This analysis reflects carrier participation, pricing, and plan type trends for the 2020 individual exchange open enrollment period. Findings are across 50 states and DC.
Although they are often pursued as an approach for vertical integration, their value is not always clearly demonstrated.
With so much attention focused on the debate over the merits of Medicare for All, it is easy to lose sight of changes in Medicare Advantage.
Why nonhospital-provider segments are primed for growth—and why that matters.
Creating or participating in a digital health ecosystem can allow payers to take advantage of their central position in the healthcare landscape and expand in new directions.
High-performing health systems have succeeded in “breaking even” in Medicare, but many continue to struggle to achieve similar results in Medicaid. A concerted effort to improve revenue can strengthen a system’s financial sustainability.
Although end-to-end digital claims management is still a distant vision, much can be gained from digitizing portions of the claims process today.
To aid APM (re)design and support providers and payers in their value-based contracting strategy, this paper highlights seven characteristics that distinguish well-performing APMs from poorly performing models.
Performance measurement for the Quality Payment Program (QPP) has begun. Although 2017 is a transition year, providers and payors need to start planning for the future, given the QPP’s implications for them.
The US health insurance industry continues to be defined by uncertainty. The 25 articles in this compendium can help health insurers navigate the changes ahead.
Pharmaceutical companies want to be rewarded for innovation, but rising drug costs are straining payor economics. This conundrum must be solved, not for one drug at a time but across the breadth of products in the pipeline.
In our healthcare system, those in the best position to control risks and costs often have inadequate incentive to do so. Refining healthcare financing and reimbursement requires a deep understanding of the nature of medical risk.
Employers are showing increasing interest in new payment, delivery, and funding models. To capture the opportunity, payors must be able to target appropriate employers; educate employers, employees, and brokers; and demonstrate savings.
Four fundamental questions can help payors and providers improve productivity and better control utilization—the prerequisites for making value-based care sustainable.