Health Care Reform Archives - Page 2 of 37

Insurance Markets Stabilization: Bipartisan Proposal From Governors

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.

2017-09-05T18:02:22+00:00 By Eric Duchinsky|Health Care Reform, Managed Care, Medicare and Medicaid, Taxes|

Alternative Payment Models In Medicaid: Is MACRA A Catalyst?

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.

2017-08-21T18:05:02+00:00 By Eric Duchinsky|Accountable Care Organizations, Health Care Reform|

Autism Care Costs: Healthcare’s Perfect Storm

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.

2017-08-01T20:13:16+00:00 By Eric Duchinsky|Behavioral Health Integration, Financial Analysis, Health Care Reform, Health Insurance, Uncategorized|

Insurance Coverage Improve Health Outcomes In Four Ways: NEJM

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?

2017-07-25T16:55:23+00:00 By Eric Duchinsky|Health Care Reform, News and Events, Quality Improvement Programs, Trends|

Payers Increasing Member Value Through Payment Initiatives

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.

2017-07-18T18:08:54+00:00 By Eric Duchinsky|Health Care Reform, Managed Care|

Provider-Sponsored Health Plans: Executive Perspectives

Provider-sponsored health plans struggle through the ever-changing political environment. For providers hoping to get a handle on healthcare costs and supplement their own medical data with claims data, launching a health plan has been a strategic move.

2017-07-26T16:57:45+00:00 By Eric Duchinsky|Health Care Reform|

BCRA, AHCA, and ACA: Winners and Losers

The Senate released its version (a.k.a. Better Care Reconciliation Act BCRA) of the House's AHCA. Payers and providers adjust as needed because healthcare reforms, like BCRA, AHCA, and ACA, continuously move through state and federal legislatures. Today's blog, pulls together summaries from numerous resources allowing you a quick glimpse or a deep dive into what waits around the corner. Here are 10 instances which can help you better identify when its time to look for a partner.

2017-06-27T16:55:22+00:00 By Eric Duchinsky|Health Care Reform, Health Insurance, Health Insurance Exchange|

Not Waiting For Capitol Hill: Health System Leaders Move Ahead

Despite industry uncertainty about the fate of healthcare under the new administration and Republican Congress, health system leaders move ahead and are preparing for the future. A recent Premier Inc. survey show the target areas for improvements within their systems. The results signal growth concerns and why the leaders will not wait for Capitol Hill results.

2017-05-23T19:29:16+00:00 By Eric Duchinsky|Clinical Operations Improvement, Compliance, Financial, Financial Analysis, Governments, Health Care Reform|

Out of Box Ideas: Prior Authorization Reform?

Responding to unreasonable hurdles for patients seeking care, a coalition including the American Medical Association (AMA) and 16 other health care organizations today urged health plans, benefit managers and others to propose prior authorization reform requirements imposed on medical tests, procedures, devices, and drugs.

2017-05-17T12:45:42+00:00 By Eric Duchinsky|Health Care Reform, Physician Advisor/Peer Review, Services|

AHCA and Three Scenarios: Repeal, Replace, Repair

Any similarities of the title of this blog and Goldilocks and the Three Bears belies the serious decisions needed for the next round of healthcare reform. Last month, PwC’s Health Research Institute (HRI) released another fantastic research piece that maps out three possible landing spots: repeal, replace, repair. Here are 10 instances which can help you better identify when its time to look for a partner.

2017-05-03T20:18:06+00:00 By Eric Duchinsky|Health Care Reform, Health Insurance, Health Insurance Exchange|

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"BHM provides consultation and direct clinical oversight to East Carolina Behavioral Health as a delegated authority for clinical peer review and physician services. We have been extremely satisfied, and value the organization’s depth and breadth of knowledge. BHM continues to exceed our expectations."

Cindy Ehlers,
V P Clinical Operations, Trillium (formerly ECBH)

"6 of the top 10 largest health plans* entrust BHM for behavioral health peer reviews.

* Ranked by, total number of members in the first quarter of 2016

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