type 2 Diabetes Management
Apps are common Type 2 diabetes management tools, but with so many options on the market how can payers identify and implement these solutions successfully? Continue Reading
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08 Oct 2021
Behavioral Health, Physical Health Worsen Among Women, Children
Behavioral health and physical health indicators among women of reproductive age and children in the US trended in a negative direction, but certain health behaviors improved. Continue Reading
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30 Sep 2021
How Benefit Design Can Steer Employees Toward High-Value Care
Employers play a key role in aligning benefit design and payment reform efforts around high-value care. Continue Reading
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27 Sep 2021
How Employers Can Control Costs with Episode-Based Benefit Plans
Employers can use cost-sharing levers around episode-based benefit plans to reduce low value care among employees. Continue Reading
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08 Sep 2021
How Ambulatory Surgery Centers Lower Payer Outpatient Spending
Payers can reduce surgical costs by 59 percent by shifting eligible members from the hospital outpatient setting to ambulatory surgery centers. Continue Reading
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31 Aug 2021
Essential Home Healthcare Quality Measures for Value-Based Care
Based on CMS home healthcare quality measures for Medicare home health agencies, payers can establish strong quality measures with their home healthcare partners. Continue Reading
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26 Aug 2021
Employers: Mental Health, Chronic Disease Needs Will Rise in 2022
Mental health and chronic disease needs will increase as employees face the long-term effects of the coronavirus pandemic in 2022, employers predict. Continue Reading
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14 Jul 2021
How Payers Can Support Population-Based Payment Model Uptake
Public and private payers alike play a role in increasing value-based care progress by boosting population-based payment model adoption. Continue Reading
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12 Jul 2021
How Payers Can Improve Cancer Patient Navigation, Experience
Cancer patient navigation through the healthcare system is notoriously challenging, but payers can help states improve that reputation. Continue Reading
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01 Jul 2021
How Employers Can Influence Employee Coronavirus Vaccine Uptake
Coronavirus vaccine uptake continues to be key to recovery from the pandemic, but as the public grows more relaxed about COVID-19 employers’ roles may be even more critical. Continue Reading
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28 Jun 2021
Going Beyond Compliance: How Payers Can Embrace Healthcare Interoperability
CMS is requiring healthcare interoperability from payers but embracing more data-sharing with the consumer in mind will be key to future success for health plans. Continue Reading
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02 Jun 2021
ARP Boosted Funding for Home, Community-Based Services, SDOH
The American Rescue Plan increased the federal matching rate for home and community-based services by 10 percentage points. Continue Reading
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26 May 2021
How MA Plans Can Build on COVID-19 Home Healthcare Strategies
Medicare Advantage plans can build on coronavirus home healthcare strategies such as bundling social determinants of health services and leaning into remote patient monitoring. Continue Reading
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19 May 2021
Cancer Patient Outcomes Significantly Worse for the Uninsured
Survival rates for cancer patients without insurance are drastically lower than patients who are insured, highlighting the connection between insurance access and patient outcomes. Continue Reading
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17 May 2021
Employer-Sponsored Wellness Programs Boost Employee Morale
Employer-sponsored wellness programs can help employees meet their mental healthcare, financial wellness, and physical wellness goals. Continue Reading
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13 May 2021
How AI Supports Low-Risk Member Identification, Care Management
Identifying and providing care management for low-risk members can be tricky for payers, but AI and machine learning can help. Continue Reading
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04 May 2021
Humana Joins Traditional Medicare Value-Based Contracting Model
The traditional Medicare value-based contracting model includes 53 direct contracting entities that will serve traditional Medicare beneficiaries across 38 states and the District of Columbia. Continue Reading
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03 May 2021
Gross Margins, MLRs May Confirm Payer Profitability in 2020
Although the results are still tentative without administrative cost data, researchers indicated that payer profitability may have increased in four health insurance markets. Continue Reading
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03 May 2021
High Health Plan Costs Serve as Healthcare Coverage Barrier in TX
More than 20 percent of Texans reported that they do not have access to health insurance, compared to 13 percent of national survey respondents. Continue Reading
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29 Apr 2021
Employers: Healthcare Spending Is on an Unsustainable Trajectory
While most employers in the study indicated that they had some control over healthcare spending in their companies, they also supported some government interventions. Continue Reading
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29 Apr 2021
Key Considerations For Implementing Diabetes Management Programs
For payers looking to create or bolster diabetes management programs, it is critical to address mental health, include wellness programming, and persist in member engagement. Continue Reading
