payer-provider relationship

Latest Headlines

Latest Headlines

ACO task force sets sights on quality, sustainability

The Health Care Task Force, which is comprised of Aetna, Health Care Services Corporation, Blue Shield of California and BCBS of Massachusetts and several providers, has a difficult goal to acheive: Establishing a standard for value-based care. Healthcare Payer News looks at the steps it must take to meet the Triple Aim.  

How payers will embrace health IT in 2015

In a post-Affordable Care Act world, technology poses a bit of a challenge for payers. But these challenges also bring opportunities for payers to embrace and adopt.

Consumers unsure how Highmark-UPMC breakup impacts them

With the contract between Pennsylvania health giants Highmark and the University of Pittsburgh Medical Center ending today, many consumers are uncertain how the separation will impact them, the Pittsburgh Tribune-Review reported.

Taking a stand against provider consolidation

I'm rarely one to advocate for fighting instead of finding peace, but every now and then, you just have to stand up for what you think is right. And that's how I view the recent decision from Blue Cross Blue Shield of Illinois to not negotiate with hospitals that affiliate with each other. I recognize the right of providers to work together and address the problem of ever-rising healthcare costs. And I certainly don't think that provider consolidation is the only driver to those increasing costs. Insurers have their share of blame, as well.

3 ways to enhance payer-provider collaboration

As payers and providers increase their collaboration to launch more value-based care programs, they must establish strong partnerships to ensure the relationships, reported  Health Data Management. Paul Taylor, an internal medicine physician at Mercy Health, shared three steps payers can take to enhance providers' performance in value-based programs. 

ACOs require payer-provider trust

Having already launched 40 accountable care organizations, Aetna views a trusting relationship between the participating payer and provider as a key component to these arrangements.

Humana CMO: Think like a provider for high-value care

Humana recognizes paying for value is central to solving industry problems, especially in a changing healthcare environment. So Humana is moving away from being an insurer that only writes checks to a company that thinks like and works with providers, Humana Chief Medical Officer Roy A. Beveridge, M.D., told Hospital & Health Networks Daily.

Medica to pay Mayo Clinic based on patient health management

Minnesota nonprofit insurer Medica has created a new arrangement with Mayo Clinic to provide individual members with in-network access to the renowned hospital, which will be paid based on how well it manages certain patients' health.

UPMC lawsuit: Highmark illegally dominates market

Highmark's purchase of West Penn Alleghany Health System (WPAHS) is a "tool" for the insurer to further its illegal domination of the Western Pennsylvania market, UPMC alleged in a lawsuit filed Thursday in U.S. District Court.

Guest Commentary: Changing relationship dynamics of payers and providers in 2011

Guest post by Sam Muppalla and Robert Capobianco The healthcare community entered into 2010 not completely sure with how the talk on Capitol Hill would end up in terms of healthcare reform. By the