Timely updates about the healthcare industry

Medicare to roll out coverage for diabetes prevention

For the first time, a Medicare pilot program will soon be expanded nationwide without an act of Congress. The expansion, made possible by the Affordable Care Act (ACA), will provide coverage for diabetes prevention programs for seniors, after a multi-year pilot showed savings of more than $2,500 per patient. Read more

insurance open enrollment

CMS looks ahead to 2017 open enrollment

Healthcare leaders have now had a chance to evaluate the most recent open enrollment period and identify steps for improving next year’s processes. While the general trends show that consumers are getting the hang of using insurance exchanges, advocates continue to push for greater transparency and more features that will make it easier to comparison shop. Read more

physician quality

Simpler physician quality measures on the way

As Medicare, Medicaid and commercial payers have shifted toward alternative payment models in recent years, their varying standards for judging value have been a headache for healthcare providers. Outcomes that one payer deemed acceptable may not have passed the bar for another payer—resulting in confusion and increased administrative time for providers. Read more

patient voices in value-based reimbursement

Will “value to the patient” one day be a part of billing? 

In the shift to value-based payments, are patients’ voices being heard? The Center for Medicare & Medicaid Innovation (CMMI), along with other payers, has been busy for some time now developing and testing new alternative payment models (APMs), all in an effort to better align payments with value. But in the midst of this change, some are wondering if the patient’s perspective is being given enough weight in the equation. Read more

The gray area of payer consolidation

Since news broke this summer of the proposed mergers between four insurance giants, voices representing payers, providers and consumers have sounded out about the benefits and drawbacks that such major consolidations would have on the insurance industry, and healthcare as a whole. In the most recent developments, the American Medical Association (AMA) has sent a letter to the Department of Justice objecting to these acquisitions, while a consumer group has also voiced its opposition. Read more