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News Items, by Subject

Health plan costs - healthcare delivery

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Progress Toward Value-Based Care Slipping
"[O]nly 27 percent of the respondents said the nation has a [value-based care (VBC)]-based healthcare system, down from 29 percent in 2017.... The percentage of respondents who said they believe physicians have the tools needed to succeed with VBC dropped to 42 percent this year from 46 percent last year. The percentage of respondents who said they think doctors lack enough information about their patients to make VBC work jumped to 72 percent this year from 60 percent last year." (HFMA)
[Guidance Overview] Telehealth Reimbursement May Be Coming to Medicare: CMS Proposes Medicare Payment for Virtual Visits and Review of Pre-Recorded Images
"[CMS], for the first time, has proposed payment for virtual visits to established patients regardless of such patients' location, effective January 1, 2019.... CMS is seeking comment on the types of communication technology that may be used in furnishing the virtual services, including whether audio-only telephone interactions are sufficient compared to interactions that are enhanced with video or other kinds of data transmission." (Drinker Biddle)
Medicare Billing Overhaul to Transform Documentation, Expand Telehealth
"Rather than continuing to comply with documentation guidelines from the 1990s, practitioners would be able to choose to document [Evaluation and Management ('E&M')] visits based on time spent with the patient or on their own medical decision-making.... Rather than having to re-document information from past visits, practitioners would have more options to simply review and update existing documentation. Physicians would further be allowed to simply review and verify certain medical records that staff members or the patient entered." (HealthLeaders Media)
Amazon, Berkshire Hathaway and JPMorgan Name C.E.O. for Health Initiative
"Amazon, Berkshire Hathaway and JPMorgan Chase, the powerful triumvirate that earlier announced its hope to overhaul the health care of its employees and set an example for the nation ... picked one of the country's most famous doctors to lead the new operation. Dr. Atul Gawande, a Harvard surgeon and staff writer for The New Yorker magazine, will become chief executive of the new company ... He said he was not stepping down from his current medical and other duties to take the job." (The New York Times; subscription may be required)
Behind the Numbers 2019: Healthcare and Medical Cost Trends (PDF)
38 pages. "[T]hree factors inflating medical cost trend in 2019: [1] Care anywhere and everywhere.... [2] Provider megamergers.... [3] Physician consolidation and employment.... Three factors are tempering the spending increases. [1] Flu impact.... [2] Care advocacy.... [3] High-performance networks.... HRI projects medical cost trend to be 6 percent in 2019 ... The net growth rate in 2019, after accounting for benefit design changes such as higher co-pays and narrow provider networks, is expected to be 5.5 percent." (PwC)
[Opinion] Can Low-Intensity Care Solve High Health Care Costs?
"[T]he cost of the same procedure on the same patient by the same physician can vary by thousands of dollars depending on whether it's performed in a hospital, a hospital's outpatient department, an ambulatory surgical center or a doctor's office. It can also vary by who's paying the bill -- which insurer or public program.... [A]ll other things equal, the shift toward lower-intensity, lower-cost settings is a worthy goal. But in some cases, outcomes may not be equal, and it seems we should make sure we're not cutting quality when we're cutting costs." (The New York Times; subscription may be required)
[Official Guidance] Text of HHS Request for Information: Facilitation of Public-Private Dialogue to Increase Innovation and Investment in Healthcare Sector
"This request for information solicits public comment ... on how to structure a workgroup, or other form of interaction between the Department and such participants in the healthcare industry, in order to best support communication and understanding between these parties that will spur investment, increase competition, accelerate innovation, and allow capital investment in the health care sector to have a more significant impact on the health and wellbeing of Americans. HHS also seeks comment more broadly on opportunities for increased engagement and dialogue between HHS and those focused on innovating and investing in the health care industry." (U.S. Department of Health and Human Services [HHS])
Department of Veterans Affairs Leads in Changing the Telehealth Landscape
"As a general rule, most telehealth practitioners are required to comply with various and state-specific licensing, registration, and certification requirements in order to render health care services via telehealth ... [T]he VA is exercising its authority as a federal agency to preempt conflicting state laws relating to the practice of medicine or other health care services via telehealth." (Epstein Becker Green)
Once a Vision for the Future, Virtual Health Is a Reality of the Present
"Virtual health led to a 15 percent reduction in length of patient stays, and improved the experience of chronically ill patients, and remote monitoring of patients once they leave the hospital can cut readmission rates. It is estimated that $7 billion a year (average of $126 per visit) would be saved if annual face-to-face doctor visits moved to virtual visits.... There are now about 200 telemedicine networks and 3,500 service sites in the U.S.... Virtual health can help improve medication adherence, health tracking, and patient accountability." (Deloitte)
How Have Healthcare Prices Grown in the U.S. Over Time?
