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Payers and Providers

AMIA, AHIMA Call for HIPAA Modernization to Support Patient Access

December 7, 2018  |  Heather Landi, Associate Editor
news
Modernization of the 22-year-old Health Insurance Portability and Accountability Act (HIPAA) would improve patients’ access to their health information and protect their health data in a burgeoning app ecosystem, according to two leading health IT industry groups.

Recent Humana Report Points to Encouraging Progress in the Shift to Value-Based Care

November 26, 2018  |  Heather Landi, Associate Editor
article
A recent study from Humana reports ongoing progress in improving health outcomes and lowering costs among patients treated by physicians in Humana Medicare Advantage value-based agreements.

At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018  |  Mark Hagland, Editor-in-Chief
article
Kerda DeHaan and her colleagues at the D.C. Department of Health Care Finance are tackling granular data management issues to expand their collaboration with health plans and providers

Survey: Healthcare Orgs Ramping up Investment in AI, Confident about ROI

November 16, 2018  |  Heather Landi, Associate Editor
news
The majority of health care executives (91 percent) are confident they will see a return on investment (ROI) on artificial intelligence investments, although not immediately, and foresee the greatest impact of AI will be on improving health care, according to an...

At the Beverly Hills HIT Summit, APG’s Crane Offers a Vision of the Future of Medical Care

November 11, 2018  |  Mark Hagland, Editor-in-Chief
article
Don Crane, CEO of APG, a nationwide association of physician groups involved in risk-based contracting, offered HIT Summit attendees a vision of a coordinated care-based future

In Northern Virginia, Rethinking ACO Strategies—For PCPs and Specialists

October 30, 2018  |  Mark Hagland, Editor-in-Chief
article
Tricia Nguyen, M.D., a senior executive at the Falls Church, Va.-based Inova Health System shares her perspectives on what she and her colleagues are learning about some of the underlying challenges in ACO work

Report: Complex and Rapidly Changing Payment Models Challenge Physician Practices

October 26, 2018  |  Heather Landi, Associate Editor
news
Physician payment models are becoming more complex and the pace of change is increasing, creating challenges for physician practices that might hamper their ability to improve the quality and efficiency of care despite their willingness to change, according to a...

Report: 34 Percent of Healthcare Payments in 2017 Tied to APMs

October 22, 2018  |  Heather Landi, Associate Editor
news
One-third (34 percent) of total U.S. health care payments were tied to alternative payment models (APMs), such as shared savings/risk arrangements, bundled payments, or population-based reimbursements, in 2017, up from 23 percent in 2015, according to a report...

UnitedHealth Group Plans to Unveil Health Record for Members, Providers in 2019

October 17, 2018  |  Rajiv Leventhal, Managing Editor
news
Health insurer UnitedHealth Group will be unveiling a “fully integrated and fully portable individual health record,” CEO David Wichmann said on the on the company’s third-quarter earnings call yesterday.

Nemours Children’s Health’s New CEO: “The Most Exciting Time in Healthcare”

October 12, 2018  |  Mark Hagland
article
R. Lawrence Moss, M.D., who joined Nemours Children’s Health as CEO on Oct. 1, discusses the challenges and opportunities facing children’s hospitals and healthcare in the current environment

DOJ Approves CVS-Aetna $69B Merger, On Condition Aetna Divest Part D Business

October 10, 2018  |  Heather Landi, Associate Editor
article
The Justice Department has approved a $69 billion merger between mega-pharmacy retailer CVS Health and health insurer Aetna, on condition that Aetna divest is Medicare Part D prescription drug plan business.

At the HIT Summit in Raleigh, a Health Plan Executive Points to the Future of Value-Based Care

October 8, 2018  |  Mark Hagland, Editor-in-Chief
article
Speaking at the HIT Summit in Raleigh last month, Humana’s Ben Lunsford offered attendees insights into the future of value-based healthcare, and his health plan’s future intentions

On the Road to Risk, Summit Medical Group is Driving in the Fast Lane

October 2, 2018  |  Rajiv Leventhal, Managing Editor
article
In a recent interview with Healthcare Informatics, Jeffrey Le Benger, M.D., outlined the progress and evolution of his organization and how it’s continuing to plunge ahead into the world of risk and value-based care.

Climbing Up the Risk Ladder: How National ACO Has Built a Winning Value-Based Care Infrastructure

September 27, 2018  |  Rajiv Leventhal, Managing Editor
article
National ACO—headquartered in Beverly Hills, Calif., but with providers in multiple states—has progressed through the federal ACO ranks in a way that could set the path for others

Study: Health Plans Account for Majority of Breached Patient Records

September 25, 2018  |  Heather Landi, Associate Editor
news
Health plans accounted for the greatest number of patient records breached over the past seven years, according to an analysis of U.S. health care data conducted by two Massachusetts General Hospital physicians.

