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.
The CDC released a report Integrating & Expanding Prescription Drug Monitoring Program Data: Lessons from Nine States detailing a promising strategy for addressing the prescription opioid overdose epidemic. The study focused on improving the use of prescription drug monitoring programs (PDMPs)...
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 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?
Many health plans are facing uncertainties: the changing health insurance landscape, the speed at which value–based care is approaching, and growing demands from customers, to name a few. But one investment may help executives meet each of these challenges—an investment in analytics. Health plans are data rich, yet those data are not always leveraged to understand what happened and why, or predict what is likely to happen. Health plans that don't take advantage of their data may risk being disrupted and left behind. Analytics can be a key payer competitive differentiator setting your organization ahead of the pack.
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.
The era of volatile swings and double-digit growth in employer medical costs appears to be ending. With medical cost trend hovering in the single digits for several years, the industry has been waiting for the inflection point when spending will take off. But that spike appears unlikely to happen. The New Health Economy is settling into a “new normal,” typically characterized by more attenuated fluctuations and a single-digit trend.For four years, medical cost trend has hung between 6 and 7 percent, seeming to settle into a “new normal.” PwC’s Health Research Institute (HRI) anticipates a 6.5 percent growth rate for calendar year 2018, half a percentage point higher than in 2017.
Over the past 40 years Health, United States provided an annual picture of the health of the United States, identified variations in health status, modifiable risk factors, and health care utilization among people by age, race and ethnicity, gender, income level, and geographic location. Examining long-term health trends inform the development and implementation of effective health policies and programs.
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.