"The average price paid by large employer plans for an inpatient admission for a laparoscopic appendectomy increased by 136% between 2003 and 2016, much faster than general price increases over the period (28%).... [T]he average price of a full knee replacement in the New York City area ($50 thousand) is more than twice the price of the same procedure in the Louisville, Kentucky area ($23 thousand). The national average was $34,063." (The Peterson-Kaiser Health System Tracker)
Network Adequacy Rules, Provider Consolidation Inhibit Insurer Entry Into New Markets
"As a newcomer to the Medicare Advantage market, Clover Health has sought to differentiate itself using big data and machine learning to improve beneficiary health management. But analytics can't save the insurer from well-established program requirements around network adequacy coupled with health system consolidation ... Instead, the insurer is asking the federal government to loosen requirements around the program to enhance competition." (FierceHealthcare)
[Opinion] Merging Insurers with the Health Care Delivery System
"The potential merger between Partners HealthCare and Harvard Pilgrim Health Care is not just another routine merger and acquisition activity, but it is one occurring at the heart of the U.S. health care system -- Massachusetts General Hospital being one of the oldest and most prestigious hospitals in the nation. It is distressing to see multiple hospitals and physicians merge to gain market advantage, but it is even more disturbing when an integrated health care delivery system is merging with one of the state's largest insurers." (Physicians for a National Health Program [PNHP])
[Opinion] Telemedicine Prescribing of Controlled Substances: The Dark Side of the New Congressional Bill
"Congress has taken another step forward to require the federal Drug Enforcement Administration (DEA) to activate a special registration allowing physicians and nurse practitioners to prescribe controlled substances via telemedicine without an in-person exam.... [T]his bill ... requires the DEA to issue 'interim final regulations.' ... Directing the DEA to issue interim final regulations, while expeditious, strips the public from the important need to review and comment on the DEA's approach to the special registration process." (Foley & Lardner LLP)
35-State Pediatric Group Claims Aetna Doesn't Review Medical Charts in Lawsuit Alleging Insurer Values Profits Over Care
"A national physician group is suing Aetna for 'improperly interfering with medical care,' alleging the insurer tried to claw back payments for necessary patient care, furthering accusations that the company fails to review patient charts.... The physician group, with employs 1,750 specialists across 35 states, also raised concerns that the insurer does not review medical charts when evaluating claims payments[.]" (FierceHealthcare)
CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements
"For 69 of the 100 claims in our sample, telehealth services met requirements. However, for the remaining 31 claims, services did not meet requirements.... 24 claims were unallowable because the beneficiaries received services at nonrural originating sites, 7 claims were billed by ineligible institutional providers, 3 claims were for services provided to beneficiaries at unauthorized originating sites ... Medicare could have saved approximately $3.7 million during our audit period if practitioners had provided telehealth services in accordance with Medicare requirements." (Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS])
Direct Primary Care Legislation Continues Its Roll Across the Country
"Direct primary care (DPC) is a style of clinical practice in which a healthcare provider ... offers primary care services to patients who pay a monthly membership fee for the provision of primary care services at no additional charge to the patient/member.... Florida Governor Rick Scott signed the 'Direct Primary Care Agreements' bill (HB 37) to amend the Florida Insurance Code and, in turn, made it clear that DPC agreements between physicians and patients do not constitute the making of insurance and therefore do not have to comply with the terms of the Florida Insurance Code." (Sheppard Mullin)
[Opinion] Impact of Prior Authorization on Patients and Physicians
"Our policymakers are still fixated on managed care, but their tool of prior authorization provides just one more demonstration on why the private insurers and their managed care excesses have to go.... 86 percent of physicians report that the prior authorization burden has increased over the past five years -- since the implementation of the [ACA]. That is a burden for both patients and their health care professionals that we need to dump." (Physicians for a National Health Program [PNHP])
