Chronic Disease Prevention

Understanding Chronic Kidney Disease Coverage, VBC Opportunities

November 22, 2023 - Efforts to improve chronic kidney disease coverage have evolved over the last several decades, but the disease remains costly and prevalent. Around 15 percent of the adult population in the US has chronic kidney disease (CKD), according to the National Kidney Foundation (NKF). The condition is one of two that, in its final stages, can make individuals eligible for Medicare regardless...

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4 Essential Components of Chronic Disease Management Strategies

by Kelsey Waddill

With the US spending $3.7 trillion on diseases like diabetes, cancer, and other long-term conditions each year, payers cannot afford to falter on chronic disease management. Chronic disease spending and prevalence trends are stark, but...

6 Key Payer Benefits that Support Behavioral Health Prevention

by Kelsey Waddill

With behavioral healthcare demands on the rise, payers must not only be aware of the current trends but establish pathways toward behavioral health prevention through their health benefits. Half of employer-sponsored health plan enrollees...

4 Categories of Preventive Care Services Covered Under the ACA

by Kelsey Waddill

There are four types of services that private payers and employers are required to cover under the Affordable Care Act (ACA) preventive care services provision, which include screenings and...

Judge Rules That Employers Do Not Have to Cover Certain Preventive Care Services

by Kelsey Waddill

A US district judge ruled in Braidwood Management vs Becerra that employers do not have to cover preventive care services based on recommendations from US Preventive Services Task Force (USPSTF). Six...

2022 Key Enrollment Trends For High Deductible Health Plans

by Kelsey Waddill

High deductible health plan (HDHP) enrollees may have a broader selection of health plans and may view pre-deductible coverage for chronic disease prevention care as a deciding factor in health plan...

Most Impactful USPSTF Preventive Care Final Recommendations of 2022

by Kelsey Waddill

The US Preventive Services Task Force (USPSTF) released a list of its top preventive care recommendations that were finalized in 2022. The list is not comprehensive. Rather, USPSTF named the...

Uninsurance, Medicaid Coverage Could Delay Colon Cancer Diagnosis

by Kelsey Waddill

Health insurance type is a risk factor for delayed diagnosis of colon cancer, according to a research letter published in JAMA Network Open. The researchers noted that less than four out of ten...

CVS Health Expands Free Screening Program To Advance Health Equity

by Kelsey Waddill

CVS Health will cover community-based screening programs in two cities in an effort to prevent and detect chronic diseases and advance health equity. The company calls its effort to improve access to...

Key Preventive Care Services Recommendations from USPSTF in 2022

by Kelsey Waddill

In the first half of 2022, the US Preventive Services Task Force (USPSTF) has issued several recommendations intended to promote effective preventive care services. The USPSTF recommendations may more...

Payer Targets Health Equity in Colorectal Cancer Prevention

by Kelsey Waddill

Independence Blue Cross (Independence) is partnering with a nonprofit dedicated to colorectal cancer awareness and research in order to improve preventive care and health equity for colorectal...

CA Medicaid Plan Seeks to Streamline Pay for Performance Model

by Kelsey Waddill

CenCal Health, a Medicaid plan in California, is employing a pay for performance model to improve quality of care, called the Quality Care Incentive Program. “The new Quality Care Incentive...

Top Employer Strategies for Health Equity in Obesity, Diabetes

by Kelsey Waddill

When it comes to obesity and diabetes benefit design, employers can—and should—adopt a health equity mindset, according to a flipbook from the Northeast Business Group on Health...

How Coverage Mandates May Impact DBT Breast Cancer Screenings

by Kelsey Waddill

Insurance coverage mandates for a certain type of breast cancer screening may drive up utilization and lower costs, according to a study published in JAMA Network Open. Digital breast tomosynthesis...

MedPAC Releases Medicare Advantage Recommendations, BMA Reacts

by Kelsey Waddill

MedPAC’s March 2022 recommendations to Congress for Medicare Advantage payment policies have roused reactions from payers, specifically Better Medicare Alliance. At the beginning of the report...

Centene Receives Health Equity Innovation Award from NCQA

by Kelsey Waddill

The National Committee for Quality Assurance (NCQA) has awarded Centene the Innovation Award for Health Equity for the company’s Health Equity Improvement model. “Advancing health equity...

Obstacles to Covering Precision Medicine Multicancer Screenings

by Kelsey Waddill

While precision medicine multicancer screening tests could blaze a path to lower cancer-related costs and earlier cancer detection, these precision medicine tools face many hurdles to acquiring payer...

State, Medicaid Coverage For Obesity Treatments Varies Widely

by Kelsey Waddill

State and Medicaid coverage for obesity treatments is not uniform, despite the epidemic-level impact of the condition and the selection of tested treatment options, according to a report from the Urban...

CareFirst Distributes $1.76M to Address Diabetes Epidemic, SDOH

by Victoria Bailey

CareFirst BlueCross BlueShield (CareFirst) has awarded $1.76 million to local health organizations to help address the diabetes epidemic and the social determinants of health that drive the chronic...

How Payers Use Chronic Disease Management Flexibilities in HSAs

by Kelsey Waddill

Pre-deductible coverage for chronic disease management through a health savings account is a widespread practice among health plans which may require policymakers to enact regulatory changes in order...

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