AHIP

A Strategic Alliance of AJMC

June 21, 2020
Presented at AHIP’s Institute & Expo Online 2020, panelists discuss in a webinar how greater collaboration of health insurance providers with state and county leaders can ameliorate barriers to access to health care and promote timely interventions to improve health outcomes.
June 19, 2020
Panelists at the AHIP Institute & Expo Online discussed whether algorithms will play a greater role in the future in reallocating health care resources.
June 19, 2020
During AHIP’s Institute & Expo Online 2020, the conversation focused on the impact the pandemic has had on health coverage and what can be done to improve health equity, among other issues. 
May 26, 2020
President Trump announced the plan today at the White House, accompanied by insulin manufacturers Eli Lilly, Novo Nordisk, and Sanofi, as well as AHIP and major health plans.
April 27, 2020
The US Supreme Court ruled in favor of health insurers seeking $12 billion from the federal government under the risk corridors program set up by the Affordable Care Act (ACA). 
April 17, 2020
AHIP wants the FDA and FTC to streamline product approvals, clarify the regulations governing biosimilars, put a stop to attempts to discourage people from using biosimilars, and start educating providers and patients about the safety and efficacy of these products.
April 08, 2020
AHIP provides information about how health insurance providers are taking action in response to coronavirus (COVID-19).
March 24, 2020
The International Olympic Committee postpones the 2020 games slated for this summer; the American Society of Clinical Oncology (ASCO) urges Congress for increased protection and support for medical practices; AHIP will allow its member payers to transfer patients with coronavirus disease 2019 (COVID-19) from hospitals to other clinical settings, if appropriate, without prior authorization.
December 24, 2019
In a news brief published by AHIP, initiatives employed by health insurance providers AmeriHealth Caritas, Geisinger, Horizon Blue Cross Blue Shield of New Jersey, and UPMC plan to address issues ranging from the opioid crisis to behavioral healthcare access.
December 20, 2019
When people are healthier, care is more affordable for everyone. For the healthcare industry, it is a common-sense decision to confront nonmedical factors that affect people’s health so dramatically.
September 27, 2019
Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.
September 12, 2019
As orphan drugs account for an increasing share of drugs approved, they are driving up the cost of drug launches and drug prices. In a new paper, America's Health Insurance Plans analyzes these rising costs and the use of orphan drugs and asserts that policy makers need to revisit the Orphan Drug Act.
August 22, 2019
Since California passed legislation in 2016 to protect patients from surprise medical bills, there have been questions about whether the law would reduce the number of in-network specialty physicians. A new, comprehensive study shows that in-network specialty doctors in the state have actually increased–not decreased–since 2017.
 
July 23, 2019
Spearheaded by Senate Finance Committee Chairman Chuck Grassley, R-Iowa, and Ranking Member Ron Wyden, D-Oregon, the bipartisan bill would lower out-of-pocket (OOP) costs for Medicare and Medicaid beneficiaries and save the government billions.
June 24, 2019
President Trump today issued an executive order intended to open the door for more transparency around healthcare costs.
May 09, 2019
President Trump today outlined a plan to tackle surprise medical billing and voiced his commitment to holding insurance companies and hospitals accountable.
March 19, 2019
America’s Health Insurance Plans (AHIP) and 16 other organizations sent recommendations to Congress this week that they said will protect Americans from surprise medical bills.
March 18, 2019
Value-based insurance design (VBID) aligns patient cost sharing with the value of clinical services, so that patients pay less for high-value services and more for unnecessary, low-value services. While there has been increased interest in VBID, with CMS expanding the VBID demonstration in Medicare Advantage to all 50 states, the situation on the state exchanges is different: The plan has to be cost neutral, so in order to remove cost sharing for high-value services, cost sharing has to increase for other, low-value services.
February 01, 2019
HHS Secretary Alex Azar proposed Thursday to end drug rebates in Medicare Part D and in Medicaid managed care plans and treat them as kickbacks, in a move that could have implications for private plans as well. The rule was announced in the same week as hearings on Capitol Hill about drug pricing, especially the rising cost of insulin.
November 14, 2018
America's Health Insurance Plans (AHIP) released what it said are 12 proposals to help increase affordability for people who buy insurance on the individual market who do not qualify for subsidies. Meanwhile, CMS said 1.2 million people signed up for health insurance during the first 10 days of open enrollment for the individual marketplaces.