[Opinion] ERIC Asks For Pay Parity Change in Connecticut Telehealth Legislation (PDF)
"[L]egislation that mandates that reimbursement for telemedicine be the same rate as that of in-person services is simply illogical and unnecessary.... [R]eimbursement rates should be negotiated between providers and insurers, not mandated by government." (The ERISA Industry Committee [ERIC])
Provider Networks: Actuarial Perspective on Performance, In and Out of Exchanges (PDF)
169 pages. "This report outlines the range of practice across the industry with respect to alternative networks for Exchanges. It starts with a basic overview and then moves through ways to drive higher performance based on the experiences of the authors of this report. This report is primarily focused on carriers and their efforts to develop networks. However, it also presents the financial perspectives of the individual buyers, hospitals and physicians and state management of Exchanges." (Society of Actuaries)
Why Does the U.S. Spend More on Health Care Than Other Countries?
"One reason could be that Americans are less healthy than people in other countries.... Another explanation could be that we use more medical goods and services. This turns out not to be the case.... A third option is for that the prices of the health care goods and services we use may be higher than those of other countries. This does indeed turn out to be the case ... One solution to this 'problem' would be to cut prices of pharmaceuticals as well as physician salaries. However, higher pharmaceutical prices have incentivized more innovation." (Healthcare Economist)
Health Care Spending in U.S., Other High-Income Countries
"In 2016, the U.S. spent 17.8 percent of its gross domestic product (GDP) on health care, while the average spending level among all high-income countries was 11.5 percent of GDP.... Except for diagnostic tests, the U.S. uses health care services at rates similar to those of other countries.... The average salary for a general practitioner in the U.S. is $218,173, nearly double the average salary across all high-income countries.... The U.S. spends $1,443 per person on pharmaceuticals, compared to the average of $749.... The U.S. spends 8 percent of total national health expenditures on activities related to planning, regulating, and managing health systems and services, compared to an average 3 percent spent among all high-income countries." (The Commonwealth Fund)
UnitedHealthcare Reports Positive Shift Towards Value-Based Care Plans
"UnitedHealthcare's annual report evaluated value-based programs that include 110,000 physicians and 1100 hospitals that treat patients in UnitedHealthcare employer-sponsored, individual, Medicare, and Medicaid products. The payer found that accountable care organizations (ACOs) had a greater effect on improving health and lowering costs than non-ACOs, with hospital admission rates being 17% lower for ACOs compared with non-ACOs." (American Journal of Managed Care)
[Opinion] A Few Suggestions to Simplify Healthcare
"The front door to healthcare delivery should be an easy-to-use smartphone application which is pre-populated with a healthcare calendar, set up with you and your doctor, to remind you of milestones including appropriate checkups for medical, dental and vision care.... Selecting your provider has to be easier.... [D]rug costs are too confusing.... Doctors' offices should be paperless." (Frenkel Benefits)
Oscar Health's Telemedicine Consultations Up 32% in 2017 as More Members Access Virtual Touchpoints
"Oscar Health saw a 32% increase in telemedicine consultations among its members last year amid an overall increase in virtual services. Telemedicine consults are less utilized than the other digital services offered by the company: 25% of members used the service in 2017, up from 17% in 2016. But those figures outpace other telemedicine leaders." (FierceHealthcare)
[Opinion] CVS-Aetna, a Few Weeks Later
"[CVS is] reserving cash for strategic acquisitions and building out their MinuteClinics.... CVS employees are required to use these clinics for their mandatory annual physicals, obviating the need for other more expensive primary care. Rumors are even circulating that following jettisoning tobacco, CVS is strongly weighing exiting the alcohol and grocery space and throwing all their resources into the health and wellness space." (Frenkel Benefits)
The Promise of Telehealth
