April 15, 2014 | Anthony Brino

After finding one state shifting millions in Medicare-Medicaid dual eligible costs to the feds, Medicare's watchdog suspects more may be doing the same.

April 14, 2014 | Anthony Brino

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

April 11, 2014 | Anthony Brino

Centers for Medicare & Medicaid Services leaders point to seniors' wide array of Medicare Advantage and Part D choices as evidence of the program's and insurer's health, but regulators may soon be terminating dozens of plans, unless sponsors pull out first.

April 11, 2014 | Eric Wicklund

Sometimes the best solution is the simplest one. That's what some payers are finding out, for instance, with a home monitoring solution that tracks activity, rather than vital signs, for seniors and their caregivers.

April 8, 2014 | Anthony Brino

The Centers for Medicare & Medicaid Services is easing back on some of the reductions to Medicare Advantage, although the negative impact could still be as much 3 percent for some insurers and many changes loom beyond 2015.

April 4, 2014 | Anthony Brino

Michigan, the federal government and some of the country's largest insurers are getting ready to test key ideas about how to improve healthcare for some of the most vulnerable Americans.

March 24, 2014 | Anthony Brino

Physicians groups want to preserve a key antitrust exemption for self-referrals under Medicare that the Obama Administration hopes to end for a number of costly services.

March 20, 2014 | Anthony Brino

The largest national dual eligible demonstration project is taking a belated start in California, amid concerns from patient advocates. The concern surrounding the project indicates that new managed care plans have a long way to go, both in fixing problems in the system and getting buy-in from beneficiaries.

March 19, 2014 | Anthony Brino

As Congress tries to reform Medicare, the program's independent advisor has its own suggestions, including a call to end to what has become a revenue buffer for many hospitals and an integral part of their physician acquisition strategies.

March 10, 2014 | Anthony Brino

Under pressure from the industry and Congress, the Centers for Medicare & Medicaid Services is withdrawing several proposed changes to the Medicare drug program, but still charging ahead with others that could prove disruptive.

March 4, 2014 | Anthony Brino

The Centers for Medicare & Medicaid Services has a lot of data on Medicare Advantage plans that it should be using to inform policy and make available to the public, according to a new Inspector General report.

March 3, 2014 | Anthony Brino

A large group of health, pharma and payer organizations are hoping to stop what some think are the most pernicious changes to Medicare Part D in the program's history.

November 22, 2013 | White Papers
This case study reveals how one Medicare Advantage health plan boosted its productivity during AEP by 102% and grew its membership by 40% while reducing staff. Learn best practices that include broader automation, increased accuracy and compliance, and instant eligibility verification that will enable your organization to experience a new level of operational efficiency and productivity during the next annual enrollment period.

November 20, 2013 | White Papers
Whether they realize it or not, most healthcare payers are losing millions of dollars each year across activities such as COB, subrogation, eligibility, MSP validation, and more. Fortunately, a new generation of "intelligent" cost containment solutions helps cut the losses and achieve significantly improved recoveries, cost avoidance, and increased revenue - all of which support health reform priorities such as medical loss ratio and waste and abuse efforts. This white paper details real-world examples of "intelligent" cost containment success, best practices for improvement, and more.

October 9, 2013 | On Demand Webinars
The healthcare sector is going through massive transformation. Payers have to invest in readiness around data delivery to federal and state or multiple health insurance exchanges before Jan 1, 2014 deadline. While the ICD-10 adoption deadline has been pushed back due to industry pressures on regulator - it is still a huge undertaking for any healthcare entity that touches diagnostic or procedural codes. These are just some of the projects that are converging on healthcare IT teams this year. For healthcare CIOs and IT teams and especially application development teams this project overload translates into a cascading capital and operational cost burden. Learn how Presbyterian reduced storage, operational costs and realized significant productivity benefits around critical business processes.

October 9, 2013 | White Papers
Healthcare reform is transforming the US medical insurance sector - creating a dynamic and competitive new market with compelling opportunities for growth. But do you have the necessary responsiveness to capitalize on these opportunities? Here are the five compelling ways technology investment delivers agility you need - and how.

April 4, 2013 | White Papers
Accountable care offers the nation’s ailing health care system new hope — but it isn’t a new idea. For the past decade, health systems, payers, and providers across the country have been practicing accountable care principles through initiatives such as the Collaborative Payer™ Model, a care delivery innovation jointly developed by a payer and provider that approximates an accountable care organization.

April 4, 2013 | White Papers
This case study profiles a struggling Medicare Advantage business responsible for 11,600 lives in the southeastern United States. Lumeris recommended that the client implement the Collaborative Payer™ Model, an approach to improving clinical and cost outcomes via a strong payer-provider relationship. The company guided the client through a three-phase approach to develop this model, achieving outcomes including: earning appropriate revenue, reducing unnecessary utilization, improving quality metrics, and improving cost outcomes.

June 20, 2012 | White Papers
Insurers are efficiently and accurately paying millions of claims that they should never pay at all. In this white paper we define state-of-the-art prepayment analytic strategies and explain how they differ from both claims edit and postpayment detection systems.

June 20, 2012 | White Papers
In this case study, you’ll learn how Highmark dramatically reduced losses with a new analytic approach to preventing and detecting fraud, waste and abuse in submitted claims. Learn how this approach enabled Highmark to identify hundreds of new pursuable cases in the first year over and above cases identified through other methods.

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