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.
The shift under way in payment in US health care – from volume to value – has sparked interest in new contracting arrangements to pay for prescription drugs. The objective of these new arrangements is to reward successful outcomes of medication use in patients, rather than pay based on the volume of drugs sold. Unfortunately, value-based contract barriers stand in the way of one approach to managing drug costs and obtaining better value for money spent. However, achieving the full potential of these contracts will necessitate regulatory and other changes.
The governors John Kasich of Ohio, John Hickenlooper of Colorado, Brian Sandoval of Nevada, Tom Wolf of Pennsylvania, Bill Walker of Alaska, Terence R. McAuliffe of Virginia, John Bel Edwards of Louisiana, and Steve Bullock of Montana sent a letter to the Republican and Democratic leaders of the House and Senate asking them to take immediate steps to restore insurance markets stabilization structures. The letter was sent ahead of the testimony governors are expected to offer to the Senate Health, Education, Labor, and Pensions committee on September 7.
The purpose of this first annual surveillance report is to summarize the latest information available on the national level for various drug-related risks and health outcomes, health behaviors, and prescribing patterns related to the drug problem in the United States. The most recent year of information available is different for different outcomes. The emphasis is on national information, but some state information is also presented. This document is intended to serve as a resource for payers, providers, and pharma companies charged with addressing this ongoing national problem. It will be updated annually.
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.
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.
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.
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.
