America’s Health Insurance Plans (AHIP) released new research on exchange reinsurance stabilization efforts leading to higher enrollment in exchanges. Funding a $15 billion reinsurance stabilization package, in combination with a delay of the Affordable Care Act’s (ACA’s) health insurance tax (HIT) through the end of 2018 and guaranteeing funding of cost-sharing reductions (CSRs), could reduce average yearly premiums by $1,363 (a 17% reduction). Uncertainty in the individual market, rising premiums, and declining issuer participation have created the need for federal and state policy makers to address these issues to stabilize the marketplace.
NCQA’s Health Insurance Plan Ratings 2017–2018 compare the quality and services of more than 1,000 health plans in the United States and provide consumers with a practical and meaningful guide to understanding their health care options and choosing the best health plans for themselves and their families. National Committee for Quality Assurance (NCQA) is releasing its 2017 Health Insurance Plan Ratings. These ratings provide consumers with a more accurate picture of how health insurance plans perform in the key quality areas of consumer satisfaction, prevention and treatment.
As healthcare payer operations integrate new practices to align with the value-based care paradigm, payers are critically challenged with identifying root causes to solve issues in order to improve and sustain performance. BHM Healthcare Solutions play a critical role in a larger operational system and offers two resources for consideration when reviewing the larger payer operational landscape.
The Association for Community Affiliated Plans (ACAP) issued a report which examines possible alternatives to the individual mandate for health insurance coverage brought about by the Affordable Care Act and evaluates their cost and efficacy. It suggests that if the individual mandate were to be repealed, a mixture of alternative mechanisms would be required to serve a similar role in maintaining a healthy risk pool in the individual stable health insurance market.
States have broad authority to influence and regulate the prescribing and dispensing of prescription drugs and do so in a variety of ways. CDC provides data and resources to equip and inform states about putting into practice strategies that help prevent high-risk prescribing and improve treatment for battles against opioid addiction and overdose.
Population trend data outlines the behavioral health challenges and changes occurring throughout the United States. For payers, understanding the movement of population segments help estimate coverage patterns and potential for claims submissions. National Survey on Drug Use and Health (NSDUH) released an annual survey of the population of the United States ages 12 years or older. The main First Findings Report contains a cross-section of NSDUH data on substance use and substance use disorders, mental health issues among adults and adolescents, and co-occurring disorders.
There was a significant change in uninsured numbers growing for people ages 35 to 49, adults making more than 400 percent of the federal poverty level ($47,520 for an individual and $97,200 for a family of four), and those living in states that have not expanded Medicaid, according to a new Commonwealth Fund survey. Policy fixes like expanding Medicaid in all states, making premium subsidies available to more people, and assisting consumers as they shop for coverage on the marketplaces, the report finds, could address some of the barriers the uninsured face in gaining coverage.
Telehealth services, which unite technology with healthcare, health information, and health education, have grown substantially over the past 15 years and are expected to increase due to new reimbursement strategies for Medicare providers who offer telehealth services as part of the Medicare Access and CHIP Reauthorization Act (MACRA). With technology racing out in front of reimbursement policies, any cost savings, quality improvement, or increased access to care waited until now. Measuring telehealth may be the key unlocking a flood of benefits for payers.
The extent of the opioid crisis means years of work, resources, and programming from payers, providers, and patients. A recent effort, funded by the Robert Wood Johnson Foundation, conducted a literature review and interviewed insurers, providers, and patient advocates looking for the most current efforts, data, and experiences from the frontlines of the opioid crisis.
The shift under way in payment in US health care - from volume to value - has sparked interest in new contracting arrangements to pay for prescription drugs. The objective of these new arrangements is to reward successful outcomes of medication use in patients, rather than pay based on the volume of drugs sold. Unfortunately, value-based contract barriers stand in the way of one approach to managing drug costs and obtaining better value for money spent. However, achieving the full potential of these contracts will necessitate regulatory and other changes.