BHM Blog 2017-08-24T17:18:45+00:00

Sharing what we learn begins here

Injured Worker Compensation Claims Uncover Relief

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.

Opioid Use Drops 32% Over 3 Years

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.

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.

Cyber-attacks: Not A Matter Of “If”, But “When”

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.

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?

Health Plans Create Best Practices: New Opioid Crisis Report

Health plans create best practices and lead with concrete strategies for preventing opioid overuse. The Association for Community Affiliated Plans (ACAP) recently issued a report detailing the innovations and best practices of its member Health Plans in their efforts to combat opioid misuse and overuse. The opioid epidemic led to an estimated 33,000 deaths and more than 300,000 emergency room visits in 2015, and recognized as a subject of intense debate on Capitol Hill and in statehouses around the country.

Key Payer Competitive Differentiator: Analytics

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.

EHR Documentation Stretching Reimbursement Cycles?

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.

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.

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