"As with any emerging technology, telehealth presents challenges. These include reimbursement limitations, statutory and regulatory barriers, investment costs, broadband access considerations, and privacy and security issues ... Patients are increasingly willing to pay to receive health care at their own convenience and, more and more, payors are paying attention as providers begin to tap the potential." (Hodgson Russ LLP)
[Opinion] The Evidence-Based Medicine Problem: U.S. Doctors Cling to Procedures That Don't Work
"Despite concerns about the rising cost of health care, ... Medicare generally covers treatments deemed 'reasonable and necessary' -- a definition that doesn't include analysis of comparative effectiveness or cost in relation to other treatments. And what Medicare does influences the behavior of private insurers.... [This] approach promotes access to new medical products, yet it doesn't protect patients against the harms from receiving useless or low-value treatments. And it leaves less money to fund expensive therapies that have proven their worth." (Vox)
Maintaining Tissue Sample Quality Might Reduce Costly Medical Errors
"You might not suspect that the success of the emerging field of precision medicine depends heavily on the couriers who push carts down hospital halls. But samples taken during surgery may end up in poor shape by the time they get to the pathology lab -- and that has serious implications for patients as well as for scientists who want to use that material to develop personalized tests and treatments that are safer and more effective." (National Public Radio)
Study Identifies Unexpected Contributor to Rising Health Costs: Low-Cost Services
"One way to improve healthcare quality and efficiency and reduce the use of unnecessary care is to apply the principles of value-based insurance design (VBID), which aligns patients' out-of-pocket costs with the value of services." (American Journal of Managed Care)
Five Simple Charts Show That Risk-Based ACOs Are Working
"In 2016, ACOs in two-sided risk models accounted for only 10 percent of ACOs (48 of 458) but generated almost 30 percent of the total aggregate savings vs. benchmarks ... ACOs in one-sided models saved an aggregate of $541 million versus their benchmarks, but CMS paid out more than that -- $613 million -- in shared savings. In two-sided models, CMS fared better." (Health Affairs)
Mega-Deals Show How Insurers Are Taking Over Access to Care
"The nation's largest insurer, UnitedHealth Group, announced [Dec. 6] that it would buy a network of 300 primary care and specialist clinics from dialysis giant DaVita for $4.9 billion ... The deal ... comes days after CVS Health agreed to buy health insurer Aetna for $69 billion.... The two deals represent companies exploring new ways to rein in costs -- and the diversity in approaches shows that no one yet knows what will work." (
The Next Big Innovation in Health Benefits Design: 'Surgeons of Excellence'
"Self-insured employers, pursuing cost-efficiencies and streamlined care for employees, select certain hospitals to become provider-partners. They label these partners 'Centers of Excellence', and design their benefits packages around them.... Surgeon-level data....enables smarter selection of provider partners.... [and] uncovers variances that could have a tremendous impact on outcomes.... The scope of possible performance disparity can be very broad in any given facility." (mpirica)
Addiction and Mental Health vs. Physical Health: Analyzing Disparities in Network Use and Provider Reimbursement Rates (PDF)
48 pages. "As state and federal regulators increase their focus on enforcement of mental health and addiction parity laws, nonquantitative treatment limitations have emerged as a key trouble area for some health plans.... Based on an analysis of two large research databases of administrative claims data, [the authors] have identified significantly higher rates of out-of-network use for behavioral care compared to medical/surgical care, and have also found that medical/surgical providers are paid at higher rates than behavioral providers, often for providing the same services." (Milliman)
Massachusetts Bill Aims to Curb Health Care Costs by Regulating Hospital Reimbursement Rates
"One of the primary ways the bill proposes to moderate costs is by establishing a hospital alignment and review council which will set a 'target hospital rate distribution,' the minimum floor payment that an insurance carrier must reimburse a hospital for services." (Foley & Lardner LLP)
Keys to Successful Business and Community Health Collaboration (PDF)
