Opioid Programs Results Announced: 2 Payers Exceed Expectations

This week and in separate press releases, Anthem and OptumRx announced significant improvements through their opioid programs. These successes mark new options for the battle in, what the President declared, the opioid "national emergency". The following are important points from their separate announcements.

One Factor Influencing Opioid Prescription Habits?

For payers, identifying doctors who write more opioid prescriptions can be key for any successful opioid management program. Using the one factor influencing opioid prescription habits, payers can target education improving the overall provider network performance. Physicians trained at the United States’ lowest-ranked medical schools write more opioid prescriptions than physicians trained at the highest-ranked schools, according to a study by Princeton University.

Challenges of Developing Workers Compensation Treatment Guidelines

Workers compensation treatment guidelines can help prevent unnecessary medical procedures and the prescribing of potentially harmful medications. However, they are not all the same, nor are they without challenges. Understanding a jurisdiction's strengths/weaknesses, taking a strategic approach to developing guidelines, and using common sense can lead to better outcomes for injured workers—and, ultimately, lower costs for payers.

More Competition? Specialty Pharmacy Growth

The specialty pharmacy industry is booming and as many pharmacies opt for moving down the specialty pharmacy accreditation path, many hospitals and healthcare systems are starting to realize opening their own specialty pharmacies (or partnership with one) could be a good idea. The jump to specialty pharmacy for a health system or hospital, isn’t only a revenue driver as it gives them access but could also help with re-admissions, quality of care, and data collection. And as specialty pharmacies crop up all over the country, with an estimated 250 to be accredited by the end of 2015, it is the perfect opportunity for health systems to take fate into their own hands. From driving revenue, to increasing quality of care here are three main areas a hospital or health system can benefit in an in-house specialty pharmacy.

Trend: Insurers and Providers Partner-Up with Jointly Owned Health Plans

Aetna is setting a new standard for healthcare partnerships as it joins forces with a north Texas health system in hopes of focusing on improving quality care, affordability and overall patient care. Partnerships are no stranger in the healthcare world, but insurers and providers partnering up to provide better care and better coordinate care, is a trend we expect to see grow in 2016.

Study: More Collaboration Aids Health Care For At-Risk Populations

By teaming with community organizations, doctors and hospitals can deliver high-quality care at good value to disadvantaged people at risk for poor health, according to a new report from a panel of experts. The report released Thursday by the National Academies of Sciences, Engineering and Medicine was produced to aid Medicare officials studying how to fairly pay hospitals that disproportionately serve patients with social risk factors for health problems. Those factors include low income, social isolation, disadvantaged neighborhoods and limited health literacy.

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