Quality Improvement & Outcomes

Latest Headlines

Latest Headlines

Insurers process a tenth of claims inaccurately

The seven largest insurers--Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, Medicare, Regence and UnitedHealthcare--paid providers the incorrect amount or incorrectly processed 9.5 percent of medical claims.

Aetna CEO: Supreme Court ruling won't dramatically impact payers

Aetna CEO Mark Bertolini said the Supreme Court ruling on the law's constitutionality won't dramatically impact payers because they would have needed to implement many of the law's changes "in order to be competitive in the marketplace anyway," he told The Wall Street Journal .

Medicare Advantage to grow 10%, CMS official predicts

A top Centers for Medicare and Medicaid Services (CMS) official predicted that the Medicare Advantage program will grow by at least 10 percent.

Independence Blue Cross offers $150K for wellness IT ideas

Independence Blue Cross (IBX) is recruiting new and innovative ideas from the public for developing health IT programs that encourage healthy behavior and will pay $150,000 for the winning idea.

Doc defrauded $1.5M from big insurers, DOJ alleges

A Texas doctor and his attorney wife have been indicted on charges of defrauding more than $1.5 million from private health insurers, as well as Medicare and Medicaid, according to a statement from the Department of Justice last week.

IT problems could unhinge exchanges

Information technology problems might represent the greatest obstacle to successfully implementing health insurance exchanges and could ultimately prove to be the undoing of the online marketplaces.

Blues plans push to improve quality of hip, knee surgeries

Blue Cross Blue Shield of Michigan has reached an agreement with 12 hospitals across the state to improve the quality of hip and knee replacement surgeries. Ideally, the collaboration and sharing of best practices will decrease the need for subsequent surgeries to replace or repair the knee or hip implants.

Humana's ACO, medical home projects yield positive results

Humana has begun working with providers on several new, collaborative delivery system models that already have yielded successful results.

Fierce Q&A: Care management programs improve customer service, lower costs

Care management programs are a key step payers can take to help improve their customer service and member outreach while also reducing their costs. These programs, which often address certain patient...

Are Medicare Advantage star rankings counterproductive?

The Medicare Advantage star rankings system doesn't serve its intended goal of rewarding quality and may even be counterproductive, the American Action Forum said.