Studies point to a simple reason, the prices, not to the amount of care. And lowering prices would upset a lot of people in the health industry.Read More
The proliferation of risk-based contracts in today's healthcare environment has made enterprise risk management (ERM) an imperative for provider organizations and health plans.Read More
Though significant barriers still stand in the way of the transition to value-based reimbursement, a new study offers encouraging signs that physicians are getting more comfortable with new payment models.Read More
Although there is still an ongoing debate in many states over whether or not to expand Medicaid, in the 33 states that have, unexpected benefits are starting to surface.Read More
The affordability and stability of premiums in the individual health insurance market figure prominently in the recent and ongoing debates over national health policy. Often overlooked in these debates is the role of risk adjustment and other risk-mitigation measures in promoting both objectives.Read More
Accountable care organizations under the Medicare Shared Savings Program show promise in both quality improvement and cost reduction, according to a new report.Read More
By collaborating with community organizations and local stakeholders, payers can help to address the impact of social determinants of health.Read More
ACA reinsurance and risk adjustment programs successfully stabilized premiums in 2016, CMS says in a new report.Read More
On June 30, 2017, CMS released the results for the third year (2016) of the reinsurance and risk adjustment programs, two of the Affordable Care Act’s “three R” premium stabilization programs. The 2016 results from the risk corridor program, the “third R” will be announced later this year.Read More
For improved population health, the industry must acknowledge that "there's more to health than healthcare," experts say.
Even as some insurers exit health insurance exchanges, there are several payers with plans to expand existing offerings and move into new marketplaces.
Syed Mehmud, an associate of the Society of Actuaries and senior consulting actuary at Wakely, recommends that insurers study their own data to determine how to design their business strategies for success on the ACA exchanges.Read More
In mid-October, CMS released its final rule outlining how it plans to implement the clinician payment changes to the Quality Payment Program (QPP) mandated under the Medicare Access and CHIP Reauthorization Act of 2015. This is a complex piece of legislation with major implications for clinician payment across the next decade.Read More