With $6.3M PCORI Contract, UPMC Health Plan to Study Tech-Based Approach to Chronic Disease

September 25, 2018  |  Heather Landi, Associate Editor
news
The UPMC Center for High-Value Health Care was recently awarded a $6.3 million contract from the Patient-Centered Outcomes Research Institute (PCORI) to study different care delivery models to improve outcomes for patients with chronic disease and a co-existing...

Premier Inc. Executives: Time to Unpack Some of the Challenges and Opportunities Inherent in the Path Into Risk

September 24, 2018  |  Mark Hagland
article
Shawn Griffin, M.D. and Steve Valentine of Premier Inc. discuss the challenges involved in the path into risk-based contracting, and the potential upending of the landscape by new disruptors

Is the Discourse Over the MSSP Program Teetering Towards Potential Conflict?

September 21, 2018  |  Mark Hagland, Editor-in-Chief
commentary
The joint statement by nine associations challenging CMS Administrator Seema Verma around her plans to insert more rigor into the MSSP program, feels like a teeter-totter moment for CMS

Town Hall Ventures Close First Fund at $115 Million

September 20, 2018  |  David Raths, Contributing Editor
news
Town Hall Ventures, an investment firm built to address the healthcare challenges of the most vulnerable Americans, has closed its first fund at $115 million.

The CEO of a Nationwide Association of MD Groups Sees the Future—and It’s Not in Fee-For-Service

September 18, 2018  |  Mark Hagland
article
Don Crane, CEO of APG, a nationwide association of medical groups working in risk-based contracting, shares his perspectives on the future of medical groups in a shifting landscape

On Staten Island, a Highly Innovative Program That's Redefining What’s Possible Under Medicaid

September 17, 2018  |  Mark Hagland, Editor-in-Chief
article
Healthcare leaders on New York City's Staten Island have been achieving exciting success in population health management in their community’s Medicaid and uninsured populations

Cigna to Invest $250M in Venture Fund with Eyes on Healthcare Startups

September 17, 2018  |  Rajiv Leventhal, Managing Editor
news
Cigna, the Connecticut-based health services company, has announced the launch of Cigna Ventures, a corporate venture fund focused on investing in promising healthcare startups and growth-stage companies.

Humana’s CMO Speaks of the “Bold Goal” Embedded in the Company's Population Health Work

September 14, 2018  |  Heather Landi, Associate Editor
article
Roy Beveridge, M.D., Humana’s chief medical officer, shares his perspectives on the drive to value-based care, population health and addressing social determinants of health.

New Healthcare Alliance Launches APM for Addiction Recovery

September 12, 2018  |  Rajiv Leventhal, Managing Editor
news
A national multi-sector alliance of healthcare stakeholders has announced the creation of the Addiction Recovery Medical Home (ARMH) model.

Putting Social Determinants of Health Data into Action

September 10, 2018  |  Heather Landi, Associate Editor
article
Leading hospitals, medical groups, and health systems, as well as ACOs and health insurers are moving forward to address social factors impacting health with a number of different approaches.

In the Emerging World of Risk-Based Contracting, Data Analytics Is a Foundational Necessity

September 7, 2018  |  Mark Hagland, Editor-in-Chief
article
With the emergence of more risk-based contracting, including two-sided risk, data analytics has now become fundamental to patient care organizations’ operational and financial success.

Top Ten Tech Trends 2018: Markets and Medicine—Where Do Physicians Land, in the Emerging World of U.S. Healthcare?

September 5, 2018  |  Mark Hagland, Editor-in-Chief
article
Even as the purchasers and payers of healthcare push hard on physicians to embrace value-based care delivery and payment, doctors remain conflicted and ambivalent about the new healthcare.

Humana to Launch Digital Health and Analytics Center in Boston

September 5, 2018  |  Rajiv Leventhal, Managing Editor
news
Humana will establish a center for digital health and analytics in Boston, the Louisville-based health insurer announced last week.

Top Ten Tech Trends 2018: A Social Determinants of Health Technology Market is Slowly Emerging

September 4, 2018  |  Heather Landi, Associate Editor
article
The IT market for social determinants of health data is currently a nascent field with many providers using homegrown solutions, but adoption of SDoH technology is expected to grow quickly.

Top Ten Tech Trends 2018: Are the Lines Between Provider and Payer Organizations Beginning to Blur? To Some, That Would be Progress

September 4, 2018  |  Mark Hagland, Editor-in-Chief
article
As physician-based and hospital-based organizations plunge further into risk-based contracting, managing the contracts and the processes is turning out to be highly challenging for everyone.

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