"[A] growing number of business leaders are investing in the health of their employees, but they also increasingly recognize the importance of engaging in efforts to create a culture of health in the communities they serve and to address concerns such as community access to health care and healthy food, emotional health issues, obesity, and graduation rates -- all factors that contribute to community health." (Health Enhancement Research Organization [HERO])
[Opinion] Hospital Impact: The Upside of Narrow-Network Insurance Plans
"Nationwide, disjointed care channels are preventing providers from reaching the quadruple aim: exceptional health outcomes, an exceptional experience for the people we serve, and an exceptional experience for providers, at an affordable cost. The ability to truly execute the quadruple aim depends on having an individual receive care within a defined network. The advantage of more targeted choice in narrow network plans is that providers can deliver quality across the continuum of care while being responsible stewards of resources." (FierceHealthcare)
The Next Generation ACO Program: Financial Results for 2016 (PDF)
"Across all NGACOs in 2016, the program had $48 million in gross savings and $3 8 million in shared savings. Shared savings are the net amounts paid by CMS to the NGACOs. If we separate the NGACOs into those that had savings and those that had losses (as shown in Figure 1), we see that the former had $58 million in shared savings and the latter $20 million in shared losses." (Milliman)
Factors Associated with Increases in U.S. Health Care Spending, 1996-2013
"Increases in U.S. health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending." (The JAMA Network)
[Opinion] NCPA Statement for House HELP Committee Hearing on the Cost of Prescription Drugs: How the Drug Delivery System Affects What Patients Pay (PDF)
"PBMs serve as the 'middlemen' in most prescription drug transactions in the United States. First, they leverage the number of beneficiaries in a plan to negotiate lucrative rebates from pharmaceutical manufacturers. Second, they formulate limited pharmacy provider networks that will supply or dispense these drugs to plans' beneficiaries and in turn, charge plan sponsors for these products.... PBMs extract 'spread' profits from both activities. Unless a plan has negotiated a true 'pass through' contract with its PBM -- and typically only the largest and most sophisticated plans are able to do so -- the PBM will keep a significant percentage of the rebate dollars that they have obtained only by virtue of the number of the plans' beneficiaries for themselves." (National Community Pharmacists Association [NCPA])
The 2017 ACO Survey: What Do Current Trends Tell U.S. About the Future of Accountable Care?
"[A] large number of ACOs are currently considering or have firm plans to participate in future risk-based contracts (47 percent planning for shared savings/shared risk and 38 percent planning for capitation), although care management strategies are largely unchanged.... ACOs are slowly becoming willing to accept increased financial risk, but they are largely still learning how to actually manage populations." (Health Affairs)
[Opinion] ERIC Submits Comments on Florida's Telehealth Advisory Council's Report of Recommendations
"ERIC encourages allowing the patient-provider relationship to be established via telehealth and applying the same standard of care to its practice as that of in-person care. Additionally, we like to see the adoption of technology-neutral requirements so that the service can be more readily available to the public. We also advise avoiding the imposition of additional requirements on telehealth services that are not imposed on in-person visits, as well as originating site restrictions that require patients to visit certain locations in order to access telehealth services." (The ERISA Industry Committee [ERIC])
Hospitals, Health Insurers Biggest Sources of Rising Health Costs
"Of the $240 billion increase in private health insurance spending between 2009 and 2015, hospitals accounted for 50 percent and health insurance administration and profit accounted for 12 percent (a 30 percent increase over that period) ... The U.S. is spending as much on insurance administration as on drugs[.]" (Bloomberg BNA)
States Protect Consumers Against Balance Bills
"Beginning July 1st, California is the latest state to enact consumer protection against balance billing.... California is now one of 21 states with some form of consumer protection against balance billing. Unfortunately, many of these 21 states have protections for consumers only in limited situations such as emergency care or on certain types of health plans." (Hill, Chesson & Woody)
[Opinion] Health Insurance Availability: Is Choice the Real Issue?
