The results from a recently released report identified promising results in some of 26 state workers’ compensation systems. Using data comprising over 400,000 nonsurgical injured worker compensation claims with more than seven days of lost time, and over 2 million prescriptions are associated with these claims from 26 states, a new study from the Workers Compensation Research Institute (WCRI) observed considerable decreases in the prevalence of longer-term dispensing of opioids to injured workers in a number of states studied.
Blue Shield of California saw opioid use drop among its plan participants with non-cancer pain during the first two years of the health plan's Narcotic Safety Initiative, a three-year program to help its members avoid opioid abuse and addiction.
The KPMG 2017 Cyber Healthcare & Life Sciences Survey of providers and health plans found a dramatic rise in computer system breaches, cyber-attacks, and data compromises, which include patient records, over the past two years. Despite that increase, more executives, who oversee protecting patient records and other information, say they are better prepared than two years ago to protect themselves against cyber-attacks.
The most important strategic security program decision that the organization can make is the framework that the organization adopts for its cyber-security and compliance program.
Behavioral health documentation is often the communication tool used by and between professionals. Records not properly documented with all relevant and important facts can prevent the next practitioner from furnishing sufficient services. The outcome can cause unintended complications.
Behavioral healthcare cuts both ways for payers and providers. Shortages of qualified expertise makes filling positions difficult to impossible, while the need for services grows on many fronts and in many populations. The Daily Briefing How 2 health systems are rethinking mental health care for a value-based world, from the Advisory Board, reinforces the connections between behavioral and physical health. This identifies tangible targets, like reducing behavioral health readmissions, for improving patient care and institutional financial health.
Payers and providers spend significant energy recruiting and retaining all levels of behavioral health professionals. The access to psychiatrists acts as the 'canary in a coal mine' signalling the impending challenges. Lacking mental health expertise hits organizations at a time of increasing use spurred on by value-based care.
Massachusetts bill (H 1070/S 1093) adds to the definition of “medically necessary services” and challenges the notion of who decides medical necessity. Medical necessity criteria sits at the center of case and claim determinations. Laws, policies, and procedures evolve through time and the various administrations both locally and nationally.
The promises of value-based payment models came to life within the last 12+ months with results of real world tests. They quickly move to the implementation of useful models and processes. With ramped-up implementations overcoming value-based care barriers step out as real things.
Fighting the health plan disconnect to members and provider networks takes diligence and the basic understanding of customer needs. The technology tools integrated into consumers' everyday lives set a very high expectation for services from their health plans and service providers.