October 08, 2018
At the National Association of ACOs Fall 2018 conference, private payers discussed how they are working with accountable care organizations (ACOs) to create new opportunities in the commercial market.
August 22, 2018
As healthcare innovation accelerates, it’s important to have scientific methods and begin to move towards a more inclusive and transparent approach to measuring value—one that acknowledges diversity among patients’ characteristics, preferences, and related treatment effects.
August 20, 2018
A coalition of diverse interest groups—payers, unions, and business groups—wrote Senate leaders Monday to express their opposition to the inclusion of “pay for” legislation regarding end-stage renal disease (ESRD) in an opioid bill passed in June by the House of Representatives.
 
July 17, 2018
Interest groups representing drug companies, patients, providers, and health plans all submitted comments to a Request for Information on the Trump administration blueprint for controlling drug prices and out-of-pocket costs. 
June 21, 2018
At the America’s Health Insurance Plans Institute and Expo, held in San Diego, California, June 20-22, Ezekiel J. Emanuel, MD, of the University of Pennsylvania’s Wharton School and School of Medicine, presented his “prescription for success” for improving healthcare in United States.
June 19, 2018
Health insurer Humana and pharmacy chain Walgreens announced Tuesday they are opening joint primary care clinics for senior citizens in Kansas City, Missouri. Separately, a report from America’s Health Insurance Plans (AHIP) found that Medicare Advantage populations continue to be more diverse and represent a larger share of low-income seniors than traditional fee-for-service (FFS) Medicare beneficiaries.
 
March 14, 2018
America’s Health Insurance Plans (AHIP) said Wednesday that its board of directors has chosen Matt Eyles, its current senior executive vice president and chief operating officer, to succeed Marilyn Tavenner, as its new president and chief executive officer.
March 08, 2018
Does meaningful competition currently exist in the pharmaceutical industry and is there enough transparency on price? This was the crux of the discussion at the 2018 National Health Policy Conference of America’s Health Insurance Plans in Washington, DC.
March 08, 2018
If healthcare is a human right, how do you pay for it in the United States so that no one is left behind? In a session called “Single-Payer Healthcare: Is It the Right Approach for the US?” at the  2018 National Health Policy Conference of America’s Health Insurance Plans in Washington, DC, a panel tried to come up with an answer to that question.
 
March 08, 2018
In a keynote address at the 2018 National Health Policy Conference of America’s Health Insurance Plans (AHIP) in Washington, DC, HHS Secretary Alex Azar asked his audience to consider 4 areas that he said are key to “accelerating value-based transformation, and creating a true market for healthcare” through means of some sort of federal intervention that puts patients in control of their own health records.
March 02, 2018
Next week, America’s Health Insurance Plans (AHIP) holds its annual National Health Policy Conference in Washington, DC. The American Journal of Managed Care® spoke to David Merritt, its executive vice president of public affairs, about possible things to watch for during this event.
February 20, 2018
The Trump administration on Tuesday proposed extending the time period that Americans can stay in short-term, limited-duration insurance plans from 3 months to 12 months. The administration claims that the proposed changes are intended to provide affordable coverage options for individuals and families that cannot afford premiums for policies that meet the full requirements set by the Affordable Care Act, such as 10 essential health benefits and other care.
August 10, 2017
Large employers that self-insure can avoid the tax, but that option is off limits to small businesses like restaurants or convenience stores.
July 13, 2017
The revised bill still converts Medicaid to a block grant program but gives states some flexibility, sets aside billions to combat the opioid crisis, and gives health savings accounts a bigger role.
May 14, 2017
Richard A. Bankowitz, MD, MBA, FACP, executive vice president for clinical affairs at America's Health Insurance Plans (AHIP) always had an affinity for data and early on in his career had an interest in using a data-driven approach to improve quality in healthcare. Throughout his career he has been dedicated to looking at safe and effective care and delivering affordable care.
November 23, 2016
The transition to value-based care allows clinicians to focus on a few common areas instead of multiple measures for different payers, explained Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.
October 28, 2016
This week, the top stories in managed care included an announcement that premiums on Obamacare plans are set to increase by 25% on average, a discussion of Medicare Advantage growth at America's Health Insurance Plans' National Conference on Medicare, and recommendations for success with the Oncology Care Model.
September 22, 2016
Compared with a decade ago, the vast majority of long-term care claimants are satisfied with their coverage and interactions with the insurance company, according to a survey sponsored by America's Health Insurance Plans.
