Payers continue wrestling with service delivery expenses to the expanded insurance coverage audience, who were previously uninsured or underinsured. Health insurers now meet the needs of these newly-covered individuals and families, including assuring access to specialty care. One strategy insurers employed is the use of telemedicine. Telemedicine expands access to needed care, facilitate better care coordination and help contain costs. These 5 Health Plan Telemedicine Cases demonstrate how to improve benefits and access.
Findings from the 11th Annual ReviveHealth Trust Index™ reveal trust in healthcare is dismal across the board, and trust in health plans hit new low. The survey represents the first 360-degree view of trust in healthcare – digging into consumer, physician, health plan, and health system executives’ views of each other – showing the industry as a whole has a long way to go. Factors driving widespread distrust in health plans by provider organizations include the hassle of doing business with payers and a lack of progress toward new models of payment and care. Consumers feel slighted by health plans as well, compared to the higher trust ratings in physicians and hospitals.
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.