The Medicare Advantage program continues to grow in popularity with both consumers and health plans. At least one-third of seniors are estimated to be in an MA plan rather than fee-for-service Medicare. As baby boomers retire in large numbers, health plans are competing to capture the Medicare Advantage market.
A new survey exams the attitudes, perspectives, and plans of healthcare leadership that are shaping telemedicine’s application, value, and potential. The research explored telehealth services adoption rates and drivers, budgets and ROI, the technology’s role in delivering care, and the factors important to executives when selecting a solution for their organization.
Hinge Health, a San Francisco startup that developed a 12-week remote monitoring program to reduce chronic knee pain and back pain, has published the results of a randomized control study to illustrate the effectiveness of its program for chronic knee pain. The program is intended to provide a noninvasive alternative to surgery to reduce chronic musculoskeletal pain.
New research released by WellCare Health Plans, Inc. and the University of South Florida (USF) College of Public Health, Tampa, and published in Population Health Management, reports that healthcare spending is substantially reduced when people are successfully connected to social services that address social barriers, or social determinants of health, such as secure housing, medical transportation, healthy food programs, and utility and financial assistance.
The Trump Administration released “American Patients First,” the President’s blueprint to lower drug prices and reduce out-of-pocket costs. When it comes to the cost of prescription drugs, our healthcare system faces four major challenges: high list prices for drugs; seniors and government programs overpaying for drugs due to lack of the latest negotiation tools; out-of-pocket costs for consumers; and foreign governments free-riding off of American investment in innovation.
Medical review is the collection of information and clinical review of medical records by physician advisors (for providers reviewing cases before submissions) or a peer review team (for payers) to ensure that payment is made only for services that meet coverage, coding, and medical necessity requirements. Here are 10 instances which can help you better identify when its time to look for a partner.
The Trump Administration released “American Patients First,” the President’s blueprint to lower drug prices and reduce out-of-pocket costs. When it comes to the cost of prescription drugs, our healthcare system faces four major challenges: high list prices for drugs; seniors and government programs overpaying for drugs due to lack of the latest negotiation tools; out-of-pocket costs for consumers; and foreign governments free-riding off of American investment in innovation.
The prices hospitals negotiate with health insurance companies vary enormously within and across geographic regions in the United States, according to a new study coauthored by Zack Cooper (Yale), Stuart Craig (University of Pennsylvania), Martin Gaynor (Carnegie Mellon), and John Van Reenen (London School of Economics).
Analyzing your revenue cycle from start to finish can lead to recouping significant revenue dollars for your organization. Knowing what are the most impactful metrics sets revenue cycle experts apart.
WEA Trust, a Wisconsin-based not-for-profit insurer, does that by protecting patients prescribed opioids for the first time. Its pharmacy utilization management program limits initial opioid prescriptions to a seven-day supply. WEA Trust also collaborates with providers to ensure opioid prescriptions are evidence-based and medically appropriate. In just five months, opiate prescriptions dropped 27 percent, with 91,000 fewer pills dispensed.