Prior authorization reform strategies allows payers to limit unnecessary spending on high-cost prescription drugs, but leading provider experts suggest that payers could do more to boost the efficiency of prior authorization procedures for clinically valid prescription requests.
America’s Health Rankings Annual Report, now in its 28th year, provides a holistic view of the health of the nation and of each state by analyzing 35 measures of behaviors, community and environment, policy, clinical care and outcomes data. The rise of premature death is a concern shared by health care professionals, payers, and leadership as well as their members.
With the CVS/Aetna acquisition, payers are grappling with new risk and a slack consensus on how to best prioritize and respond to them.
Health plans of all sizes are interested to learn where they stand in the movement toward alternative payment models (APMs) – that is, shared savings, shared risk, bundled payments, or population-based payments and how they compare to the market. Some health plans adopt APMs because of market conditions, others by factors such as data system limitations or provider readiness.
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.
The governors John Kasich of Ohio, John Hickenlooper of Colorado, Brian Sandoval of Nevada, Tom Wolf of Pennsylvania, Bill Walker of Alaska, Terence R. McAuliffe of Virginia, John Bel Edwards of Louisiana, and Steve Bullock of Montana sent a letter to the Republican and Democratic leaders of the House and Senate asking them to take immediate steps to restore insurance markets stabilization structures. The letter was sent ahead of the testimony governors are expected to offer to the Senate Health, Education, Labor, and Pensions committee on September 7.
Health plans benefit from monitoring changes to Medicaid MCO contract requirements, including those related to alternative payment models (APMs) adoption. MCOs with APM experience may have a competitive advantage when bidding on state contracts; conversely, MCOs that lack the capacity to implement APMs may be at risk of losing Medicaid business.
Autism care costs balance in the middle of many competing issues and agendas leaving payers, providers, and consumers trying to sort out the facts from fictions. The size of the funding pie “…over the next 10 years [is] about a half a million youth with autism spectrum disorder (ASD) will enter adulthood. The majority of the costs in the U.S. health care systems for ASD are directed at the adult population: $175 to $196 billion for adults compared to $61 to $66 billion for children.” writes Monica Oss, CEO, Open Minds.
The national debate over the Affordable Care Act (ACA) has involved substantial discussion about what effects — if any — insurance coverage has on health and mortality. Health plans play a leadership role in healthcare reforms. While debate continues, a recent piece in the New England Journal of Medicine answers one main question. Does having insurance coverage improve health outcomes?
The healthcare industry is undergoing an inevitable shift away from fee for service payment models towards reimbursement models that align with the healthcare triple aim, such as value based payments. The approach and question of which value-based model to implement still remains elusive for many organizations. Let’s take a look at some payment types on the value-based reimbursement spectrum.