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.
Behavioral health claims skyrocket for any number and combination of factors. Behavioral health care will increase in cost and utilization with a number of factors driving this, including the:
Workers compensation treatment guidelines can help prevent unnecessary medical procedures and the prescribing of potentially harmful medications. However, they are not all the same, nor are they without challenges. Understanding a jurisdiction's strengths/weaknesses, taking a strategic approach to developing guidelines, and using common sense can lead to better outcomes for injured workers—and, ultimately, lower costs for payers.
According to the CDC, drug overdoses are the leading cause of accidental death in the United States. Of the overdose deaths that occurred in 2015, 63 percent involved an opioid. Payer options for managing efforts against opioid overuse range from monitoring population data to working with provider networks.
Payer Success Cases focus on tangible and continuous improvements. In January 2017, the healthcare industry saw the release of a white paper...
Easing provider tension begins building trust with payers. A little trust and understanding go a long way towards more efficient payer-provider relationships. One concrete effort, by payers, not only benefits both parties, but builds trust for the long-term.
American Health Policy Institute's released a report describing its work with VBID (Medicare Advantage Value-Based Insurance Design Model) Health. Payers reduce wasteful spending in a number of common sense ways.
An article in Managed Healthcare Executive, reports that joint ventures are gaining steam as plans and providers look for ways to work together to provide higher-value care. About 13% of all U.S. health systems offer health plans, covering about 18 million members—or 8% of insured lives. according to a report from McKinsey & Company. Also according to the company, the number of provider-owned health plans is increasing about 6% each year.
When it comes to procuring and maintaining your contracts with payers, there is perhaps no skillset greater to possess than that of the art of negotiation. In today’s healthcare market, there’s not only a need to be informed and competitive, but healthcare organizations need to have a very clear understanding of where they stand amid the competition.