Quality Improvement & Outcomes

Latest Headlines

Latest Headlines

Insurers embrace reference pricing

Many insurers use reference pricing to save money by directing people toward lower-cost providers, according to D Healthcare Daily.

Payers want primary care providers to assume more risk

While most value-based contracts include shared savings, payers are ready to transform these methods to include more risk for primary care providers, according to AIS Health.

Design influences bundled payment success

If insurers want to enhance their bundled payment programs, they must create designs that reward participating providers with more cases, according to a blog post in the journal Health Affairs.

CMS seeks to change Medicare home health payments

The Centers for Medicare & Medicaid Services today issued a proposal to update Medicare's home health prospective payment system (HH PPS) rates, which include national per-visit rates and the nonroutine medical supply conversion factor.

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.

State exchanges entice more participation

States continue to add insurers to their exchanges for the 2015 enrollment period, reports MedPage Today.

Insurers, docs speed up shift to value-based care

While many doctors still operate on a fee-for-service basis, insurers are moving toward value-based reimbursement that focuses more on quality, transparency and accountability, reports Forbes.

Poll: Don't link wellness programs to premiums

While the public has largely embraced wellness programs, many say it's not fair for employers to charge higher premiums to those who don't participate in the programs. Even more people oppose employers linking premiums to their ability to meet certain health goals, according to a poll from the Kaiser Family Foundation.

Big data can help insurers predict health problems

Health insurers can use big data to predict which individuals are more likely to develop metabolic syndrome and create personalized programs to help prevent the syndrome from developing, according to new research published in the American Journal of Managed Care.

Rival plans must stay competitive in Illinois exchange

Illinois's largest insurer, Blue Cross & Blue Shield, took the cake by enrolling 92 percent of all 217,500 enrollees who signed up for coveraged via the Illinois Health Insurance Exchange, reports Insurance Networking News.