As healthcare payer operations integrate new practices to align with the value-based care paradigm, payers are critically challenged with identifying root causes to solve issues in order to improve and sustain performance. BHM Healthcare Solutions play a critical role in a larger operational system and offers two resources for consideration when reviewing the larger payer operational landscape.
States have broad authority to influence and regulate the prescribing and dispensing of prescription drugs and do so in a variety of ways. CDC provides data and resources to equip and inform states about putting into practice strategies that help prevent high-risk prescribing and improve treatment for battles against opioid addiction and overdose.
The extent of the opioid crisis means years of work, resources, and programming from payers, providers, and patients. A recent effort, funded by the Robert Wood Johnson Foundation, conducted a literature review and interviewed insurers, providers, and patient advocates looking for the most current efforts, data, and experiences from the frontlines of the opioid crisis.
Rising health care costs are threatening the fiscal solvency of patients, employers, payers, and governments. The Collaborative Payer Provider Model (CPPM) addresses this challenge by reinventing the role of the payer into a full-service collaborative ally of the physician. The article written by Thomas Doerr, Lisa Olsen, and Deborah Zimmerman for MDPI AG (Basel, Switzerland) identified and tested elements of the Collaborative Payer Provider Model (CPPM). Also in this post, the summary of the major differences between traditional payers and the CPPM.
This week and in separate press releases, Anthem and OptumRx announced significant improvements through their opioid programs. These successes mark new options for the battle in, what the President declared, the opioid "national emergency". The following are important points from their separate announcements.
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.
For payers, identifying doctors who write more opioid prescriptions can be key for any successful opioid management program. Using the one factor influencing opioid prescription habits, payers can target education improving the overall provider network performance. Physicians trained at the United States’ lowest-ranked medical schools write more opioid prescriptions than physicians trained at the highest-ranked schools, according to a study by Princeton University.
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.