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Health Insurance Marketplaces: Bringing Payers, Providers, and Technology Together in New Ways


By: 
Shelley Price, MS, FHIMSS, Director Payer and Life Sciences, HIMSS

Authorized by the Affordable Care Act, and starting in 2014, individuals and employees of small businesses will have access to affordable coverage through a new competitive private health insurance market -- the Health Insurance Marketplace (formerly known as Healthcare Insurance Exchanges). The state-based marketplace will provide individuals and small businesses with a "one-stop shop" to find and compare affordable, quality private health insurance options. Read more »

Will Your ACOs Thrive? Take the Lead with This 3-Step Plan


By: 
Michael Solomon, PhD, MBA, Consultant, Point-of-Care Partners, HIMSS Patient-Centered Payer Roundtable member

An unprecedented wave of collaboration between payers and care providers is underway. The shift to value-based payment for care is putting new pressure on both to design provider networks that deliver higher quality care at lower cost. Providers and payers are responding by forming accountable care organizations (ACOs) with the structure needed to coordinate care across multiple patient settings. Read more »

Payers Use Health Information Technology to Navigate the ACA


By: 
Tony Schueth, CEO & Managing Partner, Point-of-Care Partners, Member of HIMSS Patient-Centered Payer Roundtable

Payers are doing a serious set of wind sprints. The requirements of the Affordable Care Act (ACA) set many strategic imperatives for payers, and now it is about delivering results. While compliance may look onerous and costly, there is also more opportunity -- given the right investments -- for payers to flourish in an evolving healthcare market. Read more »

HIE: Payers Wanted


By: 
Ed Daniels, Senior Consultant, Point-of-Care Partners, Member of the HIMSS Patient-Centered Payer Roundtable

Healthcare in the United States is entering a new era of collaboration between payers and their provider networks. Recent regulatory reforms requiring technology use, information exchange and new payment structures have created an environment where data sharing is a must. All stakeholders now have more incentive to work together to achieve federal and proprietary cost and quality goals. Read more »

ePrior authorization: Primed for improvement and big returns


By: 
Tony Schueth, CEO & Managing Partner, Point-of-Care Partners, and Member of HIMSS Patient-Centered Payer Roundtable

Electronic health records (EHRs) have and will be used to improve a plethora of health care processes. Prior authorization is a process badly in need of improvement, and one of the next on the list. Read more »

HIMSS Patient-Centered Payer Roundtable: A Strategy for ACOs


By: 
Shelley Price, Director, HIMSS

The following is a summary of selected monthly meetings of the HIMSS Patient-Centered Payer Roundtable. Each session has a featured speaker and is focused on a specific topic. A session recordings of each meeting is available on the HIMSS Patient-Centered Payer Roundtable website. Read more »

HIMSS Patient-Centered Payer Roundtable: mHealth and Payers -- The Evolution of Mobile Health Applications


By: 
Ed Daniels, MS, Senior Consultant, Point-of-Care Partners

The following is a summary of selected monthly meetings of the HIMSS Patient-Centered Payer Roundtable. Each session has a featured speaker and is focused on a specific topic. A session recording of each meeting is available on the HIMSS Patient-Centered Payer Roundtable website. Read more »

HIMSS Patient-Centered Payer Roundtable: Success of Patient-Centered Accountable Care Depends on Successful HIEs


By: 
Michael R. Solomon, PhD, MBA, Point-of-Care Partners

Major initiatives to develop accountable care organizations (ACO) and their patient-centered medical homes core are being announced with increasing frequency. Connectivity to a health information exchange is essential for providers to effectively coordinate care, which is a key performance indicator of the ACO. Despite the strategic importance of health information exchanges (HIEs) to these new ventures, most hospitals and physician organizations remain disconnected. HIE enterprises confront major challenges in gaining broad adoption and becoming financially viable. Read more »

HIMSS Patient-Centered Payer Roundtable: CMS Shared Savings Program -- Final Rule Overview


By: 
Gary M. "Lumpy" Austin, President, TranzformHealth

In the November 2011 Accountable Care News, Gary Austin prognosticated the following: “Accountable Care Organizations (ACOs), or similar constructs will be either underway or announced in excess of 50 percent of the delivery marketplace, with delivery marketplace defined as delivery entities either composed of or bundled together (IPA, PHO…) greater than 25 full-time employees (FTE). While “single shingle docs” will still exist, the vast majority will have their practices acquired by ACO entities, or they will disband and become ACO FTEs. This has happened in every other cottage industry, from travel to legal to retail. There’s no reason to think that healthcare will be any different.” Read more »

HIMSS12 Review/Discussion -- Key Payer Takeaways, Emerging Topics and Next Steps


By: 
Naveen Rao, MHS

Here are some of the key discussion areas explored by the HIMSS Patient-Centered Payer Roundtable at the 2012 Annual HIMSS Conference & Exhibition. This is a useful summary for anyone seeking to become more involved with HIMSS13 in New Orleans or a HIMSS work group. Read more »

WEBINARS AND WHITE PAPERS

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