September 02, 2016
Marilyn Tavenner, president and CEO of America’s Health Insurance Plans (AHIP), explains some of the biggest transitions she faced in moving from the public sector of working with HHS to the private sector of now working with AHIP.
August 18, 2016
The use of orphan drugs for non-orphan diseases is driving up the cost of these already expensive medications. A new report from America’s Health Insurance Plans found that almost half of the utilization for 46 orphan drugs were used for non-orphan indications.
August 10, 2016
Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, believes that while the tone of this year’s presidential election race has been interesting, the discussion among the candidates regarding issues of healthcare and coverage have generally been the same as elections in years past.
July 21, 2016
The 7 sets of core quality measures from America's Health Insurance Plans (AHIP) and CMS derived from looking at areas that were either high prevalence or high cost, said Aparna Higgins, senior vice president of Private Market Innovations and Center for Policy and Research at AHIP.
July 06, 2016
The key in developing core sets of quality measures is looking at coordination of care, cost of care, and quality of care, as methods that all work simultaneously together, explained Marilyn Tavenner, president and CEO of America’s Health Insurance Plans. However, she added that creating a small amount of measures centered upon core conditions and directly tied to outcomes is far more beneficial than creating a hundred new measures.
July 05, 2016
Aparna Higgins, senior vice president of Private Market Innovations and Center for Policy and Research at America’s Health Insurance Plans (AHIP), explained that CMS and AHIP’s recent release of set core quality measures was an effort to help harmonize the varying types of measures that already exist as well as to focus in on quality improvement efforts.
June 29, 2016
Jennifer Malin, MD, staff vice president, Clinical Strategy, Anthem, spoke about her health plan’s requirements on quality measures and whether they resonate what CMS requires providers to submit.
March 14, 2016
Although health plan accountable care models have evolved provider readiness, data, analytics, and the use of performance measurement are important components of plan-provider partnerships.
December 31, 2015
Top leaders in healthcare contributed to the anniversary commentary and video series
December 23, 2015
The new rule has been issued just as states are cracking down on the practice of balance billing patients who take steps to use in-network hospitals, only to be balanced billed anyway if they are seen by a provider not on their health plan.
December 07, 2015
The appellate division rejected the more serious legal challenge to Horizon's tiered network plan, which came from 17 hospitals left out of the preferred network. The first public employees who will use OMNIA will be eligible for benefits on December 26, 2015.
November 06, 2015
An obscure notice on CMS' website outlines a proposed revised formula that would take effect in 2017.
July 18, 2015
The top story was Marilyn Tavenner became the nation's top healthcare lobbyist when she was named the new president and CEO of America's Health Insurance Plans, plus the controversial new guidelines that called for more Americans to take statins were validated, according to the results of a new study.
July 15, 2015
Former CMS administrator, Marilyn B. Tavenner, will step into the role of president and chief executive of America's Health Insurance Plans.
June 26, 2015
Accelerated review of "me-too" products would increase market competition entailing a drug price competition, said experts at a panel discussion during a recent biotechnology meeting.
June 25, 2015
The Core Quality Measures Collaborative Workgroup, initiated by AHIP and payer organizations, seeks to reduce, refine, and relate the healthcare delivery process.
May 27, 2015
The medical loss ratio recommendation sought by CMS mirrors requirements for qualified health plans under the ACA. Insurers say a blanket requirement will not align with successful measures at work in several states.
March 31, 2015
To mark its 20th year of publication, The American Journal of Managed Care has invited guest contributors to comment on the state of healthcare from their perspective. This month, Karen Ignagni, MBA, president and CEO of America's Health Insurance Plans and consistently rated as one of healthcare's most important voices, writes how health plans are supporting value-based care and promoting consumer choice.
March 11, 2015
A discussion on the Supreme Court oral arguments for King v. Burwell got very heated as America's Health Insurance Plans kicked off its National Health Policy Conference in Washington, DC, on March 11.
February 13, 2015
With the March 4 Supreme Court hearing on King v. Burwell looming, big business is stepping up to defend the healthcare reform law.
January 25, 2015
High-priced treatments continue to crush state budgets. With more drugs carrying 6-figure price tags, a problematic situation is playing out across the country.
January 06, 2015
Specialty drug costs represent a huge concern for Medicaid, which already represents the second largest budget in a state, according to J. Mario Molina, MD, president and chief executive officer of Molina Healthcare.
