Resources from BHM Healthcare Solutions

Telehealth Payer Laws: Impact and Issues

2017-08-29T20:42:31-04:00By Eric Duchinsky|Telehealth and Telemedicine, Uncategorized|

Payers interested in the market potential of under-served rural populations long for consistent options for offering affordable policies without provider network limitations. The language policymakers use in telehealth legislation may deter provider networks from offering remote services and tying the hands of payers looking to broad service options, according to a the Center for Connected Health Policy (CCHP). The CCHP, with funding from the Milbank Memorial Fund, release a report covering the current state of telehealth payer laws.

Opioid Programs Results Announced: 2 Payers Exceed Expectations

2017-08-24T19:48:08-04:00By Eric Duchinsky|Care Coordination, Clinical Analysis, Clinical Operations Improvement|

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.

BHM Leadership

2023-10-09T10:47:36-04:00By Eric Duchinsky|Staff|

ERIC ROSENBERG

Eric Rosenberg, President and CEO, spent the past several years at BHM concentrated on managing the […]

Social Determinants: Payer Cases Improving Member Health

2017-08-23T17:31:18-04:00By Eric Duchinsky|Managed Care, Population Health, Trends, Uncategorized, Utilization Management|

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.

All-Payer Model Maryland Update: Care Redesign Program

2017-08-21T18:03:30-04:00By Eric Duchinsky|Financial, Medicare and Medicaid|

In July of 2017, CMS and Maryland continued their partnership and announced the Care Redesign Program (CRP). The CRP is a new voluntary program within the Maryland All-Payer Model that advances efforts to redesign and better coordinate care in Maryland. The CRP provides hospitals participating in the Maryland All-Payer Model the opportunity to partner with and provide incentives and resources to certain providers and suppliers in exchange for their performance of activities and processes that aim to improve quality of care and reduce the growth in total cost of care for Maryland Medicare beneficiaries.

Alternative Payment Models In Medicaid: Is MACRA A Catalyst?

2017-08-21T18:05:02-04:00By Eric Duchinsky|Accountable Care Organizations, Health Care Reform|

Health plans benefit from monitoring changes to Medicaid MCO contract requirements, including those related to alternative payment models (APMs) adoption. MCOs with APM experience may have a competitive advantage when bidding on state contracts; conversely, MCOs that lack the capacity to implement APMs may be at risk of losing Medicaid business.

One Factor Influencing Opioid Prescription Habits?

2017-08-17T16:55:59-04:00By Eric Duchinsky|Care Coordination, Clinical Analysis, Clinical Operations Improvement|

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.

Offer Health Insurance: Big Employers Vow to Continue

2017-08-29T17:39:48-04:00By Eric Duchinsky|Uncategorized, Workers Compensation|

The shrinking unemployment rate has been a healthy turn for people with job-based benefits. Eager to attract help in a tight labor market and unsure of Obamacare’s future, large employers are newly committed to offer health insurance and maintain coverage for workers and often their families, according to new research and interviews with analysts.

CBO Report: Effects of Terminating Payments for CSRs

2017-08-17T00:13:48-04:00By Eric Duchinsky|Managed Care, Medicare and Medicaid|

The federal deficit would grow by $194 billion over 10 years if the Trump administration stops reimbursing private insurers for lowering out-of-pocket expenses for individuals under the Affordable Care Act (ACA), according to a report issued today by the Congressional Budget Office (CBO).

Medicare Advantage Projected Market Growth Creates Untapped Opportunities for Insurers

2017-08-15T21:28:11-04:00By Eric Duchinsky|Financial, Medicare and Medicaid|

Despite rapid-fire growth that has resulted in upwards of 33% of all Medicare beneficiaries now being enrolled in Medicare Advantage plans, few health plans are proactively marketing their offerings to consumers and all but a select few plans are falling short when it comes to successfully addressing provider integration and access to care for their members. Those are the key findings of the J.D. Power 2017 Medicare Advantage Study.

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About Eric Duchinsky

ERIC ROSENBERG