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...
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...
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...
Social determinants of health contracting with community-based organizations remains a complex and challenging task for payers as the demand for answers grows more pressing.
As the industry’s...
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...
As executive director of state government affairs at the Leukemia and Lymphoma Society (LLS), Lucy Culp has heard a common refrain from cancer patients: securing treatment and coverage has become a...
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...
The 2021 special enrollment period gains on the Affordable Care Act (ACA) marketplaces could have downstream impacts on enrollment-related factors such as customer service investments and risk...
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...
Claims management is a multi-step process that provides ample opportunity for errors and delays, but if payers modify their approach to certain steps in the process it could have a positive impact...
With numerous combinations of comorbidities and lifestyles at play in the member population with diabetes, payers have a lot to consider when creating or expanding their diabetes management...
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...
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...
As the Supreme Court deliberates the fate of the Affordable Care Act after hearing the oral arguments, payers and the public alike are processing the court case and its implications for the healthcare...
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...
How do major disruptions affect the US healthcare system’s progress toward value-based care?
A recession, a widespread natural disaster, a public health emergency—significant national events like these have the power to build...
Bonnie Burns, a training and policy specialist at California Health Advocates, has been advocating for consumers in the Medicare space for over four decades, including in the area of Medigap benefits. She was involved in the lawsuit that...
The recent surge in furloughed employees and unemployed individuals is bringing to light one major problem: how are these people going to get health insurance? Made worse by the growing pandemic,...
While the coronavirus pandemic which gripped the nation in March 2020 is still in force, payers are beginning to look to the future as the nation emerges from crisis mode.
Many uncertainties still hang in the air regarding the trajectory...
Payers are in a unique position to respond to many aspects of the coronavirus from payment of testing and treatment to community education. But there is no playbook for appropriate or effective responses.
In such unique circumstances,...