"Healthcare consolidation is the result of economic reality: the private market in healthcare is shrinking, the public market is growing and choices for consumers are fewer. And the public market is not as profitable as the private market, so access to capital and positive operating margins are increasingly achieved by fewer and bigger organizations. And that means fewer choices for consumers in choosing with whom they'll do business." (Paul Keckley)
Telehealth Experts See Quality Measurement as Vehicle for Payment Reform, Consumer Choice
"New quality measurements ... could lay the groundwork for telehealth payment reform by giving payers a better grasp on how to define an effective program and expanding access to quality care. More broadly, the framework to measure telehealth quality will help vendors and providers adapt to a larger volume of users and allow the technology to become fully integrated with traditional care models." (FierceHealthcare)
[Opinion] The Anthem-Cigna Merger: A Post-Mortem
"In the future, insurers might successfully argue that when they negotiate deep discounts, they are merely 'robbing Peter to pay Paul,' in which Peter is a powerful and profitable provider, and Paul is an employer or employee. This has the flavor of a 'countervailing market power' argument, in which the best way to counterbalance a monopoly seller is through a monopsony buyer.... Economic theory fails to tell us how to strike this balance and even suggests that the two monopolies may act in their combined best interests, at the expense of consumers." (Health Affairs)
How Below-the-Radar Mergers Fuel Health Care Monopolies
"Hospitals have gone on a doctor-buying spree in recent years, in many areas acquiring so many independent practices they've created near-monopolies on physicians.... How could this happen? Where are the regulators charged with blocking mergers that have been repeatedly shown to drive up the price of health care? The answer, in many cases, is that they're out of the game." (Kaiser Health News)
Innovation in Health Benefits
"[E]ntrepreneurs have created nearly 100 companies focused on consumer-driven innovations in the fields of telemedicine, education, model innovation, process improvement, and wellness.... These offerings, and many others, are leading the way in improving many outdated health care systems and processes, while also uncovering long-term solutions to the failures of legacy benefit approaches for consumers." (Willis Towers Watson)
An Untapped Opportunity for Health Care Progress: Redesigning Care for High-Need Patients
"Currently, 1 percent of patients account for more than 20 percent of health care expenditures, and 5 percent account for nearly half of the nation's spending on health care ... Although there is no one-size-fits-all solution, a new publication ... says successful models generally share a number of common features across four dimensions: [1] Focus of service setting.... [2] Care and condition attributes.... [3] Delivery features.... [4] Organizational culture." (Health Affairs)
Telehealth Private Payer Laws: Impact and Issues (PDF)
"[T]his study seeks to achieve a better understanding of the following policy factors that greatly affect the effectiveness of private payer laws: ... [1] Is the presence or lack of certain language or phrases a help or hindrance to the utilization of telehealth? ... [2] Does the law require a payment amount for telehealth-delivered services to be equal to what is given for in-person services? ... [3] Are there any limitations on what type of telehealth modality can be used? ... [4] Are there any limitations on where a telehealth service can take place? ... [5] Are there any limitations on the types of providers who may provide services via telehealth and/or the types of specialty it can be used for?" (Milbank Memorial Fund)
Telemedicine Expanding Rapidly
"According to one recent survey, telemedicine services (i.e., remote delivery of healthcare services using telecommunications technology) among large employers (500 or more employees) grew from 18% in 2014 to 59% in 2016. Common selling points touted by telemedicine vendors include reduced health care costs and employee convenience. However, state licensure laws imposing restrictions on telemedicine practitioners can often limit the value (or even availability) of telemedicine services to employees. But that seems to be changing." (Benefits Bryan Cave)
The Company Behind Many Surprise Emergency Room Bills
"Early last year, executives at a small hospital ... started using a company called EmCare to staff and run their emergency room.... Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks.... For a patient needing care with the highest-level billing code, the hospital's previous physicians had been charging $467; EmCare's charged $1,649.... Newport's experience with EmCare, now one of the nation's largest physician-staffing companies for emergency rooms, is part of a pattern." (The New York Times; subscription may be required)
