• Health Plan Resources

    Health plan leaders increasingly are being challenged to innovate, collaborate with other key stakeholders, and engage with their members as healthcare consumers. HFMA, the leading source of information on healthcare finance, is pleased to offer a collection of resources that are expressly designed to help health plan leaders navigate the challenges and opportunities in this new era of health care.

    Thought Leadership

    HFMA Executive Survey: Value-Based Payment Readiness

    HFMA researchers surveyed 117 senior finance executives about their organization's value-based payment readiness in September 2017. Findings of the survey, which was sponsored by Humana, indicate that the rollout of commercial value-based programs is slower than expected and that interoperability is a key factor.

    Feature Articles

    Newer Health Plan Products Align With Value-Based Care

    With the clout to steer the healthcare industry away from a volume-based approach, health plans are implementing innovative payment models.

    On the (Bumpy) Road to Interoperability

    Nationwide provider-to-provider interoperability may be a reality in the not-too-distant future. But is that enough?

    Roundtable: In Pursuit of Interoperability

    True interoperability "will make a 20, 30, 50 percent change in the quality of medicine we provide," a health system leader says. But getting there will require ample funding and ingenuity.

    New IBD Models Reduce ED, Inpatient Use

    Key elements of consumer-oriented care—patient engagement and care integration—also are core components in ongoing efforts to enhance the value that patients get from specialists.

    Incorporating Value in Behavioral Health

    Working out the details of value-based behavioral health models is challenging, experts say, but the benefits are worth the effort: lower costs, higher-quality care, and healthier patient populations.

    Roundtable: Integrating Behavioral Health Care and Primary Care

    Healthcare finance, clinical, and health plan leaders discuss strategies for integrating behavioral health care in a way that enhances patients' long-term health outcomes.

    New Models Redefine Primary Care

    New payment models such as CPC+ significantly change how primary care is delivered by providing practices with the resources to focus on population health management.

    Roundtable: Assessing the Value of Care

    Amid rising costs and the increasing emphasis on delivering high-quality care at a reasonable price, healthcare organizations require effective processes for assessing the value of drugs and healthcare services. In this roundtable, senior provider and health plan leaders examine best practices for gauging value.

    News Articles

    Insurer Data Requests Prompt Hospital Policy Overhauls

    One health system said it has started to provide the data to health plans to encourage reciprocal data sharing.

    How One ACA Insurer Had Its Best Year in 2018

    The enrollment increases were not echoed in the insurer's plans that are being sold on the off-exchange individual-insurance market, where federal subsidies are not available.

    CVS-Aetna Deal Targets Hospital Utilization for Savings

    The deal is a part of a recent trend of affiliations between health plans and non-hospital providers, which may increase competitive pressures on hospitals, analysts note.

    Short-Term Plans Advance Despite Insurer Concerns

    The Trump administration issued a proposed rule to roll back 2016 Obama administration rules that limit the duration of short-term health insurance plans to three months.

    2018 ACA Marketplace Plan Selections Reach 97 Percent of 2017

    Industry watchers are eyeing possible federal legislation, state waivers, and federal rules that could affect competition in 2019.

    Proposal Calls for 1.84 Percent Rate Hike for 2019 MA Plans

    High-profile MA policy changes include new opioid coverage restrictions and expanded supplemental benefits.

    Narrow Networks Spread from ACA Plans to Employers

    Health plans featuring narrow provider networks continue to spread in government-run marketplaces for individual insurance. And now employers are increasingly considering them.

    Many With HDHPs Save, but Few Shop

    The financial benefit to hospitals from the Affordable Care Act's coverage expansion has been offset by the growth in patient deductibles, according to a recent hospital executive survey.

    Hospitals, Insurers Wary of Medicaid Policy Changes

    Hospitals and insurers see both promise and peril in the potential financial impacts of several major Medicaid policy changes that emerged this month.

    Insurers, Hospitals Oppose Mandate Repeal in Tax Bill

    The number of people paying the individual mandate has decreased, while the number claiming exemptions has risen.

    Insurers Respond to Rising ED Use

    Emergency department use has spiked in recent years, leading to divergent responses from insurers.

    Blog Posts

    Humana's 'Bold Goal' to Tackle Social Determinants of Health

    Andrew Renda, MD

    Highmark Sees the 'Value' in VBID for MA Plans
    Ellen Galardy

    Making It OK: Insurer Helps Take Stigma Out of Mental Illness
    Donna Zimmerman

    Value-Based Care: Not Just for Primary Care Practices
    Donna Levigne

    Demand Fuels Expansion of Tiered-Benefit Insurance Products
    Stephen T. Swift


    Podcast: Payment Reform and Trends in Healthcare Finance

    Podcast: How a Health Plan Is Addressing the Opioid Crisis

    Podcast: Analysis on Insurance Plan Network Adequacy

    On-Demand Webinars

    Risk Adjustment Best Practices

    Hierarchical Condition Categories and Clinical Documentation: The Core of Risk Adjustment

    Our Healthcare Quilt: Differences Across State Lines