Keep a watchful eye on remote claims processor engagement

Dan Enthoven, Enkata

Dan Enthoven's picture

Many claims processing organizations rely on distributed workforces to save costs on office space, increase their access to labor, and have a broader talent pool to recruit out of. There are plenty of benefits of this approach, but there are also risks.

Five ideas for future-ready payer platforms

Daniel Knies, CTO, Aldera

Daniel Knies's picture

The Affordable Care Act, ICD-10 compliance and the growth of retail healthcare are just a few of the realities payer CIOs now deal with. They are also reasons why features like open architecture and consumer accessibility are much-needed.

Feature Video

President Obama acknowledges the technical issues with HealthCare.gov, pledging his Administration will resolve them soon and asserting that the distressed web portal is not the only way to shop for affordable health insurance available through the ACA.


Three years after launching a 750-patient Medicare Advantage collaborative care pilot, Portland, Maine-based independent physician practice NovaHealth and insurer Aetna have shown concrete results in improving care quality and reducing costs. Technology and provider-payer cooperation played a large part in the program's success.

The first state to use Medicaid expansion funding for private exchange insurance has attracted well over half of all eligible beneficiaries, with a healthy mix in the risk pool.

Fears about public exchanges threatening established insurers may have been exaggerated, at least in the country's largest ACA marketplace.

Leaders from the Centers for Medicare & Medicaid Services think private insurers have been too slow to adopt payment reforms, but they would be best served by adopting value-based payment systems in tandem with CMS today.

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Behavior change is critical to better outcomes, for patients, as well as providers and payers, as one health system with an insurance arm is finding.

For the first time in almost four years, WellPoint will have a chief strategy officer, just as value-based reimbursement contracts are taking off.

The Healthcare Financial Management Association's new Price Transparency Task Force has released recommendations for how health plans and providers should inform patients on estimated prices, out-of-pocket costs, in-network status and value.

The nation's largest insurer lead off the first financial quarter under the full Affordable Care Act with a blend of optimism for growth and pragmatism for confronting headwinds like Medicare Advantage and specialty drug costs.

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