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.
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 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.
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).
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.
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)…
Possible opportunities for growth, for payers and providers connected with the Medicaid systems in eligible states, exist in the continually low enrollments in Medicaid Savings Programs. The Medicaid under-utilization group demographics emerged through a recently released report from Medicaid and CHIP Payment and Access Commission (MACPAC).
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.
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.
