Healthcare Trends to Watch for 2018

In the upcoming year, persistent uncertain and risk is projected for the US health industry, according to PwC’s Health Reach Institute’s newly released Healthcare trend report. The challenges of 2017, heated debates over health and tax reform and natural disasters could echo in 2018. Payers have already been strategizing for 2018, but looking at the 12 defining healthcare trends for 2018 can assist payers with long-term planning.

ACO Success Factors: Identifying Key Strategies

Accountable care organizations (ACOs) have been the most popular vehicle for value-based payment model adoption to date, with over 923 ACOs covering approximately 32.4 million lives across the country. Recognizing the importance of successful ACO implementation, the Health Care Transformation Task Force (HCTTF) released a comprehensive analysis of high-performing ACOs and ACO success factors.

Disturbing Prescribing Trend: Pain, Opioids, And Demographics

A recent study from the University of Kansas School of Pharmacy has uncovered a disturbing prescribing trend in prescribing opioids for nonmalignant chronic pain (defined as pain lasting for more than three months not associated with cancer). The study adds definition to the opioid landscape starting with pain and possibly leading to addiction.  

Battles Against Opioid Addiction: CDC Fund States $28.6M

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.

Opioid Crisis Response: Insurers Balance Access And Need

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. 

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.

EHR Documentation Stretching Reimbursement Cycles?

Payers and providers need efficient administrative services for profitability. With all the capital and human resources invested in electronic health records and data exchange security, why are documentation errors still one of the highest cause of adverse determinations? The number of claims slowed by lack of/incomplete/poor EHR documentation became crystal clear in recent reports.

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