Value-Based Care Implementation Requires Investments, Collaboration
HealthPayerIntelligence Prioritizing the shift to value-based care has been at the forefront of the healthcare industry. But the road to transitioning from fee-for-service to value-based payment models is not always smooth. Convincing payers of value-based care’s feasibility is no longer the issue. The problem lies in the fact that basic healthcare operations do not support value-based care models,...
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How One Payer Expanded the Boundaries of Maternal Healthcare Benefits
Investing in maternal healthcare may seem like a natural decision on an individual level, given the influence that positive, healthy parenting can have on a person’s life and the many healthcare needs that parents face. In reality,...
How MN Medicaid Used Community Engagement to Address Health Disparities
Addressing health disparities within state Medicaid programs can help ensure that all beneficiaries have equal access to quality care. Prioritizing community engagement is key to reducing these disparities, according to Julie Marquardt,...
How the Inflation Reduction Act Will Impact Employers, Health Plans
While the Inflation Reduction Act of 2022 will likely improve member retention and curb healthcare costs for enrollees in the individual market, the impact on the employer market is less clear. As Medicare negotiates lower drug prices,...
Top Factors Influencing Employer Sponsored Health Plan Premiums in 2023
Employers face a challenging set of circumstances as they try to establish employer-sponsored health plan premiums for 2023. The second half of 2022 has introduced many variables that can affect healthcare prices. On the individual market,...
Top Payer Strategies Around Payment Models for Advanced Therapies
In early 2020, fifteen healthcare leaders—spanning a wide range of backgrounds from government to industry to academia—converged for a little over a day to discuss a single, pressing issue that affected each of their fields: how...
How Payers Can Move Providers Along Value-Based Care Continuum
Payers can offer essential support to providers starting their journey through the value-based care continuum, while further research on value-based care in Medicare Advantage can help inform payers about best practices in this endeavor....
What Are Employer Sponsored Wellness Programs?
What are employer-sponsored wellness programs and how are employers using these programs to advance employee wellness? The need for greater employer involvement in employee health and wellbeing is well-documented. At the beginning of 2021,...
Top Challenges, Benefits of At-Home Coronavirus Testing Coverage
In the first quarter of 2022, payers witnessed significant changes in at-home coronavirus testing coverage with mixed reactions. These changes—and the influence of the coronavirus pandemic on preventive care—present both...
How to Introduce Medicare Advantage Caregiver Benefits in SNPs
Payers cannot ignore the crucial role that caregivers play in members’ health, wellness, and recovery, and should consider supporting caregivers through Medicare Advantage caregiver benefits, especially in special needs plans. Special...
Applying Whole Person Care to Digital Care for Underserved Members
Payers have a significant role to play in ensuring that underserved populations receive whole person care, particularly among Medicaid beneficiaries. First, they can serve as a bridge between Medicaid beneficiaries and their primary care...
How to Hone Wellness Programs Using Social Determinants Data
Are wellness programs working? This question is a common refrain for employers and their payer partners, but the answer remains ambiguous. On the one hand, some studies have supported wellness programs as a cost-effective way to...
Top Employer Strategies for Implementing Episodes of Care Models
In order to best leverage episodes of care models, employers have to take more ownership of their own data and partnerships. When Kevin Lembo, former comptroller of the state of Connecticut, took on the role in 2010, the State of...
How Payers Help Tackle Substance Use Disorders, Other Conditions
The National Quality Forum’s (NQF) Opioids and Behavioral Health committee brought together healthcare leaders from across the nation to explore an under-represented subject: strategies around substance use disorders with co-occurring...
How Payers Can Launch a Virtual-First Health Plan
E-triage, telemental and telebehavioral healthcare tools, e-prescribing, virtual urgent care—in one year, these digital healthcare tools and many more transformed from somewhat obscure, non-integrated technologies to nearly ubiquitous...
Going Beyond Compliance: How Payers Can Embrace Healthcare Interoperability
Payers may be prepared to comply with the interoperability rule for the July 1 deadline, but are they ready to adopt healthcare interoperability long-term? For the past couple of years, CMS has pushed the industry to take bigger steps...
Strategies for the Physical-Behavioral Healthcare Integration Puzzle
Physical and behavioral healthcare integration is a key aim for many private payers, but progress has been slow. Brett Hart, chief behavioral health officer at Centene, has more than 20 years of managed care leadership experience and is...
Creating Strategies to Expand Transgender Healthcare Coverage
For the nearly 1.4 million Americans who identify as transgender, transgender healthcare coverage is lined with hurdles. One in five transgender individuals reported being uninsured at some point during 2017 to 2018, according to the Kaiser...
How Payer Forecasting Is Shifting Towards Real-Time Data Analytics
As aggregators of healthcare data, payers are modern-day seers for the healthcare industry and they are increasingly leaning on real-time analytics to perform this role. “Forecasting is a capability and an enabler to help create...
Key Considerations for Permanently Integrating Telehealth Coverage
Telehealth is metamorphosing and payers will have to take steps in order to permanently integrate telehealth coverage as a key form of care delivery. When the coronavirus pandemic struck, Donna O’Shea, MD, chief medical officer of...