January 01, 2015
Expanding Medicaid under the Affordable Care Act is a huge undertaking, and Michigan decided to expand the program under a Section 1115 waiver, which sets the state apart a bit, according to Stephen Fitton, Medicaid Director at the Michigan Department of Community Health.
December 30, 2014
Of the many benefits that come from achieving a 4-star CMS rating or better, retention and growth are probably the biggest ones, according to Snezana Mahon, PharmD, senior director Medicare solutions at Express Scripts.
December 27, 2014
To provide a smooth transition in the first year of the auto-enrollment and renewal process, health plans are voluntarily providing flexibility with payment deadlines for consumers purchasing coverage through the federal Marketplace.
December 23, 2014
As the healthcare industry moves to a more consumerism based environment, the number one goal for health plans is to have affordable options, explained Karen Ignagni, president and chief executive officer of America's Health Insurance Plans.
November 20, 2014
No entity in healthcare should have a blank check, but that's the current situation with specialty drugs, said Karen Ignagni, president and chief executive officer of America's Health Insurance Plans.
October 17, 2014
Funding is an obvious issue facing Medicaid right now, but another is the changing demographic, J. Mario Molina, MD, president and chief executive officer of Molina Healthcare, said at the America's Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit.
October 14, 2014
The quality bonus payments tied to CMS' star ratings makes it critical that health plans receive a 4 or better, Jonathan Harding, MD, chief medical officer of the Senior Products Division at Tufts Health Plan, said at the America's Health Insurance Plan's National Conferences on Medicare and Medicaid, and Dual Eligibles Summit in Washington, DC, from September 28 to October 2.
October 13, 2014
The high cost of Gilead Science's hepatitis C drug Sovaldi is causing Medicaid to come up with new ways of handling drug costs, according to Matt Salo, executive director of the National Association of Medicaid Directors.
October 09, 2014
How a health plan performs in the CMS star ratings to going to have a bigger impact on their finances in the coming years, Snezana Mahon, PharmD, senior director of Medicare solutions at Express Scripts, said.
October 02, 2014
Health plans, providers, and consumers have to collaborate in order to bring value, Craig Thiele, MD, chief medical officer at CareSource, said at the America's Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit.
October 01, 2014
At $531 billion, Medicaid is the second largest piece of healthcare spending and cannot be pushed off to be thought about another day, Cindy Mann, JD, CMS deputy administrator and director of the Center for Medicaid and CHIP Services, said at the America's Health Insurance Plans' National Conferences on Medicare and Medicaid and Dual Eligibles Summit.
September 30, 2014
The most recent Medicare Advantage and Part D program audits revealed that oversight of formulary administration is an area that health plans continue to struggle with, Sarah J. Lorance, vice president of Medicare Compliance at WellPoint, said at America's Health Insurance Plans' National Conference on Medicare and Medicaid and Dual Eligibles Summit in Washington, DC.
June 23, 2014
Healthcare stakeholders shared their thoughts and experiences regarding the opportunities and challenges of the healthcare industry under the Affordable Care Act.
May 28, 2014
Recent controversy over the cost of Sovaldi (Gilead Sciences)-a $1000-per-dose treatment for hepatitis C-has sparked a debate as to whether there should be federal caps on the costs of certain prescription drugs.
April 25, 2014
With the delay in ICD-10, many insurers now have to slow down a mammoth IT project and, potentially more disruptive, make adjustments to a whole slew of programs and contracts.
March 24, 2014
A new tier of coverage should be added to the health law's online marketplaces, or exchanges, that would be less comprehensive than what plans are now required to offer, the head of the health insurance industry's trade group said Sunday.
November 21, 2013
You get what you pay for: That old saw applies to most corners of American consumerism, but not to healthcare. Convincing people of that is tough.
November 13, 2013
The American Journal of Managed Care recently sat with Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), as she discussed CMS's role in the new, evolving healthcare landscape. This special AJMCtv interview highlights just some of the initiatives CMS has implemented, as well as some of the challenges that remain for the organization.
August 15, 2013
In order to deliver quality and cost-effective cancer care, Michael Kolodziej, MD, Aetna's national medical director for oncology strategies, says that providers need to get better connected with payers.
August 13, 2013
Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology, US Department of Health and Human Services, says that meaningful use sets a foundation for new models to deliver care to an entire population.