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26 Apr 2021
How to Overcome Challenges in Gathering Racial, Ethnicity Data
Payers can boost their race and ethnicity data by recognizing members’ legitimate concerns, communicating clearly, and leveraging indirect data more accurately. Continue Reading
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12 Apr 2021
Employer Strategies For Responding to the Mental Health Crisis
As the behavioral and mental health crisis grows, employers can leverage preventive care, collaborative care, employee assistance programs, and data to respond. Continue Reading
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06 Apr 2021
Disparities in Pediatric HMO Enrollment Draws Care Access Concern
Hispanic and Black children are enrolled in HMOs at higher rates than White children, drawing potential care access and health disparity concerns. Continue Reading
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25 Mar 2021
How Payers Can Identify, Reduce Low Value Care Spending Patterns
Identifying and eliminating low-value care spending will be crucial to improving overall healthcare spending and patient outcomes. Continue Reading
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17 Feb 2021
Healthcare Spending Frequency Impacts Affordability for Members
For approximately 40 percent of commercial members, one engagement with the healthcare system was responsible for nearly half of their annual healthcare spending. Continue Reading
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11 Feb 2021
Humana Launches MA Value-Based Care Model, Hospice Care Coordination
Eligible Medicare Advantage beneficiaries now have access to a value-based hospice care model that is expected to enhance care coordination. Continue Reading
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09 Feb 2021
COVID-19 Delays Value-Based Care Contract Negotiations
Value-based contracting has slowed amid the COVID-19 pandemic, revealed the second annual Value-Based Care Assessment from Insights by Xtelligent Healthcare Media. Continue Reading
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08 Feb 2021
How Payers Can Improve Care Management To Enhance Quality, ROI
To improve their care management strategies, payers can better identify sources of value, target the right kind of healthcare spending, bolster consumerism, and use operational metrics. Continue Reading
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12 Jan 2021
CMMI Shares Lessons on Value-Based Care from Its First Decade
Center for Medicare and Medicaid Innovation has released an overview of its value-based care models and lessons learned. Continue Reading
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31 Dec 2020
In 2020 Consumerism Will Steer Payer Decisions in Deals, Spending
While consumerism in healthcare is nothing new, it will play an even greater role in how payers make deals, use technology, hire, pursue equity, and spend. Continue Reading
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22 Dec 2020
How to Rethink Population Health Management for Rare Disease Care
In order to improve population health management for patients with rare diseases, payers may need to rethink member identification and modify traditional member engagement strategies. Continue Reading
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18 Dec 2020
Ambulatory Surgery Centers Could Save Private Payers $3B
When members select an ambulatory surgery center for joint replacement surgeries, their decision can have positive implications for payers’ healthcare spending. Continue Reading
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16 Dec 2020
How Payers Can Drive A Quicker Transition to Value-Based Care
A Blue Cross and Blue Shield of North Carolina executive shares how the payer quickly shifted its membership toward value-based care agreements from 2019 through 2020. Continue Reading
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11 Dec 2020
Chronic Disease Management, Preventive Care Improved in 2019
While certain chronic disease management and preventive care measures improved in the US in 2019, other challenges such as obesity rates and mental healthcare needs continued to thrive. Continue Reading
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24 Nov 2020
How Employers, Payers Can Pursue Integrated Health Care Benefits
As employers pursue integrated health care benefits, payers can better support their employer partners by being aware of this solution and sharing relevant outcomes data with their partners. Continue Reading
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12 Nov 2020
How an AI App Navigates Narrow Networks, Cuts Healthcare Spending
High healthcare spending is rampant across the US, but Anthem Blue Cross is using an exclusive provider organization and an artificial intelligence app to control costs. Continue Reading
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06 Nov 2020
Consumers Use Digital Tech for Price Comparison, Virtual Care
The survey found that 55 percent of respondents reported using digital devices for price comparison and 56 percent were interested in using them for virtual care. Continue Reading
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02 Nov 2020
How Payers Can Identify Partners for Automated Data Transfer
Trustworthy automated brokers that can facilitate automated data transfer will have broad provider and vendor networks and a proven history of successful transfers. Continue Reading
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28 Oct 2020
How a Directory Can Streamline Interoperability Rule Compliance
The CAQH directory may support interoperability rule compliance by testing endpoints in advance and allowing payers and vendors to quickly access each others’ information. Continue Reading
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27 Oct 2020
Health Literacy Improves Medicare Spending, Member Outcomes
If improved nationwide, high health literacy could lower Medicare spending by $25.4 billion and lead to more preventive care services and better member outcomes. Continue Reading