Drug-Related Risks and Outcomes: 1st Annual National Report

The purpose of this first annual surveillance report is to summarize the latest information available on the national level for various drug-related risks and health outcomes, health behaviors, and prescribing patterns related to the drug problem in the United States. The most recent year of information available is different for different outcomes. The emphasis is on national information, but some state information is also presented. This document is intended to serve as a resource for payers, providers, and pharma companies charged with addressing this ongoing national problem. It will be updated annually.

Social Determinants: Payer Cases Improving Member Health

Currently, payer strategies focus on finding healthy populations, segmenting the markets, and segmenting populations, with the target of avoiding costly procedures. Population management and all the big data trends became useful tools in those payer strategies. With the results from a study by the Robert Wood Johnson Foundation and a position paper by America's Health Insurance Plans (AHIP), social determinants quickly rose as the next measurable data used by payers.

IRO Transparency Project: Summary

Last year, we published a blog about Washington State's IRO Transparency Project. As the ACA evolves into the next phase of healthcare, states continue using tools and resources developed over the past five years. BHM's continues in its role as a leader in IRO services with an update on Washington's project.

Payers and Providers Value-Based Care Reimbursement

Value-based care reimbursement models (VBR) are becoming a popular choice for many healthcare providers and payers, as fee-for-service, (and traditional incentive based payment models), are phased out. According to a recent McKesson survey “Journey to Value: The State of Value-Based Reimbursement in 2016," 58% of payers and hospitals are planning to adopt value-based care reimbursement models.

The Opioid Epidemic: Health Insurance Companies Join the Fight

According to the Centers for Disease Control, an estimated $25 billion of U.S. healthcare costs was attributed to the abuse of painkillers—otherwise known as opioids. Up to 36 million people worldwide struggle with opioid addiction. CNN recently revealed that health Insurance companies alone lose a total of $72.5 billion annually due to of opioid addiction. Cigna is the most recent health insurance company to join the fight. By using patient data they are hoping to target overprescribing of prescription painkillers. Monitoring patient data and prescription history Cigna flags high-risk customers and notifies doctors about the patient’s history of opioid use or their high-risk behavior which puts the patient at risk for new prescriptions.

2016 Excellence in Behavioral Health Program Design

2016 is going to be a big year for Behavioral Health, thanks to The Excellence in Mental Health Act (ExACT) passed in 2014. the ExACT is a crucial step towards taking Behavioral healthcare off the back burner and sparking an important discussions on mental health. According to the National Council for Behavioral Health the program will “increase Americans’ access to community mental health and substance use treatment services while improving Medicaid reimbursement for these services.” The program has allocated over $1 billion to help protect and enhance community based mental health programs, which is the largest federal investment in behavioral health services in a very long time. Let’s take a look at the progress the Excellence in Mental Health Act has already made and what might be in store for 2016.

The 5 Biggest Challenges Healthcare Leaders are Facing in 2015

2015 has been a big year of change for many healthcare systems. With this change, healthcare leaders have been faced with many challenges, including complying with new federal regulations and making strategic moves towards better care. We've compiled a list of the five biggest challenges we've found healthcare leaders facing this year.

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