Healthcare Payers

Surprise Billing Law in NY Leading to Higher Healthcare Costs

by Samantha McGrail

A recent study from the USC-Brookings Schaeffer Initiative for Health Policy showed that New York’s solution for surprising billing increased what payers and patients pay for out-of-network...

Healthcare Price Transparency, APMs Fail to Control Costs in MA

by Samantha McGrail

Despite aiming to reduce costs and help consumers shop for quality, affordable medical services, healthcare price transparency tools in Massachusetts are not working as intended, according to a new...

Hospital Merger, Acquisition Activity Steady With 71 Deals So Far

by Jacqueline LaPointe

Hospital merger and acquisition activity through the third quarter of 2019 is running slightly ahead of 2018 levels, according to a new report from Kaufman Hall. The consulting firm recently reported...

Industry Group Ties Half of Business to Value-Based Payments

by Jacqueline LaPointe

Payer and provider members belonging to a group of leading healthcare stakeholders have increased the amount of business under value-based payments, even surpassing the 50 percent mark by the end of...

Inpatient Hospital Prices Rose 19%, Outpacing Physician Prices

by Jacqueline LaPointe

A new analysis of hospital inpatient claims for individuals with employer coverage revealed that consumers and employers are paying significantly more for hospital-based inpatient services largely...

Healthcare Price Transparency Order May Up Prices, Hospitals Warn

by Jacqueline LaPointe

Public disclosure of negotiated contracts rates is a step in the wrong direction for healthcare price transparency, major hospital and payer groups are saying in response to a newly signed executive...

Cigna CEO: Healthcare Consumer Experience Key to Transformation

by Jacqueline LaPointe

NASHVILLE - Enhancing the healthcare consumer experience is the task currently in front of healthcare payers and providers, according to David M. Cordani, president and CEO of Cigna...

Manual Healthcare Contract Management Costs Providers $157B A Year

by Jacqueline LaPointe

Healthcare contract management is still largely manual or non-existent for most providers, revealed a new Black Book survey. Ninety-six percent of the 1,275 CFO, financial management, and business...

Social Determinants of Health, APMs Coming Up at AHIP Institute

by Jacqueline LaPointe

NASHVILLE – AHIP’s Institute & Expo (AHIP Institute) conference always promises to bring the top experts from payer organizations to share how their plans and providers are adjusting to...

How Advocate Aurora Health Streamlined Prior Authorizations

by Jacqueline LaPointe

Prior authorizations used to be one of the greatest pain points for providers at Advocate Aurora Health. While most physicians recently surveyed by the American Medical Association (AMA) said they...

Interoperability Reform Should Boost Claims Data Access, AMGA Says

by Jacqueline LaPointe

Increased claims data access for providers should be at the heart of new interoperability standards and requirements, AMGA recently stressed in comment letters on two proposed rules from CMS and the...

Hospital Prices for Private Payers 241% Higher than Medicare Rates

by Jacqueline LaPointe

Hospital prices for private payers were 241 percent of what Medicare would have paid for the same services, according to a new RAND Corporation study. The study of claims data from 1,598 hospitals in...

CBO: Single-Payer System to Impact Provider Pay, Physician Shortage

by Jacqueline LaPointe

In a new report, the Congressional Budget Office (CBO) says establishing a single-payer healthcare system would involve substantial changes to coverage, provider payment rates, and financing methods,...

Insurers Ask Congress to Fix Rates to End Surprise Medical Bills

by Jacqueline LaPointe

Organizations representing major health insurers are calling on policymakers to set reimbursement rates for services from out-of-network providers to prevent surprise medical bills. Congress should...

AMA: Health Payers Lagging with Prior Authorization Reform

by Jacqueline LaPointe

Health payers have not made meaningful progress with prior authorization reform, the American Medical Association (AMA) recently argued following the release of their new physician survey. The...

EHR Vendor Help Needed for Prior Authorization Improvement

by Jacqueline LaPointe

The Workgroup for Electronic Data Interchange (WEDI) will be calling on the EHR vendor community for prior authorization improvement. “Based upon the findings of the Prior Authorization Council...

HCTTF Helps Providers Find Value-Based Purchasing Partnerships

by Jacqueline LaPointe

A new open-sourced tool from the Health Care Transformation Task Force (HCTTF) is helping providers and payers assess value-based purchasing partnerships. The Partnership Evaluation Tool is a new...

Medicare, Medicaid Spending Per Enrollee Slower Than Private Plans

by Jacqueline LaPointe

Medicare and Medicaid spending saw significantly slower growth per enrollee than private payer expenditures over the last decade, a new report from the Urban Institute shows. The public payers may...

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