Blue Cross and Blue Shield companies understand that transforming the healthcare reimbursement system depends not just on cutting costs but, rather, reinventing how doctors and providers are paid.
The health insurance industry's latest overhaul to shift away from paying for volume to paying for value may be behind Aetna's rumored deal to acquire either Cigna or Humana.
Of $360 million in Medicare fee-for-service payments in 2013, 42 percent were value-based, according to an independent scorecard from nonprofit Catalyst for Payment Reform.
Earlier this year, the Department of Health and Human Services announced it would fundamentally reform how it pays providers for treating Medicare patients. FierceHealthPayer spoke with three industry executives at two insurance companies to discuss payers' role to align with providers to meet this goal.
Humana has its eyes set on a healthy task: To make the communities it serves 20 percent healthier by 2020. The insurer plans to move from its traditional role of having an episodic relationship with its members to a role that focuses on getting people healthy, Humana CEO Bruce Broussard wrote in a guest post for Forbes.
Last month, the Department of Health and Human Services announced that it would fundamentally reform how it pays providers for treating Medicare patients in the coming years. it's a positive move, but there is one potential flaw: The plan relies on the success of accountable care organizations--success that has yet to be achieved fully.
As new payment methods gain traction, the nation's second-largest insurer is taking leaps and bounds to transition away from the traditional fee-for-service model toward value-based payments.
CareConnect, a health insurance company created by New York City-based healthcare group North Shore-LIJ Health System last year, is building its performance-based reimbursement model--and its market share.
As insurers continue the shift toward value-based reimbursement, two Medicaid health plans improved members' health outcomes and lowered costs by combining value-based payments with a fee-for-service approach.
More people in New York and New Jersey die in the hospital because the region has more than enough beds to offer, leading to more tests, treatments and prescriptions and people dying in the intensive care unit on a feeding tube or a ventilator, Kaiser Health News, National Public Radio and WNYC reported.