Out-of-Network Billing for Emergency Care in the United States
"Because patients cannot avoid out-of-network physicians during an emergency, physicians have an incentive to remain out-of-network and receive higher payment rates. Hospitals incur costs when out-of-network billing occurs within their facilities.... [P]hysicians offer transfers to hospitals to offset the costs of out-of-network billing and allow the practice to continue.... [A] New York State law that introduced binding arbitration between physicians and insurers to settle surprise bills reduced out-of-network billing rates." (National Bureau of Economic Research [NBER])
[Guidance Overview] Telehealth Expansion Finally Comes to Texas
"For insurers, the bill clarifies that the Texas telemedicine parity law does not apply to services rendered only through audio interaction or by facsimile. In other words, insurers in Texas are prohibited from restricting coverage solely because it is provided through telemedicine, unless the services are only rendered through phone or fax. The bill also requires insurers to prominently post their telehealth coverage policies and payment practices on their websites so that consumers can easily determine whether and how coverage is available." (Morgan Lewis)
From Hotspot to Health Hub: How Communication and Data Can Help Solve the Growing Health Divide
"Just as law enforcement uses data to analyze and map out crime 'hotspots,' the health care community can do the same to hone in on the heaviest users of the health care system in communities across the country -- and that could help improve health outcomes and decrease spending." (Health Affairs)
Which Markets Are Most Likely to Be Disrupted by New Care Delivery Models
"To better evaluate the health markets poised for potential growth or disruption in care delivery models, Accenture examined market dynamics across payers, providers and consumers among more than 400 Core Based Statistical Areas (CBSAs) in the continental United States.... [A]pproximately 21 percent of CBSAs (86 CBSAs that comprise more than 37 million people) are well positioned for providers to disrupt local care delivery models.... These are the top 25 markets with a population base of more than 250,000[.]" (Accenture)
Why the Utilization Conversation in Telemedicine Is Bigger Than Dollars and Cents
"[A recent study] found that 88 percent of visits were additive, and only 12 percent replaced in-person visits. The result: telemedicine cost the payer $45 per patient more than a plan without telemedicine would have.... [T]he study doesn't consider the long-term impact of increased utilization of preventative care. If those extra visits keep patients out of the hospital because they catch a respiratory infection early and it prevents a more serious condition like pneumonia, those savings could make up for the cost of extra visits." (MobiHealthNews)
The Future is Now: Healthcare Delivery Systems
"[T]he next cost mitigation 'silver bullet' for employers who had already adopted high deductible plans [could be] provider-directed initiatives like bundled payments and value-based contracting.... [In one] exchange model ... instead of employees purchasing insurance networks, they are selecting from healthcare delivery systems.... [V]irtually every PBM is now hawking some version of limited retail networks with tougher clinical oversight." (Frenkel Benefits)
[Opinion] Healthcare is Complicated: Is it Fixable?
"[C]onsumers think healthcare is too complicated for them to understand. Thus, they depend on their caregivers to educate them and are predisposed to be dependent on what they're told. It hasn't changed. In this digital health age, only one in eight consider themselves well-informed and capable of navigating the system. It's too complicated for most Americans and perhaps even more for the GOP lawmakers seeking to transform it in an environment of intense media scrutiny and partisan rancor." (Paul Keckley)
[Opinion] Health Care Can Be Patient-Centered, Accessible and Affordable
"[A] new paradigm of innovative value-based payment and care delivery ... reconciles what many consider competing values: access, affordability and a patient focus.... Value-based care is patient-centered care.... Incentives and accountability create better outcomes for patients.... Realizing the benefits of value-based care requires commitment and investment.... Value-based care works when every stakeholder is engaged.... Value-based care doesn't just benefit patients; it's an economic engine that creates jobs." (Morning Consult)
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