Hospitals & Providers

To survive, hospital executives must find new and creative ways to help uninsured and low-income patients secure health insurance.

After more than 20 years with America's Health Insurance Plans (AHIP) as president and CEO, Karen Ignagni is leaving the organization to become the CEO of New York-based EmblemHealth.She will replace Frank Branchini effective September 1. Branchini, who has served EmblemHealth and its predecessor GHI as president/CEO for 30 years, will continue as the Chair of the Board of Directors.

We asked healthcare experts and analysts how the move to value-based care will affect prior authorizations. Here's what they said.

Several changes, from new payment models to the "Cadillac Tax," are impacting the health insurance market.

As managed care and hospital organizations increasingly take on the risk for managing patient populations, it is critical to improve patient engagement and awareness of patient care opportunities beyond the acute care setting, according to the results of a new survey.

Only 5% of Medicaid-enrolled Americans account for 50% of total Medicaid spending, and the top 1% account for almost 25% of spending, according to a new study from the Government Accountability Office.

The Affordable Care Act has led to community-based approaches for super utlilizers like health homes that appear to be making inroads.

Consensus is building on the promise of genetic testing and other technological advances to help individualize testing, prevention and treatment for better outcomes.

Research has been given a shot in the arm by Apple Corp, which recently expanded the use of ResearchKit to include clinical trials.

A new survey from KPMG of 270 healthcare professionals found only 10% are using advanced tools for data collection with analytics and predictive capabilities.

In the first release of its star ratings, only 251 hospitals scored “five out of five stars” on Medicare’s Hospital Compare site.

Current methods used to measure hospital quality are fraught with problems that have large consequences for how hospitals are reimbursed by Medicare, according to a new study published in the March edition of The American Journal of Accountable Care.

Hospital rankings provide consumers with valuable information, but they're not always in agreement.

A significant and growing performance gap exists between dual eligible and non-dual eligible members that cannot be attributed to a health plan's quality of service, a new study by Inovalon has found.

After the first year of Medicaid expansion under the Affordable Care Act (ACA), some healthcare providers and plans on the front lines are confronting operational-as well as political-challenges.

After several years of uneven progress, the pace of healthcare payment reform shifted into high gear in January when the U.S Department of Health and Human Services (HHS) announced plans to tie 30% of traditional, or fee-for-service, Medicare payments to quality or value alternative payment models by the end of 2016, and 50% by the end of 2018.

Blue Cross Blue Shield of Michigan's program lowered costs and improved patient outcomes.

Health plans and providers play a critical role in maintaining U.S. vaccination rates and can help reverse the recent MMR vaccination-rate decline, a factor responsible for the recent re-emergence of measles.

Executives of Medicare managed plans can benefit from knowing the challenges of the Medical Loss Ratio, a key cost control tool that went into effect last year.

In what is being called a first-of-its-kind joint effort, the Texas Medical Association and Blue Cross and Blue Shield of Texas are launching a resource initiative to assist independent physicians with providing accountable care.

More than 11 million UnitedHealthcare members are enrolled in accountable care organizations (ACOs), and the nation's top insurer plans to contract with 250 more ACOs in 2015.

The demand for price transparency in healthcare continues to grow, spurred in part by the increase of high-deductible healthcare plans.

The percentage of employers and plans offering wellness incentives is steadily rising, and program designs are becoming more diverse.

Medicare Advantage (MA) members in Humana’s accountable care programs in 2013 had 7% fewer emergency room visits and 4% fewer inpatient hospital admissions than members in traditional, fee-for-service settings.

Recently, accountable care organization's aims have broadened to include overseeing patients with cancer, end-stage renal disease and certain other diseases and chronic conditions.

The industry is challenged by a number of issues in 2015 including cost control, technology threats, and the emerging consumer market.

An estimated 50,000 fewer patients died in hospitals and approximately $12 billion was saved between 2010 and 2013 because of reduced hospital-acquired conditions,according to the U.S. Department of Health and Human Services (HHS).

ACOs in Medicare’s Shared Savings Program (SSP) will have three more years before they are liable for losses if rules proposed by the Centers for Medicare and Medicaid Services (CMS) on December 1 are adopted.

The collective performance of U.S. hospitals on individual accountability measures is on the rise, according to a new report by The Joint Commission.

Hospitals and health plans need each other and can use this relationship to enable improvements that benefit both parties.