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.

Now about that individual mandate

Robert Laszewski, Health Care Policy and Marketplace Review

Robert Laszewski's picture

Will the 2014 mandate to buy health insurance be enforced come tax time? It sure doesn't look like it.

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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.

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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How the small employer market has a lot to gain by from private exchanges.

The Centers for Medicare & Medicaid Services is letting New York take $8 billion in federal Medicaid savings to experiment with ambitious delivery and payment reforms that may give more responsibility to managed care plans.

The Congressional Budget Office has revised its estimates of the Affordable Care Act's costs, with results favorable to the Treasury. However, it also now predicts more premium and network turmoil.

Highmark sees a market for guiding the millions of American adults helping their aging and ill parents, relatives and friends.

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