July 25, 2013
Karen Ignagni, President and Chief Executive Officer, America's Health Insurance Plans (AHIP), says health plans are doing a number of things to reduce cost and improve value, as they know the two go hand in hand.
July 02, 2013
Bruce Feinberg, DO, Vice President and Chief Medical Officer, Cardinal Health Specialty Solutions, says that the healthcare system today is fragmented, if not broken.
June 27, 2013
Susan Dentzer, Senior Policy Adviser, Robert Wood Johnson Foundation, says that there is growing interest in protecting healthcare providers from medical liability if they are following evidence-based protocols.
June 21, 2013
The impacts the Affordable Care Act (ACA) will have on healthcare delivery will reach far beyond the clinical level. For that reason, America's Health Insurance Plans (AHIP), a strategic partner of The American Journal of Managed Care, knows that cultivating collaborative discussions about health law implementation is only common sense.
June 20, 2013
To create a strong sense of co-ownership between health systems and physicians, Robert Williams, MD, Director, Deloitte, Consulting LLP, says it's important to encourage physician engagement with organizations.
June 18, 2013
In this video, Karen Ignagni, President and Chief Executive Officer, America's Health Insurance Plans (AHIP), addresses the importance of joining The American Journal of Managed Care's Strategic Alliance Partner Program.
May 29, 2013
Michael Cropp, MD, MBA, President and Chief Executive Officer, Independent Health, believes Accountable Care Organizations (ACOs) are one of the current models redesigning the healthcare system.
May 22, 2013
Jeff Goldsmith, PhD, President, Health Futures, Inc, Associate Professor of Public Health Sciences, University of Virginia, says that the biggest barrier that accountable care organizations (ACOs) face is the lack of collaboration between physician communities and hospitals.
May 17, 2013
Paul Ginsburg, PhD, President, Center for Studying Health System Change, says that consolidation plays a role in healthcare costs regarding the shift in hospital and provider market power.
April 16, 2013
Health plans are fundamentally transforming the delivery of healthcare for patients by reforming payment models, coordinating care, and partnering with providers.
January 14, 2013
A new year has begun. Make sure one of your resolutions is to become more familiar with Twitter and how to utilize this social network to get the latest information in managed care.
December 10, 2012
The America's Health Insurance Plans Fall Forum 2012 conference took place in Chicago, IL, from December 3-5. Here are some of the highlights from the conference.
December 04, 2012
An expanding retail marketplace means that there are more opportunities for health plans to develop innovative strategies to reach consumers that are entering the market space for the first time. It is essential for health plans to not only engage these consumers but also to assist them in making good healthcare decisions.
December 04, 2012
Tuesday morning at AHIP's Fall Forum 2012 included a session on the methods in which evolving technologies and disruptive innovations will undoubtedly lead to better and more cost-efficient patient care.
December 03, 2012
The America's Health Insurance Plans Fall Forum 2012 is taking place in Chicago's Renaissance Hotel from December 3-5. Here are some of the topics and trends that will be discussed.
December 03, 2012
Day 1 of the America's Health Insurance Plans Fall Forum 2012 featured a pre-conference workshop on patient engagement strategies to promote wellness in a consumer-driven marketplace. Presenter and moderator Jen Cressman, Vice President, Strategic Accounts, Krames StayWell, centered her discussion on the design of effective communication strategies and how to attract and engage consumers while also fostering loyalty.
December 03, 2012
Healthcare is in the midst of a shift toward more patient-centric and accountable care; as a result, time- and resource-constrained providers are embracing new and innovative models for delivering and organizing care.
November 02, 2012
Karen Ignagni, President and Chief Executive Officer, AHIP, says that we need to move from paying hospitals and clinicians based on volume to the value of services provided. In this video, Ms. Ignagni addresses the need to change the way payment is designed and delivered.
September 25, 2012
Robert Berenson, MD, FACP, Institue Fellow, Health Policy Center, Urban Institute, states that the development of new care delivery models will not happen overnight. There is time before expectations are put into specific quality metrics and regulations for models such as patient-centered medical homes and accountable care organizations.
September 25, 2012
Sara Rosenbaum, JD, Harold and Jane Hirsh Professor of Health Law and Policy and Founding Chair, Department of Health Policy, George Washington University School of Public Health and Health Services, says that the purpose of health reform was to provide people a source of affordable coverage so everyone would be attached to a payment system.
