Reimbursement
At the World Economic Forum (WEF) in Davos, Switzerland, a handful of American health insurance companies publicized their focus on issues like payment reform and the link between exercise and diabetes.
A study published this week in the Journal of the American Medical Association shows that having Quality Improvement Organizations (QIOs) to improve care transitions decreased hospitalizations and re-hospitalizations of Medicare beneficiaries by nearly 6 percent over two years.
The U.S. Supreme Court solidified the federal government's authority to limit Medicare reimbursement appeals with a unanimous ruling to deny the claims of a group of hospitals seeking compensation for miscalculated payments going back to the late 1980s.
The U.S. Supreme Court has solidified the federal government's authority to limit Medicare reimbursement appeals, with a unanimous ruling denying the claims of a group of hospitals seeking compensation for miscalculated payments going back to the late 1980s.
A study published in a recent issue of Medical Care found that increased nurse-to-patient staffing ratios and good work environments for nurses were tied to lower 30-day readmission rates for Medicare patients suffering from heart failure, myocardial infarction and pneumonia.
With the insurance and healthcare landscape in this country changing on almost a monthly basis, payer software vendor HealthEdge has begun conducting regular surveys of insurers as a means to take the pulse of a market at any given time. The surveys, conducted currently at six-month intervals provide a snapshot of the industry.
The Illinois exchange wants to offer in-person consumer assistance in addition to federal navigators, as part of the partnership exchange. Covered California is pretty much covered financially until 2015 with federal grants. And as Wal-Mart expands into healthcare, HHS has rebranded exchanges as "marketplaces."
As Aetna finalizes the acquisition of the managed care insurer Coventry, it is selling one of its own Medicaid businesses, Missouri Care, to WellCare Health Plans, for an undisclosed sum.
Last week the Department of Justice (DOJ) announced that it will not challenge a proposal by the Greater New York Hospital Association (GNYHA) to offer a gainsharing program to its member hospitals in the state.
If hospitals launching health plans strikes some as a sign of traditional health insurance's coming extinction, the business model so many American hospitals were built upon -- fee-for-service -- is declining too. Integrated healthcare and shared savings contracts between payers and providers are going to become the norm.