September 25, 2012
Peter Cunningham, PhD, Senior Fellow and Director of Quantitative Research, Center for Studying Health System Change, says that the expansion of people gaining coverage will be a big challenge for primary care delivery systems.
September 17, 2012
The America's Health Insurance Plans (AHIP) Medicare and Medicaid Conference took place in Washington, DC, this past week. Here are some of the highlights.
September 13, 2012
Len Nichols, PhD, Professor of Health Policy and Director, GMU Center for Health Policy Research and Ethics, College of Health and Human Services, George Mason University, says that if states do not expand their Medicaid programs half of the uninsured will continue without coverage. States will continue to pay for healthcare inefficiently while patients receive suboptimal care.
September 13, 2012
Although there are contentions regarding its mechanisms, health policy and managed care authorities agree that the ultimate goal of healthcare reform is to increase access, improve quality, decrease costs, and measure progress. The initiative of further integrating digital health systems and implementing health information technology continues to receive substantial support and growth in a positive direction.
September 13, 2012
Juliette Cubanski, PhD, Associate Director, Program on Medicare Policy, Kaiser Family Foundation, believes that the Medicare program overall has as much at stake in the 2012 election. Specifically, Dr. Cubanski says increasing private plan participation in Medicare and whether Medicare should move towards privatization will be some of the greatest challenges moving forward.
September 13, 2012
Karen Ignagni, President and Chief Executive Officer, AHIP, feels Medicare is right to take on the challenge of hospital readmissions. Ms. Ignagni also discusses how the Medicare Advantage plans have done a better job with traditional fee-for-services programs and tackling high hospital readmission rates.
September 13, 2012
Robert Berenson, MD, FACP, Institute Fellow, Health Policy Center, Urban Institute, thinks that new healthcare delivery models are inevitable due to the behavior of physicians and providers who have abused fee-for-service. Dr. Berenson says that there has been unacceptable growth in the bias of fee-for-service activities, and new delivery models are necessary to improve quality and costs in healthcare.
September 13, 2012
Peter Cunningham, PhD, Senior Fellow and Director of Quantitative Research, Center for Studying Health System Change, says that delivery systems should be moved more towards care management in order to deal with the high levels of wasteful care and emergency room use associated with Medicaid.
September 12, 2012
Robert Berenson, MD, FACP, Institute Fellow, Health Policy Center, Urban Institute, thinks that new healthcare delivery models are inevitable due to the behavior of physicians and providers who have abused fee-for-service. Dr. Berenson says that there has been unacceptable growth in the bias of fee-for-service activities, and new delivery models are necessary to improve quality and costs in healthcare.
September 12, 2012
The current movement toward healthcare reform is a multifaceted initiative that attempts to increase healthcare access and improve quality across the nation while balancing budgets and reducing current fiscal deficits. One health program that is a major component in the movement is Medicaid, and in this article, 2 health policy experts share their insight on the impact and future direction of Medicaid reforms.
September 12, 2012
Juliette Cubanski, PhD, Associate Director, Program on Medicare Policy, Kaiser Family Foundation, believes that the Medicare program overall has as much at stake in the 2012 election. Specifically, Dr. Cubanski says increasing private plan participation in Medicare and whether Medicare should move towards privatization will be some of the greatest challenges moving forward.
September 12, 2012
With healthcare and Medicare reform initiatives set in motion and garnering substantial momentum, mechanisms and programs for assessing improvement and determining quality measures have gained increased attention. In today's featured presentation, 2 health policy experts shared their insight on the current and future movement of performance and quality measurement.
September 11, 2012
Joseph Antos, PhD, Wilson H. Taylor Scholar in Healthcare and Retirement Policy, American Enterprise Institute, says people need to accept and understand that Medicare will not pay for all healthcare expenses after the age of 65. It is necessary to realistically look at other payment alternatives.
September 11, 2012
The abuse of government programs and misappropriation of limited healthcare resources contribute significantly to, and further complicate, the growing burden of healthcare expenditures and utilization in the United States. Government bodies have demonstrated a paradigm shift, embracing collaborations and implementing evolved strategies, to more effectively combat Medicare fraud.
September 11, 2012
Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology, US Department of Health and Human Services, says that meaningful use sets a foundation for new models to deliver care to an entire population.
September 11, 2012
As the search continues for effective cost-containment strategies in a landscape of substantial healthcare expenditures, policy authorities are looking at Medicare reform and the Part D model for opportunities and direction. In this discussion, 2 policy experts share their insights on the progress, trends, and possibilities of Medicare Part D.
September 10, 2012
Although delivery systems are seemingly designed with beneficial intentions and streamlined utilization, a number of current practices and policies have been the subject of criticism and controversy. Two leaders in health policy shared their insights regarding these concerns and discussed the necessary steps to further improve an antiquated delivery system during changing times.
September 10, 2012
Karen Ignagni, President and Chief Executive Officer, AHIP, feels Medicare is right to take on the challenge of hospital readmissions. Ms. Ignagni also discusses how the Medicare Advantage plans have done a better job with traditional fee-for-services programs and tackling high hospital readmission rates.
September 10, 2012
The hotly debated proposition of premium support comes during a time of healthcare improvements through the Affordable Care Act and Medicare reform, which aim to combat the rising costs and substantial budget deficits resulting from an aging population and increased healthcare utilization.
July 31, 2012
Jeff Lemieux, Senior Vice President, Center for Health Policy and Research, AHIP, and Jon Bumbaugh, Director of Statistics & Actuarial Services, MedAssurant, Inc, address preventing hospital readmissions.
July 20, 2012
Keith Dunleavy, MD, President and CEO, Inovalon, discusses the importance of comparative effectiveness research in order to improve chronic disease management at both the individual and population levels.
July 17, 2012
Barry Kinzbrunner, MD, Executive Vice President, Chief Medical Officer, VITAS Corporation, discusses the use of payment reform models to reduce hospital readmissions.
July 06, 2012
Keith Dunleavy, MD, President and CEO, Inovalon, addresses the importance of healthcare data and the digitization of medicine. Dr. Dunleavy states that having quality data allows for more accurate care on an individual level, along with cost savings and a better risk score.
July 03, 2012
Barry Kinzbrunner, MD, Executive Vice President, Chief Medical Officer, VITAS Corporation, speaks about ways for managed care organizations to reduce hospital readmissions.
June 29, 2012
Sarah Thomas, Vice President, Public Policy and Communications, NCQA, says there are three options for states looking to initiate health insurance exchanges (HIX): federally facilitated, state sponsored, and partnership models.
June 27, 2012
Karen Ignagni, President and CEO, America's Health Insurance Plans (AHIP), states that higher costs and reductions in health plan options were consequences of states that did not link Affordable Care Act insurance market reforms and the individual mandate.
June 22, 2012
Many organizations would like to get consumers more engaged in their health. However, many programs miss the mark by lacking key features that have the potential to improve participation rates.
June 21, 2012
Barry Kinzbrunner, MD, Executive Vice President, Chief Medical Officer, VITAS Corporation, states that hospice and palliative care programs are important in the coordination of care for patients.
June 21, 2012
"The problem is that incentives are still not aligned. Health plans need to align incentives so that hospitals are not losing and not being counterproductive of the goals they are striving for, says Jan Berger, MD, MJ, President & CEO, Health Intelligence Partners and Editor-in-Chief, The American Journal of Pharmacy Benefits.
June 21, 2012
In a heavily regulated market, it is becoming increasingly important for health plans to rely on innovative ideas. In order to do so, health insurers must create an organizational culture that places emphasis on flexibility and new ideas. In this session, presenters discuss some of the ways their organizations continue to break the mold in order to stay ahead of the curve.
June 21, 2012
Robert Margolis, MD, Managing Partner and CEO, HealthCare Partners, states that physicians and hospitals need to understand how to assess health and insurance risks in order to provide better care.
June 20, 2012
Karen Ignagni, President and CEO, America's Health Insurance Plans, spoke on Wednesday about the looming Supreme Court decision and how it will impact insurers.
June 20, 2012
One of the featured workshops at the America's Health Insurance Plans Institute 2012 on Wednesday was the Health Reform Advanced Studies Workshop, which was an interactive session that touched on a number of healthcare issues. Here are some of the highlights.
June 20, 2012
Sarah Thomas, Vice President, Public Policy and Communications, NCQA, states that there are 3 significant pieces of quality improvement strategies for health insurance exchanges.
June 06, 2012
James C. Capretta, MA, answers what process can be put in place for continual improvement in the productivity and quality of patient care.
May 09, 2012
Jeff Lemieux discusses health system partnerships that work to control costs in a managed care setting.
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